Are you someone who has diabetes? If you're expecting a baby, you probably have a lot of questions on your mind. It's normal to wonder, "Will my diabetes affect my baby?", "What should I do during this time?", "Will I be able to do everything right?" But don't worry. If you manage it properly, you can definitely bring a healthy, beautiful baby into the world even if you have diabetes. Let's talk about this clearly and simply.
First, let's understand: This is not gestational diabetes!
This is where many people get confused. Some people develop diabetes only during pregnancy. We call it gestational diabetes. The condition usually goes away after the baby is born.
But that's not what we're talking about in this article. We're talking about how to manage your pregnancy if you have pre-existing diabetes, either Type 1 or Type 2. Doctors also call this "Pregestational Diabetes." No matter how used to living with diabetes you are, pregnancy is a whole new challenge.
Why is pregnancy with diabetes 'high-risk'?
Yes, when someone with Type 1 or Type 2 diabetes becomes pregnant, we classify it as 'high-risk' . This is not to scare you, but to remind you that you and your baby need special care. Your medical team will monitor you very closely because high or low blood sugar levels are not good for you or your baby.
During this time, you may need the help of other specialists in addition to your general obstetrician and gynecologist.
- A Maternal-Fetal Medicine Specialist (MFM): A doctor who has special knowledge in these types of special cases.
- Endocrinologist: A doctor who specializes in hormones and diabetes.
- A Registered Dietitian: Will help you prepare meals that are appropriate for pregnancy and diabetes.
- Diabetes Educator: A specially trained person who can answer your questions and give you advice about diabetes management.
Remember, these people are here to help you. So don't hesitate to talk to them about any questions or concerns you may have.
How should you prepare before having a baby?
If you have diabetes, start thinking about having a baby at least 6 months before you conceive.It's best to talk to your doctor. Because you'll need to keep your blood sugar levels under control throughout your pregnancy, it's important to be prepared for that ahead of time.
Doctors often recommend that you keep your A1C at 6.5% or lower before you get pregnant. This is because the baby's major organs, such as the brain and heart, are forming in the early weeks of pregnancy. If your blood sugar levels are uncontrolled during this time, it can affect your baby's development.
The benefits of meeting with the medical team early are:
- They will help you bring your sugar levels back to a healthy level.
- You can talk to a nutritionist and create a healthy eating plan that is suitable for pregnancy.
- You may need to make changes to your diabetes medication during pregnancy. You can find out about this in advance.
- You may be recommended to use a new technology, such as a Continuous Glucose Monitor (CGM) or an Insulin Pump. This is a good time to get used to it early.
- You can check the health of your eyes, kidneys, and heart before getting pregnant, because some complications caused by diabetes (such as ``Retinopathy'' and ``Nephropathy'') may increase or develop new ones during pregnancy.
How does diabetes management change during pregnancy?
There are several major changes in your diabetes management during pregnancy.
1. Keep blood sugar levels under control: To minimize complications, you need to be more careful about your sugar levels than usual.
2. Changing insulin needs: The amount of insulin you need often changes with hormonal changes in the body.
3. Balancing dietary needs: Controlling sugar levels while getting the nutrition needed for the baby's growth is a challenge.
Goals to maintain your blood sugar levels during pregnancy
These are the target levels that doctors usually recommend. However, these may vary slightly depending on your condition. Therefore , it is important to follow your doctor's instructions.
| Checking time | Target sugar level (mg/dL) |
|---|---|
| Fasting (before breakfast) | Less than 95 mg/dL |
| One hour after a main meal | Less than 140 mg/dL |
| Two hours after a main meal | Less than 120 mg/dL |
To reach these goals, you will need to do the following:
- Be careful about the amount of carbohydrates in the foods you eat.
- Inject insulin 10-15 minutes before eating.
- Exercise to help control your blood sugar levels (talk to your doctor about this).
How insulin needs change during pregnancy
This is the biggest challenge for many people. During pregnancy, your body's hormones change dramatically. Because of this, the amount of insulin you need also changes constantly.
- First trimester (first 3 months): Some people have a slightly reduced need for insulin during this time, but this is not common for everyone.
