Can you have a healthy baby even if you have diabetes? (Diabetes in Pregnancy) Let's talk about this!

Hello! If you are expecting a baby these days, especially if you have diabetes, you probably have a lot of questions and fears in your mind, right? "Oh, will there be problems with the baby when I have diabetes?" "Will this be managed properly?" You may be thinking things like that. Don't worry, you are not alone. Many mothers face this situation. The most important thing is that with the right understanding and following medical advice, you too can have a healthy baby. Let's talk about this in a little more detail, shall we?

How does diabetes affect pregnancy?

Simply put, if you have Type 1 or Type 2 diabetes before you get pregnant, it's called "pregestational diabetes." This is different from gestational diabetes, which develops during pregnancy. Gestational diabetes usually goes away after you have the baby.

If you already have diabetes, controlling your blood sugar levels during pregnancy can be a bit challenging. You know what? During pregnancy, our hormones change a lot. With those changes, you may have to change your diet, exercise routine, and even your medications. Often, this diabetes management plan will have to be changed several times until the day your baby is born. Therefore, it is very important to talk to your medical team regularly and tell them about your condition. Only then can they decide exactly what treatments you need and whether they need to be changed.

But remember this, having diabetes doesn't mean you can't have a healthy baby. It's a little harder, but it's not impossible. Your medical team is there to help you.

Is Type 1 diabetes a high-risk pregnancy condition?

Yes, Type 1 diabetes and Type 2 diabetes increase the risk of complications during pregnancy. Therefore, your obstetrician will closely monitor your baby's health and your blood sugar levels throughout your pregnancy to ensure that you are maintaining a healthy level. If your blood glucose levels remain too high or too low, it can be dangerous and lead to complications.

You will often work with a maternal-fetal medicine specialist (MFM). In addition to your obstetrician, your medical team may include:

• Endocrinologist: A specialist in hormone-related diseases.
• Registered dietitian: A person who can help control diabetes and provide guidance on healthy eating habits during pregnancy.
• Diabetes educator: A specialist with extensive training and knowledge in diabetes management.

How can someone with diabetes prepare for pregnancy?

If you have diabetes and you're trying to have a baby, the first thing to do is talk to your doctor. It's best to talk about this about six months before you start trying to have a baby.

It's important to control your blood sugar levels well before you get pregnant. The goal during pregnancy is to keep your blood glucose levels within a very narrow range. It can be even more difficult to maintain this after you're pregnant.

Many guidelines recommend keeping your A1C at 6.5% or lower before you get pregnant . This is to reduce your risk of complications. Did you know? The baby's organs and other important tissues begin to form during the first trimester of pregnancy. If your blood sugar levels remain high during that time, it can affect the baby's development.

Meeting with your medical team before trying to have a baby has the following benefits:

• Doctors can recommend ways to help bring your blood sugar levels to a healthy level.
• A dietitian can help you create meal plans that are appropriate for pregnancy and diabetes management.
• You may need to change your diabetes medication after you become pregnant.
• You may be able to get used to using new diabetes technologies (for example, a continuous glucose monitor - CGM) that can be especially helpful during pregnancy.
• Your doctor may recommend that you have your eyes (risk of retinopathy), kidneys (risk of nephropathy), and heart checked before you become pregnant, as pregnancy can sometimes worsen or cause new complications from diabetes.

How will my diabetes management change during pregnancy?

There are several key factors that affect how you manage diabetes during pregnancy:

• The need to keep blood glucose levels within a narrower range to reduce the risk of pregnancy complications.
• Adjusting to changing insulin needs.
• Managing nutritional needs during pregnancy by keeping blood sugar levels balanced.

