Risks of Diabetes for Mother and Baby
Your health and the health of your baby can be affected by pre-existing diabetes or by diabetes that develops during pregnancy, gestational diabetes. Pregnancy changes like hormonal shifts and weight changes affect your blood sugar levels. Your routines that have managed your pre-existing diabetes will also need to change to support your pregnancy.
Maternal Risks
The stresses of pregnancy can worsen some long-term diabetes complications like eye or kidney diseases, especially if blood sugar levels trend high.
You have an increased chance of developing preeclampsia. Preeclampsia is a progressive disorder during the second half of pregnancy that involves high blood pressure, kidney changes as evidenced by increased protein in your urine, and liver changes as evidenced by increasing liver enzymes. Preeclampsia can progress to causing life-threatening problems and may require an early delivery for your safety and the safety of your baby.
Newborn Risks
High blood sugar levels during the first 8 weeks of pregnancy can alter the early development of your baby's brain, heart, kidneys, and lungs. This increases the incidence of birth defects.
High blood sugar levels can increase the risk of miscarriage or stillbirth, a risk of the fetus dying in the womb during later pregnancy.
High blood sugar levels can increase risks of preterm birth, large for gestational age, difficulty during the birth process, difficulty breathing after birth, or low blood sugar levels during the first 24 hours of life.
Prenatal Evaluation of Diabetes
The risks of diabetes during pregnancy can be reduced by careful blood sugar management. Evaluation of diabetic status needs to begin before conception to protect the early development of your baby’s vital organs. Your health care provider can evaluate pre-pregnancy status of your:
blood pressure,
vision,
cardiac,
vascular,
neurological,
kidney, and
thyroid.
Supportive measures can be initiated early:
Adjusting your medications
You may need to stop taking a medication that is not safe in pregnancy. Your diabetic medications may need to be adjusted for better control of blood sugar levels. Sometimes it is necessary to begin use of insulin to improve blood sugar control. Your health care provider will usually recommend taking Folic acid 400 mcg daily starting at least one month before pregnancy.
Blood sugar testing
You may need to increase the frequency of testing blood sugar levels and add testing ketone levels when your blood sugar is too high. Your health care provider can recommend target blood sugar levels specifically for your pregnancy needs. Usual blood sugar target levels are 90 or less for before meals and overnight, and 120 or less two hours after eating.
Onset of Diabetes During Pregnancy
Gestational diabetes can develop during pregnancy when your body has difficulty producing enough insulin to support your growing needs. The symptoms of gestational diabetes are mild or even absent. Excessive thirst and frequent need to urinate are sometimes present. Your health care provider will test for gestational diabetes between 24 to 28 weeks. For the glucose screening test you will drink a glucose solution and a blood glucose level is drawn after two hours. If this test is high, you will have a three-hour glucose level drawn. If your three-hour test is also high, gestational diabetes is diagnosed.
Guidelines for Management of Diabetes During Pregnancy
Healthy foods that are high in nutrition and low in refined carbohydrates help you manage your blood sugar levels. A registered dietician or certified diabetic care specialist can work with you to build a meal plan to meet your specific needs and goals.
Exercise can lower your blood sugar levels and decrease difficulties with back pain, constipation, and sleeping. Moderate activity like walking, cycling, or swimming for 30 minutes each day is often recommended by health care providers.
Blood sugar monitoring is usually recommended as soon as you get up in the morning and two hours after each meal. Sometimes additional monitoring is needed. You use monitoring to keep your blood sugar stable and notify your health care provider of your status. You can use a log of your blood sugars to track your progress.
Medication
Diet and exercise may be adequate to manage your blood sugar for gestational onset diabetes. Preexisting diabetes often requires oral medication like Metformin, or insulin to manage your blood sugar with the changes of pregnancy. Close daily testing, diet, exercise and medication management are all essential to your health and the health of your baby.
Monitoring of your baby
Ultrasound testing is used during your first visit to verify your due date, the date when your baby will be 40 weeks of gestation. Ultrasound testing will continue to monitor your baby’s growth, screen for anatomical problems and can be used during diagnostic testing if problems are detected.
Routine prenatal testing including blood work to screen for genetic problems, will be supplemented by monitoring specific to your baby’s needs.
NST, non-stress tests, may done weekly after 28 weeks of gestation to monitor your baby’s wellness. This test monitors your baby’s heart rates for 20-40 minutes. If there are concerns about your baby’s responses an ultrasound is added to the testing to complete a Biophysical Profile score. This evaluation will help your health care provider to plan for closer monitoring, possibly with a hospital stay or an early delivery to keep your baby safe.
Follow-up after delivery
After delivery your body continues to change and your diet, exercise, blood sugar monitoring, and medication use continues to be important. Postpartum visits to your health care provider will monitor your progress. Gestational diabetes that was able to be controlled with diet and exercise may resolve. Preexisting diabetes and some gestational diabetes will continue to need oral medications or insulin to be managed. Assessed and Endorsed by the MedReport Medical Review Board