Risks Of Diabetes And Pregnancy
This information is for women who were diagnosed with Type 1 or Type 2 diabetes before they got pregnant. It does not cover gestational diabetes.
Most pregnant women with diabetes will go on to have a healthy baby. But there are some possible complications you should be aware of.
Risks to the baby can include:
- the baby having low blood glucose levels, low calcium or jaundice after delivery – this is common
- having a larger baby – which can cause problems during labour
- having a smaller baby than expected – who might need care in a neonatal unit
- malformation incorrect development of the baby – this is rare
- being stillborn – baby dies before it is delivered – this is also rare
Risks to the mother can include:
- more frequent low blood glucose
- poor hypo awareness of a low glucose
- developing a blood pressure problem
- worsening of existing diabetes kidney or eye problems
Blood Sugar Levels For Pregnant Women With Diabetes
Whether you had diabetes before you got pregnant or you developed diabetes during your pregnancy, you’ll need to keep a close eye on your blood sugar levels. Tight control will help you avoid complications and long-term health problems for both you and your baby.
You’re eating differently because your body needs more energy to help your baby grow and be healthy. And your changing hormones affect how your body makes and uses insulin. In the later parts of your pregnancy, you may become more insulin resistant, so blood sugar builds up to higher levels.
How often should you check your blood sugar?
- Pre-existing diabetes: Before and after meals and before bedtime
- Gestational diabetes: Before breakfast and after every meal your doctor can tell you how long after eating you should check.
If you are pregnant and have type 1 diabetes, your doctor might sometimes ask you to check your blood sugar in the middle of the night, around 3 a.m. Your doctor may recommend that you check your fasting urine ketones on a regular basis, as well.
For every type of diabetes, if you’re pregnant you need to see your doctor at least once a month, perhaps as often as once a week.
Mensing, C. The Art and Science of Diabetes Self-Management Education Desk Reference, 2nd Ed., American Association of Diabetes Educators, 2011.
American Diabetes Association. “Standards of Medical Care in Diabetes2014,” Diabetes Care, January 2014.
Urgent Advice: Contact Your Diabetes Team Straight Away If:
- you find out you’re pregnant
You’ll need to make an urgent appointment.
Keeping your blood glucose levels stable can be more difficult in early pregnancy as your hormones change, especially if you have morning sickness. Low blood sugars can happen more easily. It is important to check your blood glucose often. Carry hypo treatment with you in case your blood glucose goes too low.
You’ll have extra appointments with your maternity and diabetes teams when you’re pregnant. This usually means check-ups every 2 weeks, as well as extra tests and scans.
You can have a normal birth, but it’s recommended you have your baby in hospital. You might be advised to have your labour started early .
Before You Get Pregnant
Manage your blood sugar. Many doctors will recommend that you reach and keep your A1C goal for a few months before becoming pregnant.
Review your medicines. Some medicines and supplements arent safe to use while pregnant. You should speak with your health care team about each medicine and supplement you take before you get pregnant. Dont stop taking prescribed medicines without talking to your doctor first.
View this guide to planning a pregnancyexternal icon with type 1 diabetes for more info.
Your insulin needs may change throughout your pregnancy. Be sure to talk to your doctor about how to manage your blood sugar.
How May Gestational Diabetes Affect The Baby
During pregnancy, nutrients from the womans bloodstream fuel the babys growth. With gestational diabetes, an expectant womans high blood glucose can cause the baby to absorb more glucose than it needs. This excess glucose can be stored as additional fat, which can lead to complications at birth and later in life. Other effects include:
Heavier than average birthweight . The extra weight could cause shoulder damage during birth.
Low blood glucose levels due to the extra insulin the babys body produces before birth.
Higher risk of childhood obesity.
Higher risk of developing type 2 diabetes as an adult.
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We Dont Know What Causes Gestational Diabetes
But we know that you are not alone. It happens to millions of women. We do know that the placenta supports the baby as it grows. Sometimes, these hormones also block the action of the mothers insulin to her body and it causes a problem called insulin resistance. This insulin resistance makes it hard for the mothers body to use insulin. And this means that she may need up to three times as much insulin to compensate.
Gestational diabetes can also start when the mothers body is not able to make and use all the insulin it needs for pregnancy. Without enough insulin, glucose cant leave the blood and be changed into energy. When glucose builds up in the blood, its called hyperglycemia.
Whatever the cause, you can work with your doctor to come up with a plan and maintain a healthy pregnancy through birth. Ask questions. Ask for help. There are many ways to combat gestational diabetes.
Maternal Complications Of Diabetes On A Pregnancy
Complications for the mother depend on the degree of insulin need, the severity of complications associated with diabetes, and control of blood glucose.
Most complications occur in women with pre-gestational diabetes and are more likely when there is poor control of blood glucose. Women may require more frequent insulin injections. They may have very low blood glucose levels, which can be life threatening if untreated, or they may have ketoacidosis, a condition that results from high levels of blood glucose. Ketoacidosis may also be life threatening if untreated. It is not clear whether pregnancy worsens diabetic related blood vessel damage and retinal changes, or if it causes changes in kidney function.