Blood sugar targets during pregnancy with diabetes

Typically, blood sugar targets for pregnant mothers with diabetes are as follows:

• Fasting: Less than 95 mg/dL
• One hour after eating: Less than 140 mg/dL
• Two hours after eating: less than 120 mg/dL

In other words, these goals can be thought of as `time in range (TIR)`. In general, `TIR` goals for adults with `Type 1` diabetes during pregnancy are:

• At least 70% of the time between 63 and 140 mg/dL (within the target range)
• Less than 5% of the time below 63 mg/dL
• Less than 25% of the time above 140 mg/dL

Many guidelines recommend maintaining an A1C of less than 6% during pregnancy. This can reduce the risk of complications.

Because of these strict goals, your doctor may recommend using a continuous glucose monitor (CGM) during pregnancy. Rather than using fingersticks, a CGM gives you a better picture of how your glucose levels are changing over time, making it easier to make the right changes to your diabetes management.

To maintain this narrow blood sugar range, you will need to follow several methods:

• Carefully count the amount of carbohydrates in your meals and snacks.
• Taking insulin 10-15 minutes before (or even earlier) eating.
• Using physical activity to control blood sugar levels.

Your doctor will talk to you about these methods and other strategies.

Changing insulin needs during pregnancy

Expect your insulin needs to change frequently during pregnancy. This is mainly due to the different hormones in your body. Just as diabetes affects everyone differently, so does pregnancy. Therefore, it is important to work closely with your medical team to make any necessary adjustments to your diabetes management plan. These changes will be unique to you and your needs.

If you have Type 1 diabetes, it's common to need less insulin in the first trimester – but not everyone does. Around the 16th week of pregnancy, insulin needs start to increase. This is because the placenta produces hormones that increase insulin resistance. This happens in all pregnancies, not just those with diabetes.

You will likely need more insulin until the 36th or 37th week of pregnancy. At that time, insulin resistance usually stabilizes. Many people may need two to three times the amount of insulin they took before pregnancy.

You will work with your doctor to make any necessary insulin changes during pregnancy. This may include:

• Your `basal` or long-acting (background) insulin (`long-acting insulin`)
• Insulin-to-carb ratio (ICR)
• Insulin sensitivity factor (ISF)

Importantly, once the placenta is delivered, your insulin needs will drop dramatically. Within about 30 minutes of the placenta being delivered, your insulin needs will return to their pre-pregnancy levels – or even lower. Your doctor will talk to you about how to adjust your insulin regimen after delivery. It’s important to have a plan for this.

Diabetes and dietary needs during pregnancy

Proper nutrition is very important for a healthy pregnancy. Balancing the nutritional needs of pregnancy and maintaining a narrow blood sugar range can be a bit tricky. If you have nausea and/or vomiting during pregnancy, it can be even more complicated.

A registered dietitian who specializes in pregnant women with diabetes can help you create a meal plan. They will guide you on the amount of `macronutrients` (major nutrients) – that is, `carbohydrates` (carbohydrates), `protein` (protein) and `dietary fat` (dietary fat) – you should eat each day. Their recommendations may differ from the general recommendations for pregnant women without diabetes. They will also recommend meals and snacks that are balanced in `macronutrients` to help keep blood sugar levels stable.

Management of Type 1 Diabetes During Pregnancy

Many people with type 1 diabetes find that their insulin needs change frequently – usually from week to week – during pregnancy. Keeping a close eye on your glucose levels and identifying trends can help you and your doctor make the right changes to your treatment plan.

If you are taking multiple daily injections (MDIs), your doctor may recommend switching to an insulin pump to give you more flexibility in adjusting your insulin settings. However, you can still have a healthy pregnancy with an MDI. If you were taking other medications before you became pregnant, be sure to discuss whether you can continue to use those medications during pregnancy.

As always, it is important to manage high blood sugar and low blood sugar levels quickly. If you are experiencing frequent high and/or low blood sugar, talk to your doctor.

Managing Type 2 Diabetes During Pregnancy

Most oral medications and non-insulin injectables for type 2 diabetes are not suitable for use during pregnancy. The only exception is metformin. Therefore, you may need to use insulin for the first time to manage your blood sugar levels during pregnancy. Also, your insulin needs may increase as your pregnancy progresses.

