What to Know About Pregnancy When You're Diabetic

From health.usnews.com

If you have diabetes and you’re pregnant – or you’d like to become pregnant – here’s a bottom-line message.

“Women with diabetes are more likely to have a healthy pregnancy if they prepare for pregnancy before they conceive,” says Lory Gonzalez, a nurse educator and certified diabetes educator at the Diabetes Research Institute at the University of Miami Miller School of Medicine.

That means healthy eating, physical activity and good blood sugar control before you even become pregnant.

If your health and blood sugar aren’t in great shape and you become pregnant, you could have serious complications. That may include high blood pressure (a dangerous condition also known as pre-eclampsia), an emergency C-section due to the baby’s large size, more infections and worsening of common diabetes health problems. There’s even the risk for a miscarriage or stillbirth. Tight blood sugar control is so important because your baby's organs are forming in those early weeks of pregnancy, before you may even know that you're pregnant.

Naturally, there’s a lot on your mind when you’re pregnant, and there’s even more to consider if you have diabetes. The good news is that you can ask for help even before you get pregnant. “Make an appointment with a diabetes educator and/or a maternal fetal medicine specialist for a refresher and reminder about the American Diabetes Association diet and to ask any questions,” recommends Dr. Lara Friel, an author for Merckmanuals.com and an assistant professor in the department of obstetrics, gynecology and reproductive sciences at the University of Texas Health Science Centre at McGovern Medical School in Houston. Those health professionals can set you on the right course for pre-pregnancy health.

Next, keep these tips in mind for a healthier baby.

Check your blood sugar numbers frequently, even before you get pregnant. “Prior to getting pregnant, a woman needs to control her blood sugars and is usually advised to reach a certain hemoglobin A1C level before getting off birth control to ensure the blood sugars are close to normal when conception begins,” says Mercy T. Molina, a registered dietitian and certified diabetes educator at the Diabetes Research Institute at the University of Miami Miller School of Medicine. Blood glucose recommendations before getting pregnant are generally 70 to 100 milligrams per decilitre before meals and below 140 mg/dL at two hours after a meal. Your hemoglobin A1C should be 7 percent or sometimes lower, as directed by your endocrinologist, Gonzalez says.

During pregnancy, the optimal blood sugar levels are 60 to 90 mg/dL when you wake up and haven’t eaten, below 105 mg/dL before lunch and dinner and below 120 mg/dL at two hours after meals.
Frequent blood sugar checks may be inconvenient, but they’re important for both your health and the health of your baby.

Ask for help from your health team. Getting your blood sugar numbers consistently low can be a challenge, but again, you can get guidance from health professionals. “Working with a certified diabetes education team of a nurse and a nutritionist will ensure that a woman is following her treatment plan, monitoring her blood sugars, achieving her blood sugar targets and following a healthy meal plan,” Molina says.

Eat regularly, but don’t overeat. “Most people can put off eating if they are busy with something else,” Friel says. “However, food is a big part of a diabetic’s treatment and is necessary to maintain blood sugar levels.” Although you shouldn’t skip meals, that also doesn’t mean you should raid the fridge. In fact, if you’re already overweight, you may need little to no increase in your calories while pregnant, says endocrinologist Dr. Saima Farghani, on staff at CentraState Medical Centre in Freehold, New Jersey. Stick to nutrient-dense food choices and avoid what Farghani calls “man-made carbohydrates” like cereals, cookies, snacks and chips. Instead, aim to eat foods with complex carbohydrates such as oatmeal and fruits and vegetables and healthy fats like avocados and nuts.
Exercise if it’s OK with your doctor. Regular exercise will help you feel better and build your strength for having a baby. Most women can stick to the guideline for all adults of 150 minutes a week or 30 minutes, five days a week. (If you’re having trouble fitting in 30-minute periods of exercise, you can break that into 10- to 15-minute bursts throughout the day.) One exception to this is if you did not exercise before getting pregnant. In that case, work up slowly to longer exercise time periods and do so under your doctor’s guidance, Farghani says. Of course, always listen to your doctor’s advice regarding exercise while pregnant. If you’re on bedrest, you won’t be able to exercise regularly.

You'll also want to plan what kind of physical activity you're doing. Avoid exercises that require bouncing, are high-impact or that cause your back to arch backwards. “Walking, swimming, cycling or prenatal yoga are your best bets,” Gonzalez says.

Check with your doctor about diabetes medications you should continue to use. Generally speaking, many of the medications you take for diabetes can be continued while you’re pregnant. In fact, you may need changes to your diabetes medications while you’re pregnant as your insulin resistance increases. However, there may be some limitations, so it’s always important to verify with your doctor what you can safely take. Also let your doctor know about herbal or dietary supplements so you can make sure you take only what is necessary, Gonzalez advises.
Follow these tips if you have gestational diabetes as well – and monitor your risk for diabetes after you have your baby. Gestational diabetes is the kind of diabetes that develops when you are pregnant, but then it goes away once you have the baby. “Approximately 50 percent of women with gestational diabetes will develop diabetes in the next 10 years,” Friel says. The children of women with gestational diabetes also are at higher risk for diabetes development. Make sure you see your doctor regularly to test your diabetes risk after giving birth.

https://health.usnews.com/health-care/patient-advice/articles/2017-10-03/what-to-know-about-pregnancy-when-youre-diabetic