Managing Diabetes During Pregnancy

Managing Diabetes During Pregnancy

Florence Brown, M.D.
Co-Director, Joslin-Beth Israel Deaconess Medical Center Diabetes and Pregnancy Program; Instructor in Medicine, Harvard Medical School

Tamara Takoudes, M.D.
Co-Director, Joslin-Beth Israel Deaconess Medical Center Diabetes and Pregnancy Program; Instructor in Medicine, Harvard Medical School

According to the Centers for Disease Control and Prevention, about 1.2 million women of reproductive age (18-44 years) have diabetes.

As this number continues to rise, it is increasingly important for women with diabetes to achieve normal blood glucose levels before they become pregnant, because if women have poorly controlled diabetes going into a pregnancy they are at much higher risk for serious fetal complications.

Changing hormones in the body during pregnancy cause blood glucose levels to rise, and high blood glucose levels within the first four to six weeks can result in a 30 to 40 percent chance of having a baby with a birth defect compared with a 2 percent risk in women whose diabetes is in excellent control.

Women with type 1 or type 2 diabetes are also at higher risk for:

Large birth weight babies, resulting in more Cesarean deliveries and increased complications during delivery
Premature births or fetal death
Preeclampsia: a dangerous surge in blood pressure associated with protein in the urine
Diabetic retinopathy: damage to the retina caused by high glucose levels
Nephropathy: diabetic kidney disease
Severe hypoglycemia: episodes of low blood glucose that can result in confusion or unconsciousness

Ensuring a Healthy Pregnancy

The good news is that women with uncomplicated diabetes who keep their blood glucose levels in a normal range before and during pregnancy have about the same chance of having a successful pregnancy as women without diabetes.

We recommend the following blood glucose goals and medical assessments before pregnancy:

Fasting and pre-meal blood glucose: 80-110 mg/dl (4.44-6.11 mmol/l)
Blood glucose one hour after meal: 100-155 mg/dl (5.56-8.61 mmol/l)
A1C, a blood test that measures average blood glucose over two to three months: less than 7 percent
Review of diabetes and obstetrical history
Eye evaluations to screen for and discuss risks of diabetic retinopathy
Renal, thyroid, gynecological and cardiac evaluations


Once pregnant, women should monitor their blood glucose levels four times a day (before breakfast and one hour after every meal). Fasting and pre-meal glucose levels should be between 60 and 99 mg/dl (3.33 and 5.50 mmol/l), and one-hour post-meal readings between 100 and 129 mg/dl (5.56 and 7.17 mmol/l).

Gestational Diabetes

The other form of diabetes that affects women is gestational diabetes, which develops during pregnancy. Mirroring the epidemic of type 2 diabetes, rates of gestational diabetes are also on the rise in the United States, particularly in the African-American, Latino, Asian-American, American Indian and Alaskan native communities.

Gestational diabetes usually develops between the 24th and 28th weeks of pregnancy and affects about four percent of all pregnancies. This condition typically ends after birth; however, these women have a 50 percent risk of developing type 2 diabetes over the next 10 to 20 years.

Factors that increase a womans risk of developing gestational diabetes:

Obesity
Previous history of gestational diabetes
Sugar in the urine
A parent or sibling with diabetes
Polycystic ovary syndrome or other glucose metabolism problem
Previous pregnancy in which the baby weighed more than nine pounds at birth

If you fall into any of these categories, you should be screened early, within the first trimester, for gestational diabetes. Women who find out that they have gestational diabetes should see a nutritionist and diabetes nurse educator, as diet is the first line of therapy.

With careful diabetes management, women can and do have successful pregnancies and healthy babies.

This article first appeared in the Nov. 13, 2006 issue of TIME.

Courtesy of Joslin Diabetes Center

Last Modified Date: November 27, 2012

All content on dLife.com is created and reviewed in compliance with our editorial policy.

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