Your medical team will work closely with you to develop a management plan. If you are not already using one, they may recommend using a CGM (continuous glucose monitor).

What can you expect during pregnancy with diabetes?

If you have diabetes, you can expect to have more prenatal visits and tests than you would during a normal pregnancy. This is so that your prenatal care provider can closely monitor your baby's development and your overall health. In addition to the usual prenatal tests (such as blood tests and an anatomy scan), you can also expect these "extra" tests:

• Fetal echocardiogram: Your doctor may recommend this test to check the structure of your baby's heart, as having diabetes increases the risk of developing congenital heart conditions.
• Growth scans (ultrasounds): Your doctor may recommend scans every few weeks to check your baby's growth. This is especially important because there is a high risk of your baby being larger than normal. But remember, these ultrasounds are only estimates. Your baby may be larger or smaller than the scan shows.
• Nonstress tests (NSTs): During the third trimester of pregnancy, your doctor may recommend weekly NSTs. These tests check the baby's heart rate and movements.
• Biophysical profiles (BPPs): Your doctor may also recommend weekly BPPs. These are ultrasounds that check the fetus' breathing patterns, muscle tone, and movement. They also measure the amount of amniotic fluid.

You will also need to talk regularly with your endocrinologist or diabetes educator. They will suggest ways and changes to help keep your glucose levels as close to your target range as possible.

What are the risks and complications of having Type 1 or Type 2 diabetes during pregnancy?

It's important to take steps to manage diabetes during pregnancy. If your blood sugar levels remain too high, you're at an increased risk of developing certain complications. Frequent or severe low blood sugar levels can also be dangerous.

These people are at higher risk of complications due to having pregestational diabetes:

• Embryo and pregnancy
• Your baby after birth
• You

Prenatal and postpartum complications

Having diabetes during pregnancy can increase the risk of complications for the fetus, such as:

• Birth defects (congenital conditions): Birth defects occur in 6% to 12% of pregnancies with previous gestational diabetes. Congenital heart defects are the most common, but neural tube defects and other abnormalities can also occur.
• Fetal macrosomia: This is when a newborn baby weighs more than 9 pounds and 15 ounces. Having a large baby increases the risk of injury during delivery for both you and your baby.
• Polyhydramnios: This is an increase in the amount of amniotic fluid in the amniotic sac. This can lead to preterm labor and stillbirth.
• Preterm birth: If complications arise, you are at increased risk of having a premature birth because your doctor may decide that delivery is the safest option, even if you have not reached full term.
• Stillbirth: Having had gestational diabetes before can increase the risk of stillbirth.

After birth, your baby is also at higher risk of developing certain health conditions. Although most people with diabetes give birth to healthy babies, there is a slightly higher risk of these things:

• Low blood sugar levels after birth
• Breathing difficulties
• Jaundice

If your baby has any of these complications, they may need to be treated in the NICU ( neonatal intensive care unit).

Babies born to people with diabetes may also be more likely to become obese later in life.

Complications that may affect you

Having diabetes during pregnancy can increase your risk of:

• Preeclampsia: Preeclampsia is a condition characterized by high blood pressure and protein in the urine. Diabetes is a major risk factor for preeclampsia. To reduce the risk of preeclampsia, your doctor may recommend taking low-dose aspirin after 12 weeks of pregnancy.
• Need for a cesarean section (`C-section`): The main reason for this is the risk of the baby being too large at birth.
• Low blood sugar: Because you are trying to keep your blood sugar levels in a narrow range, you are at increased risk of frequent and/or severe low blood sugar levels.
• Diabetes-related ketoacidosis (DKA): You are at higher risk of developing DKA during pregnancy because of increased insulin resistance. Vomiting due to morning sickness can also contribute to DKA.
• Diabetes-related complications: Pregnancy can worsen or cause new complications of diabetes (such as retinopathy, nephropathy, and neuropathy).

How does diabetes affect labor and delivery?

