Pregnancy and type 1 or type 2 diabetes

It is important to manage your pregnancy and type 1 or type 2 diabetes.

Good News:

With planning and good glucose control in pregnancy the majority of woman with diabetes can expect to have a normal pregnancy and a healthy baby!

Bad News:

This is a lot of work!

If there were ever a time in life when one should pay extra attention to their diabetes it is when planning a pregnancy. Prior to pregnancy it is important to be under the care of a team that has expertise in the area of diabetes and pregnancy. It is essential that blood sugars be well controlled prior to getting pregnant with an A1C close to 7%.  The developing fetus is very sensitive to elevated blood sugars and birth defects can happen very soon after the baby is conceived if the blood sugars are elevated. As well, later in pregnancy, if blood sugars are not well controlled the baby will put on extra fat that can make the delivery more difficult.

Women should have an assessment for complications of diabetes such as eye, kidney and circulation disease prior to getting pregnant.  For example, in a small number of women, eye disease may worsen during pregnancy if eye complications are not treated prior to getting pregnant.

Type 2 Diabetes and Pregnancy

Pre- planning

If a woman is on oral medications, she may be switched to insulin to stabilize the sugars prior to pregnancy. The medication metfomin may sometimes continue until conception, or for a short while after, especially if it is being used to treat a condition called Polycystic ovarian syndrome (PCOS), a clinical syndrome with some of the following features : obesity, infertility issues, irregular period, increased facial hair, acne or ovarian cysts. The amount of testing of blood sugars will increase when planning a pregnancy to ensure all the blood sugars numbers are at target.

Medications

It is recommended that women with pre-existing diabetes take 5 mg of folic acid (a vitamin) prior to getting pregnant and during the first part of the pregnancy. Some medications that control blood pressure (ACE or ARB) can cause birth defects and need to be discontinued prior to pregnancy and if needed, others that are safe are used to treat blood pressure. Statin medications that control cholesterol must be stopped prior to pregnancy.

Management

A meal plan to ensure the baby gets enough nutrition while not encouraging extra weight gain by Mom is essential and is best done by the diabetes team, which will include a dietitian. If on insulin, the woman will meet regularly with the team for adjustments. Usually there is a substantial increase in insulin requirements in pregnancy. It is not unusual for the amounts to double or triple as the hormones of pregnancy block the action of insulin.

Type 1 Diabetes

Insulin and Blood sugars:

Insulin routines should be optimized prior to getting pregnant. If women are not on multi-dose insulin routines (Basal/ Bolus- usually 4 injections per day) or on a pump, this is the time to get this going and learn how to fine tune blood sugar control prior to getting pregnant.

There are many hormonal changes that happen in pregnancy and these affect blood sugars. In the middle of the first trimester (1-13 weeks), there is actually a drop in insulin requirements and sometimes women have to decrease their dose of insulin or they will have sudden and unexpected lows. Then after the first trimester, the requirements go up slowly over the pregnancy.  Woman often find that they do not notice their low sugars until their blood sugars are lower than usual, so frequent testing is a must during pregnancy.

Finally, there are changes in insulin requirements after pregnancy. Immediately after delivery, women are unusually sensitive to insulin and may need substantially less insulin after delivery. This may last a few days, weeks or even months. Typically, as well, women may have less insulin requirements when they are nursing, so constant vigilance and adjustments are necessary.

In addition, women with type 1 diabetes are more susceptible to thyroid disease and this may come on after having a baby, so follow up with a blood test for thyroid function should happen in the months after delivery.

All of this sounds like a lot of work but by planning for a pregnancy when a woman has diabetes she will ensure the best start for her baby!

For information on diabetes that presents during pregnancy, see my blog Diabetes for two...diabetes in pregnancy.