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Diabetes & Pregnancy
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Preconception planning |
Pregnancy in diabetes If you are like many women, the moment you think you are pregnant, you will start reading about it. There are many informative books available, and your doctor may also provide you with some literature. And just about all of the advice in any literature on pregnancy applies to women with diabetes as well - including advice to eat a healthy, balanced diet, avoid smoking, and get enough vitamins, including extra folic acid. However, there are additional things you will have to consider and do to accommodate both your diabetes and your pregnancy. When you become pregnant, the most important thing to do is to reduce your blood glucose levels to as near normal as possible. This is especially critical during the first trimester when the baby is rapidly developing and growing. It is during this phase of pregnancy that high blood glucose levels can cause birth defects or miscarriage. If you have been taking anti-diabetes pills (often called oral hypoglycemic agents), your doctor will shift you to insulin injections, since the safety of those medications during pregnancy is not known at this point. You'll need to monitor your glucose levels frequently. It is not
unusual for pregnant women to perform self-monitoring of blood glucose (SMBG)
six to eight times a day. The ADA recommends these goals for blood glucose
control during pregnancy:
Goals for self-monitored glucose When tested Whole blood glucose reading
Plasma glucose reading
Before meals 70-100 mg/dl (3.9-5.6 mmol/l) 80-110 mg/dl (4.4-6.1 mmol/l)
2 hours after meals Under 140 mg/dl (<7.8 mmol/l)
Under 155 mg/dl (<8.6 mmol/l)
Steps to achieve a smooth
pregnancy
The following steps can
help you achieve a smooth pregnancy and a healthy baby:
Your eating patterns are especially important now, since
you want to control blood glucose levels and also assure that both you and
your baby are getting adequate nutrition during your pregnancy. If you
weren't already following a personalized meal plan as part of your
diabetes self-management program, then it is vitally important that you do
so now. Your diabetes educator or a dietitian can help you with this. If
you already have a good meal plan, you will need make some changes to
accommodate the increased nutritional needs for the baby. Some of these changes are: It's more
important than ever not to skip meals or snacks, since that can lower
blood glucose to dangerous levels. If you are having morning sickness, let
your doctor know about it. If you have trouble eating three large meals a
day, split your daily food into six or eight smaller ones, regularly
spaced and carefully planned.
Related information
The only way to tell if you are
succeeding in controlling your blood glucose is to monitor your levels,
and to do it frequently. Pregnant women are advised to monitor AT LEAST
four times a day, and sometimes as often as ten times a day. You may want
to take this opportunity to look into the newer glucose monitors that
require such a small amount of blood that it doesn't have to come from a
fingerstick. New tests can be done on blood drawn from areas less painful
such as the forearms or thighs.
Related information
If you previously controlled your glucose levels with diet and exercise, you may now need to take insulin. If
you've been on oral anti-diabetes medications, you will certainly need to switch
to insulin, since the safety of those medications during pregnancy has not been established. You
should use only human insulin, since the use of insulin analogs has not
been adequately tested in pregnant women.
Your body's need for insulin is going to steadily increase
throughout your pregnancy. That's because the hormones that accompany
pregnancy interfere with the activity of insulin. As the levels of these
hormones increase as the pregnancy progresses, so will your need for
insulin. Your insulin dose may have to be adjusted upward periodically; it
may also have to be recalculated as you and your baby get bigger. Your
doctor will be watching this area carefully and will want to see your SMBG
results for guidance. In order to maintain tight control, you will need to know
how to adjust your dosage depending on the results of your frequent
monitoring. Again, your healthcare provider or pharmacist can help you
master this
process. Related information When people with
diabetes undertake a program to achieve tight control, they increase the
risk of severe hypoglycemia. There is no evidence that hypoglycemia is a
risk to the developing baby, but it can be a problem for you. The first
and most important step is to prevent or reduce the risk of hypoglycemia.
This means learning enough to become an expert at controlling blood sugar,
and paying meticulous attention to the details of diabetes management. It
is probably not possible to completely prevent hypoglycemia, so it is
important to keep ready sources of carbohydrates with you at all times,
including glucose tablets or gel. It would also be a good idea for your
family and perhaps a close co-worker to learn how to administer glucagon
injections in case of a hypoglycemic crisis.