In most cases, doctors recommend a planned induction (`scheduled induction`) for pregnant women with diabetes. The time they recommend an induction depends on several factors, but it usually happens at or before 39 weeks of pregnancy. Everyone and every pregnancy is different. You and your doctor will decide together what is best for you.

Due to hormonal and physical changes during labor, your blood sugar levels may go up or down – it's hard to say for sure. Depending on your doctor and hospital policies, you may be able to self-manage with an insulin pump or injections during labor and delivery, or you may need an IV insulin drip.

After the placenta is removed, your insulin needs will decrease significantly – usually to the same level as before pregnancy or even lower. Talk to your doctor about making a plan to re-adjust your diabetes management plan after delivery.

How do I cope with the changes that come with diabetes and pregnancy?

Diabetes and pregnancy can bring new challenges. Your pregnancy may be different than you expected, and you may have questions about your diabetes management plan. While everyone's journey is different, anyone with diabetes can follow these tips to make their experience as healthy as possible when they become pregnant:

• Check your blood sugar levels regularly (as directed by your doctor).
• Keep your blood sugar levels within the target range.
• Follow your doctor's instructions about insulin, medications, and other treatments.
• Attend your prenatal clinic appointments and checkups.
• Stay physically active. Talk to your doctor about your activity level and whether you need to change it.
• Eat healthy, balanced meals and snacks.
• Avoid beverages containing alcohol and tobacco products.
• Take care of your mental health. It's normal to feel stressed during this time. Don't be afraid to talk about it and ask for help.

When should I see my doctor?

If you have diabetes and notice any of these things, talk to your prenatal care provider:

• If you can't keep your blood sugar level in the target range despite your best efforts. (If it's too low or too high.)
• If your blood sugar levels suddenly increase or change for reasons you don't understand.
• If you feel like the fetus is moving less.
• If you have any fluid or blood coming out of your vagina.
• If you have blurred vision or excessive thirst.
• It's okay if you're vomiting, it's okay if you can't keep food and drink down.

Remember, it's always better to be safe than sorry and ask questions. In addition to worrying about pregnancy, worrying about managing diabetes can be stressful. Don't second-guess your feelings or ignore them – talk to your doctor for guidance.

What questions should I ask my doctor?

If you have diabetes and you become pregnant, you may want to ask your doctor about these things:

• How often should I check my blood sugar levels?
• What should my target range be?
• What complications can occur if my blood sugar levels are not kept in the target range?
• Will I need to change my insulin doses?
• Should I stop or start other medications?
• Do you recommend lifestyle changes?
• How often will I have to come for follow-up?
• Will I have to have an early induction?

Can people with Type 1 diabetes have healthy babies?

Yes, many people with Type 1 diabetes (and Type 2 diabetes) have healthy babies. Managing your blood sugar levels and maintaining close communication with your medical team are the keys to a healthy pregnancy.

Managing diabetes during pregnancy can be especially difficult, even for those who have lived with diabetes for decades. Keeping your blood sugar levels in a healthy range while you're pregnant can be mentally and physically demanding. But with the right support system and a diabetes management plan, you can overcome the challenges that diabetes brings to pregnancy.

Keep close communication with your medical team. Tell them when you're feeling down. Through it all, focus on the light at the end of the tunnel – meeting your baby.

A final take-home message

Okay, so from what we've talked about, you should be clear about getting pregnant with diabetes. There's no reason to be afraid, but you should be careful.

• Plan ahead: If you are thinking about having a baby, seek medical advice several months in advance.
• Blood sugar control: Try your best to keep your blood sugar levels within the goals your doctor has set for you throughout your pregnancy. Things like `CGM` can help with this.
• Work together with the medical team: talk to them regularly, ask questions, and share your feelings.
• A healthy lifestyle: good diet, exercise if necessary (as directed by a doctor), and mental well-being are very important.

Remember, even if you have diabetes, with proper management and medical supervision, you too can bring a healthy, happy baby into this world. May you find the strength and courage you need to do so!

` Diabetes, pregnancy, blood sugar, insulin, childbirth, complications, healthy baby