Diabetes and Pregnancy
Pregnancy is a marvel! Every aspect of the process is magical – yes, even the delivery. However, the magic can be stolen from a woman with diabetes if she doesn’t have the proper care, treatment, and management of her diabetes before and during pregnancy.
This month, let’s explore the issue of diabetes and pregnancy and what it takes to ensure both mom and baby are healthy.
When I first started considering the possibility of having a baby (a few years ago), I met all kinds of responses. The range was everywhere from elation to dismay. It seems so many people have the image of Shelby from “Steel Magnolias” in mind when a woman with diabetes talks about pregnancy. For those of you who don’t know, Shelby – a diabetic – becomes pregnant, has a child, and shortly thereafter dies from diabetes complications. The situation need not be so bleak. It is possible to have a wonderfully normal pregnancy, along with a healthy baby all while managing diabetes. But, there is a caveat – if the diabetic woman is not in good control of her glucose, tragedy can result; tragedy for both mother and baby. This was the case in the movie, although subtle in presentation and often not understood by all viewers. Shelby’s diabetes was not under control and she was having wild glucose swings before her pregnancy.
Most healthcare professionals recommend that if a woman with diabetes wants to have a child, she, along with her OB/GYN and endocrinologist, should plan her pregnancy months if not years in advance. Before conception, glucose numbers should be as close to the normal range as possible and the A1c value should be in the 6% range. Science shows that if the A1c level is in the 8% range, complications are more likely for the baby, including brain damage and neural tube defects.
Many women, myself included, get scared by those recommendations. A1c’s that are akin to a person without diabetes seem impossible for a person struggling with this disease. The notion is even more frightening if you have ever experienced low glucose reactions or diabetes emergency situations. Lower A1c results mean more low blood sugars. There is a lot of risk and it takes a lot of work, but the end result is – well, magic.
Here are some suggestions to help a person with diabetes deliver a healthy baby:
1. Meet with your healthcare team before you become pregnant. Your team should consist of your endocrinologist, diabetes educator and obstetrician or neonatologist (high risk OB). This group will work with you to help prepare for your pregnancy, advise you of the right time to become pregnant, and they will see you through nine months of incredible diabetes changes, and post partum care.
2. Once you become pregnant, your doctor’s visits will consist of several tests, including A1c, urinalysis, thyroid tests, and electrocardiograms – for both you and the baby. Your doctor will probably check your A1c level on a monthly basis before and during pregnancy. My healthcare team evaluated my A1c monthly during pregnancy, and quarterly when I was not pregnant. Toward the end of the pregnancy, the frequency of tests increases dramatically. During the last month or so, you could find yourself in the OB office strapped to monitors three times a week! Be prepared. (I used to joke that pregnancy was at least a part-time job for me!)
3. Your healthcare team will direct you regarding your calorie intake based on your height, weight, age, and activity level. They will work with you to develop a meal plan so you can maintain an ideal weight and good control. Excessive weight gain is dangerous for women with diabetes because the baby gains too much weight as well and makes natural delivery almost impossible. It is recommended that women gain between 25-35 pounds during pregnancy. Be forewarned that it is somewhat common for women with diabetes to gain excess fluid weight at the end of the pregnancy. This made my weight gain jump to over 40 pounds! I had severe swelling for the last 6 weeks of my pregnancy. (My ankles and knees were non-existent.)
4. It is also recommended that you visit your ophthalmologist for a baseline exam before pregnancy. If any laser treatment is necessary, it should be performed prior to getting pregnant. During pregnancy there should be two more visits to the ophthalmologist. Diabetic retinopathy can escalate during pregnancy. Plus, it is common for the mother’s vision or glasses/lens prescription to change while carrying the baby. (My contact lens prescription changed shortly after my first trimester ended.)
5. Be sure to talk to your doctor about starting or continuing an exercise program. Your doctor will have suggestions on the type and intensity level that is best for you. If you are currently exercising, you may need to make adjustments to your routine. Activity is great for the growing baby and helps the mother maintain good muscle tone and strength – a benefit during delivery. However, some exercises are not recommended. The American Pregnancy Association advises women to be cautious of the following:
- Avoid rocky terrain or unstable ground when running or cycling. Your joints are more lax in pregnancy and ankle sprains and other injuries may occur.
- Contact sports should be avoided during pregnancy.
- Weight training should emphasize improving tone, especially in the upper body and abdominal area. Avoid lifting weights above your head and using weights that strain the lower back muscles.
- During the second and third trimesters, avoid exercise that involves laying flat on your back, as this decreases blood flow to your womb.
Most important, realize that with diabetes pregnancy poses unique challenges, however those challenges are not insurmountable. You can do it if your diabetes is well managed. Low blood sugars are best for mom and baby – although they do require more work from mom. For nine months, you can do anything! Just remember the magic and the payoff is for a lifetime.
NOTE: The information is not intended to be a replacement or substitute for consultation with a qualified medical professional or for professional medical advice related to diabetes or another medical condition. Please contact your physician or medical professional with any questions and concerns about your medical condition.
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