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Monitoring Your Blood Glucose
Youll know how well youre doing controlling your blood glucose level by monitoring it several times per day. This is done by checking your blood glucose. Your health care practitioner will explain how to use a blood glucose monitor, and you’ll receive detailed instructions on when and how often to check your blood sugar. Youll also be asked to keep track of your glucose daily levels to help both you and the doctor know how well you are managing.
How Is Gestational Diabetes Managed After Pregnancy
Research has shown that women with gestational diabetes have a 3 to 7 percent chance of developing type 2 diabetes within five to 10 years which is why its important to make healthy habits routine during pregnancy and keep a check on your health after your pregnancy is over.
Here are a few ways to stay healthy after baby is born:
- Keep up with doctor visits. Make sure your primary care physician and/or OB/GYN reevaluates you after your postpartum visit at six weeks and then again every year to check your fasting glucose and HbA1c levels.
- Talk to a registered dietitian. An R.D. help you to develop an eating plan that will help keep glucose levels in a healthy range.
- Continue to choose healthy foods. Opt for wholesome picks like vegetables, beans, nuts, seeds, fruit, lean meats, dairy and whole grains.
- Consider breastfeeding longer, if you’re able. Breastfeeding may decrease your risk of developing type 2 diabetes after gestational diabetes. There are several possible explanations, including that breastfeeding women have lower levels of glucose circulating in their blood.
- Fit in fitness. Although your newborn will undoubtedly take up a lot of your attention, try to get in as much doctor-approved exercise as possible. It’s important to take some time to care for yourself during the postpartum period .
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Obesity Risk Continues For More Than A Decade
A pregnant womans higher blood sugar level is linked to a significantly greater long-term risk of obesity in her child even more than a decade later, reports a large new international study led by Northwestern Medicine investigators and in JAMA. The higher the womans blood sugar, the greater the risk of her child being obese.
The mothers blood sugar level during pregnancy is an independent contributor to the childs weight and risk of being obese later in childhood, said corresponding study author Boyd Metzger, MD, professor emeritus of Medicine in the Division of Endocrinology, Metabolism and Molecular Medicine.
Weve known for a long time that family characteristics predict a lot about how youre going to look, how fat a child will be, how tall he will be. This is above and beyond the mothers weight. This takes into account all those other factors, Metzger said.
Mothers with higher-than-normal blood sugar during pregnancy even if not high enough to meet the definition for gestational diabetes commonly used in the U.S. today also were significantly more likely to have developed type 2 diabetes a decade after pregnancy than their counterparts without high blood sugar.
But prior to this study, scientists did not know that risks related to blood sugar during pregnancy continue into childhood. And they still dont know if treating the mother reduces these longer-term risks. Future studies will need to help answer these questions, Metzger said.
Who Is At Risk For Diabetes During Pregnancy
The risk factors for diabetes in pregnancy depend on the type of diabetes:
Type 1 diabetes often occurs in children or young adults, but it can start at any age.
Overweight women are more likely to have Type 2 diabetes.
Overweight women are more likely to have gestational diabetes. Its also more common in women who have had gestational diabetes before. And its more common in women who have a family member with Type 2 diabetes. Women with twins or other multiples are also more likely to have it.
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How Is Gestational Diabetes Mellitus Diagnosed
The American Diabetes Association recommends screening for undiagnosed type 2 diabetes at the first prenatal visit in women with diabetes risk factors. In pregnant women not known to have diabetes, GDM testing should be performed at 24 to 28 weeks of gestation.
In addition, women with diagnosed GDM should be screened for persistent diabetes 6 to 12 weeks postpartum. It is also recommended that women with a history of GDM undergo lifelong screening for the development of diabetes or prediabetes at least every three years.
Gestational Diabetes Tests And Diagnosis
Gestational diabetes usually happens in the second half of pregnancy. Your doctor will check for it between weeks 24 and 28, or sooner if you’re at high risk.
Your doctor will give you a glucose tolerance test: Youâll drink 50 grams of glucose in a sweet drink, which will raise your blood sugar. An hour later, youâll take a blood glucose test to see how your body handled all that sugar. If the results show that your blood sugar is higher than a certain level, youâll need a 3-hour oral glucose tolerance test, meaning youâll get a blood glucose test 3 hours after you drink a 100-gram glucose drink. Your doctor can also test you by having you fast for 12 hours, then giving you a 75-gram glucose drink and a 2-hour blood glucose test.
If youâre at high risk but your test results are normal, your doctor might test you again later in your pregnancy to make sure you still donât have it.
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Key Points About Diabetes During Pregnancy
Diabetes is a condition in which the body can’t produce enough insulin, or it can’t use it normally.
There are 3 types of diabetes: Type 1, tType 2, and gestational diabetes.
Nearly all pregnant women without diabetes are screened for gestational diabetes between 24 and 28 weeks of pregnancy.
