Diabetes is a condition that causes high levels of glucose in the blood. It occurs when there is a problem with the way the body makes or uses insulin. Insulin is a hormone that converts glucose, (a sugar that is the body’s main source of energy) into energy. When the body does not make enough insulin or the body is not using it properly the level of glucose in the blood becomes too high. This is called hyperglycemia.

During pregnancy, the hormones produced by the placenta can limit the actions of insulin, resulting in gestational diabetes. Gestational diabetes can occur even when no risk factors or symptoms are present and will go away after the baby is born. Women who had gestational diabetes during pregnancy are at a greater risk of developing diabetes later.

Risk factors for diabetes increase with age and is more likely in women who:

• Are overweight
• Are not physically active
• Have high blood pressure
• Have high cholesterol
• Have a family history of diabetes
• Have polycystic ovary syndrome
• Have a history of cardiovascular disease
• Are Native American, Asian, Hispanic, African American or Pacific Islander

Testing for Diabetes

Women who have several of the above risk factors should have a blood glucose screening at their first prenatal visit. Other women may be tested between 24 – 29 weeks of pregnancy. The test is a safe and simple blood test after you drink a sugar solution. The glucose level is then measured. A high level suggests that there may be a problem. If the test result shows a high level of glucose further testing will be done to determine if you have diabetes.

Effects During Pregnancy

The risk of problems during pregnancy are greatest when blood sugars are high. Some problems may increase the chances of a cesarean birth. Good control of blood sugar levels before and during pregnancy can lower the risks. The following problems can arise with diabetes or gestational diabetes:

• Macrosomia (very large baby): If a mother’s blood sugar is high throughout the pregnancy, it gets transferred to the baby growing too large. This can make delivery difficult.
• Preeclampsia is high blood pressure and protein in the urine during pregnancy. This condition can pose problems for the baby and mother which may lead to early delivery.
• Polyhydramnios occurs when there is too much amniotic fluid in the sac surrounding the baby. This can cause discomfort and may result in preterm labor.
• Urinary tract infections can occur without any symptoms. If it goes untreated the infection can spread to the bladder and kidneys.
• Respiratory distress syndrome can make it harder for a baby to breathe after birth. The risk of this condition is higher in babies of mothers with diabetes.
• Stillbirth: the delivery of a baby that has died before birth occurs more often in babies of mothers whose diabetes is not well controlled.

Diabetes Control

There are many ways for women to monitor their glucose levels. They include going to a lab and having a blood test or you can check your own using a glucose meter. With the meter, a simple device is used to obtain a sample drop of blood that is placed on a strip of special paper. The paper is then read with the meter. There are many types of glucose meters available on the market. Consult your health care provider on the options and how often you should be checking your blood sugars. Glucose levels can also be controlled by diet and exercise. In some cases, insulin or medications may be needed.

Diet: A balanced diet is key to a healthy lifestyle and for pregnancy. Your baby depends on the foods you eat for nourishment and growth. This is even more important if you are diabetic. Not eating properly can cause glucose levels to go too high or low.

The number of calories in your diet depends on your age, weight, stage of pregnancy and level of activity. Your health care provider will adjust your diet from time to time to meet the growing needs of your baby.

Exercise: Moderate exercise is also very important for women with diabetes. Regular exercise helps to keep blood glucose levels low. Discuss with your health care provider what types and how much exercise you need.

Medications: Insulin may be needed by some women to keep their glucose levels within normal range. Insulin can be used safely during pregnancy to control diabetes. The amount needed will vary from woman to woman and depends on many factors. The amount needed during the pregnancy can change.

Some women will take medication to control their diabetes. Talk with your health care provider to see which treatment is the best for you.

Prenatal Care: Prenatal care helps to monitor the condition of the baby and in controlling your diabetes. A woman with diabetes often needs to see her health care provider more frequently for checkups and tests during pregnancy. Tests include:

• Ultrasounds to follow the growth and development of the baby
• Electronic fetal monitoring helps to detect signs of problems the baby may be having late in pregnancy.
• Biophysical profile can assess the wellbeing of the fetus
• A kick count may be used to track how active the baby is in the latter part of pregnancy.

Delivery

Often women with diabetes go into labor normally when the time comes and have a normal delivery. They may require monitoring of their glucose levels. If there are problems, labor may need to be induced early.

Postpartum Care

Problems with newborn: After birth, most babies do well. Some may need to spend time in a special nursery. Problems that may occur include:

• Low glucose levels
• Low blood calcium and magnesium levels
• An excess of red blood cells
• Neonatal jaundice
• Breathing problems

These problems are most often not serious. But are treated soon after birth.

Glucose control: After birth, you blood sugar levels may be monitored. 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. Work with your health care provider to establish a program for diet and exercise following delivery.

Finally. . .

Most women with diabetes can have healthy babies. Your health care provider and you can work together to plan your pregnancy and manage your glucose levels.