Despite advances, babies born to women with diabetes, especially women with poor diabetes control, are still at greater risk for birth defects. High blood glucose levels and ketones (substances that in large amounts are poisonous to the body) pass through the placenta to the baby. These increase the chance of birth defects.

For this reason, good blood glucose control before you get pregnant is very important. Most women do not know they are pregnant until the baby has been growing for two to four weeks. During the first six weeks of pregnancy, the baby’s organs are forming. Your blood glucose levels during these early weeks affect the baby’s growing organs. High blood glucose levels can lead to birth defects.

Because these early weeks are so important to your baby, you need to plan your pregnancy. If your blood glucose levels are not in good control, work to bring your diabetes under control before getting pregnant. It is a good idea to be in good blood glucose control three to six months before you plan to get pregnant. You’ll want to keep excellent blood glucose control during pregnancy, and after as well.

How do high blood glucose levels cause problems? When extra sugar is in your blood, the baby is “fed” extra sugar, too. All this excess sugar can make the baby too big and fat. Delivery of big babies is harder on mom and baby.

Because your baby is getting extra sugar, your baby’s pancreas makes extra insulin. After birth, it’s hard for the baby to stop putting out extra insulin. The baby must be watched, and treated if the blood glucose level drops too low.

For some reason, jaundice happens more often in babies of women with diabetes. Jaundice is a build-up of old red blood cells that the body can’t process fast enough. This problem goes away rapidly with treatment.

· a doctor, trained to care for people with diabetes, who has cared for pregnant women with diabetes

· an obstetrician who handles high-risk pregnancies and has cared for other pregnant women with diabetes

· a pediatrician (children’s doctor) or neonatologist (doctor for newborn babies) who knows and can treat special problems that can happen in babies of women with diabetes

· a registered dietitian who can change your meal plan as your needs change during and after pregnancy

· a diabetes educator who can help you manage your diabetes during pregnancy

Pregnancy is often a time of great highs and lows. It can be awesome and thrilling — when you hear the baby’s heartbeat or feel the first tiny kick. It can be frustrating, even scary. It is always a time of change. Your body is changing as the baby grows. Because you have diabetes, these changes will affect your blood glucose level. Pregnancy can also make symptoms of low blood sglucose hard to detect. During pregnancy, your diabetes control will require more work. The blood glucose checks you do at home are a key part of taking good care of yourself and your baby before, during and after pregnancy.

Insulin and Diabetes Pills

If you have type 1 diabetes, pregnancy will affect your insulin treatment plan. During the months of pregnancy, your body’s need for insulin will go up. This is especially true during the last three months of pregnancy. The need for more insulin is caused by hormones the placenta makes. The placenta makes hormones that help the baby grow. At the same time, these hormones block the action of the mother’s insulin. As a result, your insulin needs will increase.

If you have type 2 diabetes, you too need to plan ahead. If you are taking diabetes pills to control your blood glucose, you may not be able to take them when you are pregnant. Because the safety of using diabetes pills during pregnancy has not been established, your doctor will probably have you switch to insulin right away.

Checking Your Blood Glucose

Blood checks will help you keep your blood glucose on target.

Check your blood glucose levels at the times your diabetes team advises; this may be up to eight tests daily and will probably include after-meal checks.

· Write down your results

· Keep notes on your meal plan and exercise

· Make changes in your meal plan and insulin only with the advice of your diabetes team

Pregnancy and Food

During pregnancy you and your dietitian or doctor may need to change your meal plan to avoid problems with low and high blood glucose levels. This is the most important reason for keeping track of your blood glucose results.

If you start pregnancy weighing too much, you should not try to lose weight. Instead work with your dietitian or doctor to curb how much weight you gain during pregnancy.

Your dietitian will keep track of your weight gain. If you start pregnancy at a normal weight, expect to add between 25 to 35 pounds. Women who start pregnancy too thin need to gain more. If you are obese at the start of your pregnancy, work with your dietitian to limit your weight gain to about 15-25 pounds.

Pregnancy and Exercise

Exercise, especially for people with type 2 diabetes, is a key part of diabetes treatment. Just as you need to get your blood glucose under control before getting pregnant, it’s best to get fit before you get pregnant. Can you keep your current exercise program during pregnancy? Is it safe to start exercise after you are pregnant?

Discuss your exercise plans with your diabetes team. Ask for guidelines. Exercise can help you stay healthy during pregnancy. But if you have any of the following conditions (see the list below), then you will need to talk to your diabetes team about the risks of exercise during pregnancy.

· high blood pressure

· eye, kidney, or heart problems

· damage of the small or large blood vessels

· nerve damage

In general, it’s not a good idea to start a new strenuous exercise program during pregnancy. Good exercise choices for pregnant women include walking, low-impact aerobics, swimming or water aerobics.

We now know that the key to a healthy pregnancy for a woman with diabetes is keeping blood glucose (sugar) in the target range — both before she is pregnant and during her pregnancy. To do this, you need a diabetes treatment plan that keeps meals, exercise, and insulin in balance. This plan will change as you change with pregnancy. You will also need to check your blood glucose often and keep a record of your results. With your blood glucose in the target range and good medical care, your chances of a trouble-free pregnancy and a healthy baby are almost as good as they are for a woman without diabetes.

Before Pregnancy
Find out what precautions a person with diabetes needs to take before getting pregnant.

Good Prenatal Care
Learn how to take care of yourself and your baby when you have diabetes and you are pregnant.

Delivery
Find out what to expect when you deliver your baby.

After Delivery
Get tips on breastfeeding and how to take care of yourself after delivery.

Your labor may start on its own, or you may decide to have labor induced or have a planned cesarean section (C-section). During a cesarean birth, an incision is made through the abdomenand uterus, through wich the baby is removed. Because of the surgery, your recovery time may be longer than if you delivered your baby vaginally.

No matter how you deliver your baby, your doctors will be working during labor and delivery to keep your blood glucose level under control. At the start of active labor, your insulin needs will drop. You will most likely not need any insulin during labor and for 24 to 72 hours after delivery.

To help you prepare for labor, many hospitals and other organizations offer classes (such as lamaze) to help you have a smooth delivery. They teach you what to expect during delivery, techniques to improve delivery and to relieve pain during labor, and how to care for your baby after birth. Because of the care needed for both mom and baby during and after delivery, home births are not advised for women with diabetes.

Breastfeeding is good for women with diabetes, but it may make your blood glucose a little harder to predict. During the first weeks at home with baby, you are likely to be tired, stressed from lack of sleep, and off schedule. Odd sleep patterns increase the danger of napping through a snack or mealtime. Low blood glucose is a real danger. It’s important for your baby’s safety to avoid blood glucose reactions that could confuse you. For all of the above reasons, it is important to check your blood glucose often during this time. And your records of your blood glucose levels will help you and your team adjust your insulin dose.

With baby’s arrival, your focus turns to caring for your little one. But keep in mind that to take good care of your baby you need to take good care of yourself. Stick to your habits that helped you keep your blood glucose levels on target during pregnancy.

Breastfeeding

To help prevent low blood glucose levels due to breastfeeding:

• Plan to have a snack before or during nursing
• Drink enough fluids (plan to sip a glass of water or a caffeine-free drink while nursing)
• Keep something to treat low blood glucose nearby when you nurse, so you don’t have to stop a feeding to treat low blood glucose levels

Women who breastfeed use more calories. What you drink and eat can affect your milk supply, as well as your blood glucose. You will need to work with your doctor and dietitian to adjust your meal plan while you are nursing.