Diabetes In Pregnancy

Diabetes mellitus (“diabetes”) is a condition that causes high levels of glucose in the blood. Glucose is a sugar that is the body’s main source of energy. Health problems can arise when glucose levels are too high.

Pregestational diabetes is diabetes that was present before pregnancy. When diabetes starts during pregnancy, it is called gestational diabetes. Both types of diabetes require special care during pregnancy.

Pregestational Diabetes- REVIEW
About 1 in 100 women have pregestational diabetes. Diabetes occurs when there is a problem with the way the body makes or uses insulin. Insulin is a hormone that converts glucose in food into energy. When the body is not using insulin properly, the level of glucose in the blood becomes too high.

Gestational Diabetes
During pregnancy, the hormones produced by the placenta can limit the actions of insulin. As a result, gestational diabetes may occur. Gestational diabetes is thought to affect 2–10% of all pregnancies. Women who are overweight, have a strong family history of diabetes, or a personal history of polycystic ovarian syndrome are at increased risk of gestational diabetes.

Effects During Pregnancy
The risk of problems during pregnancy is greatest when blood sugar levels are high. Some of these problems may increase the chance of a cesarean birth. This is why you need good blood sugar control during pregnancy. Good control of glucose levels, before and during pregnancy, can lower the risks.

If you have diabetes or if you are at risk of developing gestational diabetes, you should be aware of the problems that may arise:

  1. Macrosomia (very large baby) occurs when the mother’s blood sugar level is high throughout pregnancy. This increases the risk of cesarean delivery.
  2. Preeclampsia is high blood pressure and protein in the urine during pregnancy. This can pose problems for the mother and the baby.
  3. Hydramnios occurs when there is too much amniotic fluid in the sac that surrounds the baby.
  4. Urinary tract infections can occur without symptoms.
  5. Respiratory distress syndrome can make it harder for the baby to breathe after birth.
  6. Stillbirth — delivery of a baby that has died before birth — occurs more often in babies of women whose diabetes was not well controlled before and during pregnancy.

Effects After Pregnancy
One third of women who had gestational diabetes during pregnancy have diabetes or a milder form called glucose intolerance after giving birth. Up to one half will develop type 2 diabetes later in life. Women who have had gestational diabetes should get regular tests for diabetes after pregnancy.

Diabetes Control

Testing for Diabetes
If you have risk factors for gestational diabetes, your blood glucose level is measured early in pregnancy. If you do not have risk factors, you may be tested between 24 and 28 weeks of pregnancy.

The test is safe and simple. First, you drink a liquid that has sugar in it. Next, samples of your blood are taken. The glucose level is measured. If the level is high, more tests are done to find out if you have diabetes.

Both kinds of diabetes must be controlled during pregnancy. Doing so requires daily tracking of glucose levels, eating healthy foods, exercising regularly, and taking medication, if needed.

Healthy Eating
A balanced diet is a key part of any pregnancy. Your baby depends on the food you eat for its growth and nourishment. All patients with diabetes in pregnancy will consult and follow with a nutritionist.

For all pregnant women, but especially those with diabetes, exercise is important. Exercise helps keep glucose levels in the normal range. You and your health care provider will decide how much and what type of exercise you need. Usually, 30 minutes of exercise per day are recommended.

Women with pregestational diabetes who took insulin before pregnancy usually need to increase their insulin dosage while they are pregnant. Insulin is safe to use during pregnancy.

Mild gestational diabetes often can be controlled with a special diet and exercise. Some women with gestational diabetes need oral medications or insulin to keep levels normal.

Prenatal Care
Prenatal care helps monitor your health as well as that of your baby. A team of health care experts may help care for you during pregnancy. A woman with diabetes often needs to be monitored closely during pregnancy, and may need special tests in addition to routine health care.

In most cases, women with diabetes go into labor normally when the time comes and have a normal vaginal delivery. They may require monitoring of their glucose levels and the baby during labor.

Problems in the Newborn
After birth, most babies do well. Some babies may need to spend time in a special care nursery.

Problems that may occur include:

  1. Low glucose levels
  2. Low blood calcium and magnesium levels
  3. An excess of red blood cells
  4. Neonatal jaundice (yellow discoloration of the skin)
  5. Breathing problems

These problems are not serious in most cases.

Postpartum Care
If you had gestational diabetes, you should have a test for diabetes 6–12 weeks after you give birth. Even if the result is normal, you are more likely to develop type 2 diabetes later in life. The American Diabetes Association recommends that women who have had gestational diabetes and who had a normal postpartum glucose test result be tested for diabetes every 3 years.

Women with diabetes or those who develop gestational diabetes need to plan future pregnancies with care.

Glucose Control
Your blood sugar levels may be monitored after you give birth. If they remain high, you may need to take medication to control your blood sugar.

Weight Control
Weight loss during pregnancy is not a good idea-even if you are overweight. You and your doctor should set up a program of diet and exercise for you to follow after delivery.

Most women with diabetes can have healthy babies. You and your doctor can work together to plan your pregnancy and control your glucose level.

This excerpt from ACOG’s Patient Education Pamphlet is provided for your information. It is not medical advice and should not be relied upon as a substitute for visiting your doctor. If you need medical care, have any questions, or wish to receive the full text of this Patient Education Pamphlet, please contact your obstetrician-gynecologist.

o ensure the information is current and accurate, ACOG titles are reviewed every 18 months.

Copyright ©June 2009 The American College of Obstetricians and Gynecologists