Diabetes and pregnancy

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If you have diabetes, you can still have a have a healthy pregnancy. Eating well, gaining the right amount of weight, and exercising go a long way to help you control your blood sugar level and prevent complications for both you and your baby.

What is diabetes?

Diabetes is a condition that affects the body's natural way of storing and using energy. It causes a high level of glucose (sugar) in the blood stream, which may lead to many health problems.

Pregnant woman using computerSome women have diabetes before becoming pregnant; others develop diabetes during pregnancy (gestational diabetes). Either way, high blood glucose levels during pregnancy can cause the baby to grow too large, making a natural delivery difficult and causing problems for the baby.

"If your blood sugars are too high in the first trimester, your baby's chance of having a birth defect is higher, so this is a very important time for good glucose control," says Kaiser Permanente doctor Anne Regenstein, MD.

Gestational diabetes

If your blood sugar becomes too high for the first time while you are pregnant, you have gestational diabetes. Gestational diabetes is the most common form of diabetes in pregnant women. Learn more about gestational diabetes and how to care for yourself.

Type 2 diabetes

Type 2 diabetes is usually diagnosed in adulthood, but has become more common in children and teens due to an increase in childhood obesity. This type of diabetes can be managed with lifestyle changes (diet and exercise) or with medications such as insulin shots or oral medication.

Women with type 2 diabetes should see their doctor before they become pregnant to discuss steps they can take to ensure a safe pregnancy and a healthy baby. Women with type 2 diabetes should also be seen as soon as they find out they are pregnant, so that blood sugar levels can be monitored carefully. Learn more about type 2 diabetes.

Type 1 diabetes

Type 1 diabetes is usually diagnosed in children and young adults. It is less common, but more likely to cause problems in pregnancy.

In type 1 diabetes, the body does not produce insulin, a hormone that is needed to help your body properly use and store glucose. Type 1 diabetes can be managed with diet, exercise, and insulin to control blood sugar. Learn more about type 1 diabetes.

How will diabetes affect my baby?

There are no guarantees, but with careful lifestyle changes, including wise food choices, physical activity, and good blood sugar control, it is less likely that there will be any problems.

Special monitoring usually starts between 32 to 34 weeks for mothers who are taking insulin or oral medications. If a mother is not on medications, then special monitoring usually starts by week 40 of your pregnancy.

If there are problems, your health care team will be there to assist you and your baby. Potential complications include the following:

  • Macrosomia (large baby) happens when the baby grows too big from receiving too much sugar in the blood from the mother. Extra blood sugar turns to fat and the baby may grow too large to fit through the birth canal. To avoid possible injury to the baby during a vaginal delivery, your doctor may recommend a cesarean section.
  • Hypoglycemia in the baby (low blood sugar) may occur if the mother's blood sugar levels have been consistently high during pregnancy. This causes the fetus to develop high levels of insulin in the blood. After delivery, the baby no longer has the high level of sugar from the mother but continues to produce high levels of insulin. As a result, the newborn's blood sugar becomes very low. Immediately after birth, your baby's blood sugar level will be checked. If it is too low, the baby may need to be fed right away.
  • Polyhydramnios (excess amniotic fluid) happens in a relatively small number (about 10 percent) of pregnancies with pre-existing diabetes. Excess fluid can cause premature labor or other problems.

Mothers with high blood sugar levels at the beginning of pregnancy are at an increased risk for having a baby with birth defects. However, this risk can be lowered if blood sugars are well-controlled before pregnancy. Some mothers who have diabetes before pregnancy have a slightly increased chance of stillbirth.

Delivery of the baby

When the mother's blood sugar remains normal throughout the pregnancy, diabetes should not affect the delivery of the baby. Discuss your concerns with your practitioner. Sometimes a cesarean section may be necessary to deliver a baby that is too big to fit through the birth canal.

Should I breastfeed?

We strongly encourage breastfeeding. Your body uses the calories stored during the first part of pregnancy to make breast milk. About 300 to 500 calories per day are used for breastfeeding.

By 6 weeks after delivery, women who breastfeed usually have lost an average of 4 pounds more than women who bottle feed. This can be especially important for women with gestational diabetes, since keeping a normal body weight may reduce the risk of developing diabetes later in life.

Breastfeeding is also good for your baby. Breast milk offers health benefits that formula can't match. Learn more about the benefits of breastfeeding.

If you have had gestational diabetes, you should be able to breastfeed your baby without any complications. The amount and type of milk your body makes is the same as a woman who did not have gestational diabetes.

Breastfeeding mothers are encouraged to use oral medications or insulin after talking with your doctor. If you took insulin or oral medications before you were pregnant, your insulin or medication needs may be different while breastfeeding.

If you have type 1 diabetes, be aware that your blood sugar may drop during or after nursing. You may want to check your blood sugars before and after feedings during the first few weeks of breastfeeding. You may need to eat snacks to prevent low blood sugar, especially during the night. Most likely, you will need to control your blood sugar with smart food choices, exercise, and possibly with oral medications or insulin while breastfeeding.

What happens after pregnancy?

Once you have delivered your baby, the way you manage diabetes may change quite a bit.

If you have gestational diabetes, you will probably not need insulin or oral medication after you deliver. However, as many as 60 percent of women with gestational diabetes will develop type 2 diabetes later in life.

It is important that you have a blood sugar test in the laboratory 6 weeks after your baby is born to see if you still have diabetes. You may need to do this test again after you stop breastfeeding. If you do have diabetes, your doctor will let you know if you need to take diabetes medications.

Continue with any healthy lifestyle changes you made during pregnancy to prevent type 2 or gestational diabetes in the future.

"You should continue with the dietary modifications made during pregnancy and exercise regularly to prevent the development of type 2 diabetes or recurrent gestational diabetes in the future," says Kaiser Permanente physician Kim Vesco, MD. If your blood test is normal, it is still important for you to keep in mind that you have an increased risk of developing diabetes later, especially if you gain weight.

If you took insulin or oral medications to treat your diabetes before you were pregnant, there may be big changes in your insulin needs the first few days after delivery. That's why it is important to check your blood glucose frequently before meals to know when to adjust your medication.

If you were on insulin before you got pregnant, you probably needed to increase your dose during your pregnancy. After delivery, your body's insulin needs will be closer to what they were before pregnancy.

To decrease your risk for diabetes after pregnancy, remember the following:

  • Try to reach or maintain a healthy weight. Losing the weight you gained during pregnancy will help decrease your risk.
  • Try to eat plenty of fruits, vegetables, and whole grains.
  • Aim for at least 30 minutes of physical activity each day.
  • Have a laboratory test of your blood sugar every 1 to 3 years to see if you have developed diabetes.
  • Plan your pregnancies and consult with your doctor or other medical professional before getting pregnant again to be sure your blood sugar is normal.

Reviewed by: Jeff Convissar, MD, November 2015
Additional Kaiser Permanente reviewers

© 2015 Kaiser Permanente

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