- After 16 weeks: During this time, hormones secreted by the placenta increase the body's resistance to insulin. This happens even to people without diabetes. As a result, the amount of insulin you need gradually increases.
- By 36-37 weeks: By now you may need double or triple the amount of insulin you needed before you got pregnant.
- After delivery: Surprisingly, after the baby is born and the placenta is delivered, your insulin needs drop dramatically. You may need the same amount as before pregnancy or even less. It is important to discuss this with your doctor in advance and come up with a plan.
What additional tests should I expect during pregnancy?
Because you have diabetes, you will need to have more medical tests and scans than a normal pregnant mother. These are done to make sure that your baby is developing and that you are healthy.
| Test | Why do it? |
|---|---|
| Fetal Echocardiogram | Since diabetes increases the baby's risk of congenital heart disease, check the structure of the baby's heart. |
| Growth Scans | The baby's growth is monitored every few weeks. Babies born to mothers with diabetes are at risk of being larger than normal (Fetal Macrosomia). |
| Non-stress Test (NST) | It's done about once a week during the last half of pregnancy. The baby's heartbeat and movements are checked. |
| Biophysical Profile (BPP) | This is also a scan. It measures the baby's breathing movements, muscle tone, movement, and the amount of amniotic fluid in the uterus. |
What are the possible risks and complications?
It's important to keep your blood sugar levels under control to minimize these risks. It's important to be aware of these things, but don't be afraid that all of this will happen to you.
Possible risks to the baby
- Birth defects: The risk of birth defects, especially heart defects, is slightly increased.
- A baby that is larger than normal (Fetal Macrosomia): The baby's weight may exceed 4 kg. This can cause difficulties for both the mother and the baby during delivery.
- Preterm Birth: If any complications arise, the baby may have to be delivered before the due date.
- After birth: After the baby is born, conditions such as low blood sugar, difficulty breathing, and jaundice may occur. At such times, the baby may need to be kept in the neonatal intensive care unit (NICU).
Risks to you (the mother)
- Preeclampsia: High blood pressure and protein in the urine during pregnancy. Diabetes is a major risk factor for this.
- Need for a cesarean section (C-section): A normal delivery may be difficult due to the baby's large size.
- Low blood sugar levels (Hypoglycemia):When trying to control your blood sugar levels, sometimes your blood sugar levels can get too low.
- Diabetic Ketoacidosis (DKA): This condition is more likely to occur during pregnancy due to increased insulin resistance. Morning sickness can also be a cause.
- Other complications related to diabetes: The effects of diabetes on organs such as the eyes and kidneys may increase during pregnancy.
How do you face this challenge? When should you see the doctor?
Living with diabetes during pregnancy can be mentally and physically exhausting, but if you follow these steps correctly, you can make it through this journey successfully.
- Check your blood sugar levels regularly as directed by your doctor.
- Try your best to keep your blood sugar levels within the target range.
- Use insulin and other medications exactly as directed by your doctor.
- Don't skip any clinic or test.
- Eat a healthy, balanced diet.
- Stop drinking alcohol and smoking completely.
- Think about your mental health too. If you're feeling stressed, talk to a friend or a doctor.
If you have these symptoms, call your doctor immediately.
| Symptom | Description |
|---|---|
| If you can't control your sugar levels | No matter how hard you try, your sugar levels are always above or below the target. |
| If the baby's movements are low | If you feel like your baby is moving less than usual. |
| Vaginal discharge or bleeding | If there is a watery discharge or blood coming out. |
| Other features | If your vision is blurry, you feel extremely thirsty, or you vomit continuously. |
Remember, if you have any concerns about anything, never be afraid to talk to your doctor. It's very important for your safety and that of your baby.
Take-Home Message
- Even if you have diabetes, with proper planning and management, you can give birth to a healthy baby.
- Before you think about having a baby, talk to your doctor a few months in advance and get your blood sugar levels under control.
- Pregnancy is like a 'team sport.' You, your family, and your medical team need to go through this journey together.
- Your insulin needs will change frequently throughout your pregnancy, so make any necessary adjustments as directed by your doctor.
- If you have any concerns or questions, talk openly with your medical team. They are there to help you.
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