Related information
When people with diabetes undertake a
program to achieve tight control, they increase the risk of severe
hypoglycemia. There is no evidence that hypoglycemia is a risk to the
developing baby, but it can be a problem for you. The first and most important step is to
prevent or reduce the risk of hypoglycemia. This means learning enough
to become an expert at controlling blood sugar, and paying meticulous attention to
the details of diabetes management. It is probably not possible to completely prevent hypoglycemia, so it
is important to keep ready sources of carbohydrates with you at all
times, including glucose tablets or gel. It would also be a good idea for your
family and perhaps a close co-worker to learn how to administer glucagon injections
in case of a hypoglycemic crisis.
If you aren't exercising regularly, now is
a good time to start, but check with your doctor about your
planned activity and start slowly. Vigorous walking is an excellent way to start. Even if
you are having some problems during your pregnancy, light exercise such as leisurely
walking is still a good idea.
You'll need to plan your periods of activity along with
your food intake and insulin injections.
Related information If you're on
insulin, you'll need to take a few precautions:
Related information Your doctor will
give you guidelines for gaining weight during your pregnancy. Caloric input and
nutrition are especially important for you and your
baby. The "optimal"
weight gain depends on your weight when you became pregnant. If your weight was
in a good range for your body size, then a weight gain of 24 to 27 pounds is
recommended. If you are 20 or more pounds above your desirable level, you should
gain 24 pounds. If you gain too
much weight, the extra fat requires the body to produce more insulin to try to
keep blood sugar levels normal. But if your body is incapable of producing more
insulin, then your blood glucose levels will rise above acceptable
levels. How will my diabetes affect my baby? A common problem among diabetic women who are pregnant is a condition called "macrosomia," which means "large body." In other words, babies of diabetic women are apt to be considerably larger than others. The reason for this lies in the interchange of the mother's blood with the fetus. If the mother's blood has too much glucose, the baby's pancreas will sense that and produce more insulin in an attempt to use the glucose. The baby then converts the extra glucose to fat. The combination of high blood glucose levels from the mother and high insulin levels in the baby results in large deposits of fat, causing the baby to grow excessively large. Sometimes the baby gets too big to be delivered vaginally, and a cesarean delivery becomes necessary. Your doctor will be closely watching the size of your baby and planning the safest delivery for you and the baby. Sometimes the baby of a diabetic mother will have very low blood sugar immediately after delivery. This occurs if the mother's blood glucose levels have been high throughout the pregnancy, and especially if they were high in the 24 hours prior to delivery, causing the baby to have a high level of insulin in its circulation. After delivery the baby continues to have a high insulin level, but it no longer has the high level of sugar from its mother, so its glucose level drops quickly. Your baby's levels will be checked after birth and it may be necessary to give the baby glucose intravenously. Infants of mothers with diabetes may also have other chemical imbalances such as low serum calcium or magnesium levels. Your baby should receive special examinations and tests right after birth. Women with mild diabetes or who are very well controlled often
carry their baby to term without any problems. However, many physicians prefer
to plan for early delivery of the babies of diabetic mothers, usually around 38
or 39 weeks (full term varies from 38 to 42 weeks), usually when the baby is
getting large.
Glucose
control during labor and delivery Control of blood glucose levels
remains important during labor, which can be a stressful time. High blood
glucose in the mother will produce high insulin levels in the baby, which can
drive its blood glucose levels very low immediately after delivery since the
baby no longer has the high sugar concentration from the mother's
blood. If you have been taking insulin
during your pregnancy, you may be given insulin by injection or intravenously
when labor begins. Insulin requirements often drop rapidly immediately after
delivery.
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As the world’s top supplier of commercial blood pressure monitors and health management systems, Lifeclinic is committed to helping to improve the health and wellbeing of individuals across the globe. Active monitoring of blood pressure, heart rate, weight, body fat, body mass index (BMI) and blood oxygen levels when combined with proper diet, nutrition and physical fitness can help ensure a longer, more healthy lifestyle. © 2009 Lifeclinic International, Inc. |
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Pregnancy in diabetes |
