Lifeclinic: Blood Pressure Monitors & Health Stations
HomeBlood PressureCholesterolDiabetesNutritionSenior Care
Key Word Search
 
Diabetes Basics
Glucose Control
Insulin and Medication
Special Issues
Children & Teens
Pregnancy
Foot Care
Diabetic Supply
Latest Developments
Resources
My Health Record
FREE
Blood Pressure Health Station Locator
Locate a Dealer
Resources
Find a Diabetes Expert
Diabetes Resource Locator
Diabetic Cookbook
Diabetes Dictionary
Health News
Reminders
My Saved Articles
Links
Diabetes Site Map
About Us
Contact Us
Press Releases
Advertising
About the Channel
Terms of Use
Privacy Policy
 

Diabetes & Pregnancy Home:   Preconception planning | Pregnancy in diabetes | Gestational Diabetes

    
Pregnancy in diabetes
     Important steps | Weight gain | Impact on baby | Labor & Delivery Glucose control

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)

Top of page

Steps to achieve a smooth pregnancy

The following steps can help you achieve a smooth pregnancy and a healthy baby:

  • Following an appropriate meal plan
  • Frequent self-monitoring of blood glucose (SMBG)
  • Administering insulin injections and knowing how to adjust the doses depending on results of SMBG
  • Controlling/treating hypoglycemia
  • Adding or maintaining an appropriate level of physical activity

Top of page 

1) Following an appropriate meal plan

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:  

  • Your calorie requirement will increase by about 300 calories a day over what you needed before you became pregnant.

  • You will need about 30 grams more of protein a day -- that's about the equivalent of one serving of meat or fish.

  • To maintain normal blood glucose levels, you'll have to be sure to get enough carbohydrates in the morning.

  • Snacks will be important, and should probably include a complex carbohydrate (such as whole-grain bread) and a protein (such as meat or cheese).

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 Diet for diabetes

Top of page

  

2) Frequent self-monitoring of blood glucose (SMBG)

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 Glucose testing | Monitoring devices

Top of page

 

3) Administering insulin injections and knowing how to adjust the doses depending on the results of SMBG

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 Insulin | Insulin delivery device | Latest development

Top of page

4) Controlling/treating hypoglycemia

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 Hypoglycemia | Emergency products

Top of page

 

5) Adding or maintaining an appropriate level of physical activity

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  Diabetes and exercise

Top of page

If you're on insulin, you'll need to take a few precautions:

  • Be aware of the risk of hypoglycemia, and take a high-sugar snack along with you.
  • It may be necessary to eat small snacks between meals.
  • If you exercise right after a meal, have a snack after the exercise.
  • If you exercise two hours or more after a meal, eat the snack before the exercise.
    • One serving of fruit will maintain blood sugar for most short-term activities (about 30 minutes).
    • One serving of fruit plus a serving of starch will be enough for activities that last longer (an hour or more).
  • Don't inject insulin into a part of the body that will be exercised; for example, if you'll be walking, avoid injecting into your leg.

Related information  Diabetes and exercise

Top of page

How much weight to gain?

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. 

Top of page

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.

Top of page

Labor and delivery

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.

Top of page

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.

Top of page

 
PAGE OPTIONS
Bookmark Printer Friendly Format Email This Page
CONTACT
Technical Help

 
 

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.

© 2011 Sentry Health Monitors, Inc.