Treatment for diabetes focuses on keeping blood sugar levels in the normal range.
Women with gestational diabetes are more likely to develop Type 2 diabetes in later life. Follow-up testing is important.
Target Blood Glucose Levels During Pregnancy
Recommended daily target blood glucose numbers for most pregnant women with diabetes are
- Before meals, at bedtime, and overnight: 90 or less
- 1 hour after eating: 130 to 140 or less
- 2 hours after eating: 120 or less3
Ask your doctor what targets are right for you. If you have type 1 diabetes, your targets may be higher so you dont develop low blood glucose, also called hypoglycemia.
Elevated Blood Sugar Levels Boost Pregnancy Risks
Pregnant women whose blood sugar levels are elevatedbut not high enough to be considered diabetesface an increased risk for Cesarean delivery, high-birthweight newborns and other problems normally seen in women with gestational diabetes.
Gestational diabetes affects about 5% of all U.S. pregnancies, putting both mother and fetus at risk for a variety of health problems. The condition is a temporary form of diabetes that usually arises around the 6th month of pregnancy and resolves a few weeks after delivery. The criteria for diagnosing gestational diabetesblood sugar levels rising above a certain levelwere developed more than 4 decades ago. But in recent years, some scientists have questioned whether expectant mothers with normal but elevated blood sugar might also be at risk for diabetes-related problems.
To address this issue, an international research team conducted a 7-year study of more than 23,000 pregnant women. Funding for the study came primarily from NIH’s Eunice Kennedy Shriver National Institute of Child Health and Human Development , with additional support from NIHs National Institute of Diabetes and Digestive and Kidney Diseases and National Center for Research Resources , as well as other organizations. The results were reported in the May 8, 2008, issue of the New England Journal of Medicine.
Who Is At Risk For Gestational Diabetes
In the United States, 6 out of every 100 pregnant people develop gestational diabetes. Youre more likely to have gestational diabetes if you:
- Are older than 25.
- Are overweight or obese and not physically active.
- Have had gestational diabetes or a baby with macrosomia in a past pregnancy.
- Have high blood pressure or youve had heart disease.
- Have polycystic ovarian syndrome . This is a hormone problem that can affect reproductive and overall health.
- Have prediabetes. This means your blood glucose levels are higher than normal but not high enough to be diagnosed with diabetes.
- Have a parent, brother or sister who has diabetes.
- Are a member of a racial or ethnic group that has a higher prevalence of diabetes that isnt entirely explained by race or ethnicity, such as Black, American Indian or Alaska Native, Asian, Hispanic/Latino or Pacific Islander
Racism and risk of gestational diabetes
Being a person of color is not a cause for having gestational diabetes.
Researchers arent exactly sure why people in these groups are more likely to have gestational diabetes, but they have noticed some patterns in studies about gestational diabetes. For example, many people of color experience chronic stress and lack access to fresh and healthy food. These factors are known as social determinants of health. They are the conditions in which you are born, grow, work, and live. In many cases, the social determinants of health are related to racism.
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How Do You Know If You Have Gestational Diabetes
If the glucose screening test comes back positive, youll have another test called a glucose tolerance test. After this test, your doctor will be able to tell whether you have gestational diabetes.
What Are Possible Complications Of Diabetes During Pregnancy
Most complications happen in women who already have diabetes before they get pregnant. Possible complications include:
Need for insulin injections more often
Very low blood glucose levels, which can be life-threatening if untreated
Ketoacidosis from high levels of blood glucose, which may also be life-threatening if untreated
Women with gestational diabetes are more likely to develop Type 2 diabetes in later life. They are also more likely to have gestational diabetes with another pregnancy. If you have gestational diabetes you should get tested a few months after your baby is born and every 3 years after that.
Possible complications for the baby include:
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What If Gestational Diabetes Develops
If you do get gestational diabetes, your doctor will monitor it throughout your pregnancy because it can cause problems for both you and your baby.
Since your bodys insulin supply cannot keep up, extra glucose stays in your blood and the baby receives more sugar than it needs and stores it as fat. Possible outcomes include a large baby, more chance of a cesarean delivery, and a slightly higher risk of fetal and neonatal death.
Babies born to mothers with diabetes need their blood sugar levels monitored after birth. Low blood sugars can result in newborn babies from mothers with any type of diabetes, and this can lead to problems for your baby, including seizures, Dr. Chapa says.
However, you can still have a healthy baby if you focus on good habits. To ensure stable blood sugar levels:
- Monitor your blood glucose levels regularly.
- Limit the amount of carbohydrates and simple sugars in your diet.
- Exercise regularly.
For most women, blood sugar levels return to normal after delivery, but your doctor will likely check them during the postpartum period. About 10% of women with gestational diabetes have type 2 diabetes without knowing it.
If a woman has gestational diabetes, she also has a higher chance of developing type 2 diabetes later in life. About half of women with gestational diabetes will have type 2 diabetes in 10 years, so it is important for your primary care physician to closely monitor your blood sugars.