Pregnancy and diabetes: From conception to birth

Pregnancy and diabetes presents unique challenges. Here's what you need to know to deliver a healthy baby.

Whether you have type 1 diabetes or type 2 diabetes, pregnancy presents unique challenges. Naturally, you're concerned about the effect diabetes may have on your health and your baby's health. But there's much you can do to promote a healthy pregnancy. Here's what you need to know about pregnancy and diabetes — and delivering a healthy baby.

Pregnancy and diabetes: Your health care team

Your diabetes health care team likely includes an endocrinologist or other diabetes specialist, a diabetes educator and a registered dietitian. As your pregnancy progresses, your health care team can help you manage your blood sugar level and adjust your diabetes treatment plan as needed.

During pregnancy, you may need to consult other specialists as well:

An obstetrician. Choose an obstetrician who handles high-risk pregnancies and has cared for other pregnant women who have diabetes. Your obstetrician will carefully monitor your health and your baby's health throughout the pregnancy.
An eye specialist. An eye specialist can monitor diabetes-related damage to the small blood vessels in your eyes, which can progress during pregnancy.
A pediatrician. You may want to establish a relationship with the doctor who will care for your baby after he or she is born.

The goal: Tight blood sugar control

Controlling your blood sugar level is the best way to prevent diabetes complications. In fact, when it comes to pregnancy and diabetes, blood sugar control is more important than ever.

Consider what good blood sugar control during pregnancy can do:

Reduce the risk of miscarriage and stillbirth. Good blood sugar control reduces the risk of miscarriage and stillbirth, the primary concerns for pregnancy and diabetes.
Reduce the risk of birth defects. Good blood sugar control during early pregnancy greatly decreases your baby's risk of birth defects, particularly those affecting the brain, spine and heart.
Reduce the risk of excess growth. If you have poor blood sugar control, extra glucose can cross the placenta. This triggers your baby's pancreas to make extra insulin, which can cause your baby to grow too large (macrosomia). A large baby makes vaginal delivery difficult and puts the baby at risk of injury during birth. Fortunately, keeping your blood sugar under control can make excess growth less likely.
Prevent complications for mom. Good blood sugar control decreases the risk of high blood pressure and other potentially serious pregnancy complications. Good blood sugar control also keeps existing diabetes complications — especially eye disease (retinopathy) — from getting worse.
Prevent complications for baby. Sometimes babies of mothers who have diabetes develop low blood sugar (hypoglycemia) shortly after birth because their own insulin production is high. Good blood sugar control can help assure that your baby is born with a healthy blood sugar level. Good blood sugar control also helps prevent a yellowish discoloration of the skin and eyes (jaundice) after birth.

The action plan

Your diabetes specialist will help you establish your target blood sugar range. Then it's up to you to make healthy lifestyle choices and follow your diabetes treatment plan.

Check your blood sugar level often. Frequent blood sugar monitoring — perhaps up to eight times a day — can help you prevent low blood sugar and high blood sugar (hyperglycemia). Remember, controlling your blood sugar level is the best way to promote a healthy pregnancy and prevent diabetes complications.
Take insulin or other medications as directed. Although oral diabetes medications are sometimes used during pregnancy, your doctor may recommend switching to insulin instead. And some medications — including certain drugs to treat high blood pressure or kidney problems — shouldn't be taken during pregnancy.
Be flexible. You'll need to adjust your insulin dosage depending on your blood sugar level, what you eat, whether you're vomiting and various other factors. Your stage of pregnancy matters, too. During the last three months of pregnancy, hormones made by the placenta to help the baby grow can block the effect of insulin in your body. As a result, you may need significantly more insulin than usual.
Remember healthy-eating principles. Your diabetes diet probably includes plenty of fruits, vegetables and whole grains. Although you can eat the same foods during pregnancy, your doctor or registered dietitian may suggest changes to your meal plan to help you avoid problems with low blood sugar or high blood sugar. It's also important to take prenatal vitamins containing folic acid.
Include physical activity in your daily routine. Physical activity is another important part of your diabetes treatment plan, even during pregnancy. Get your doctor's OK to exercise. Then choose activities you enjoy, such as walking, swimming or biking. Aim for at least 30 minutes of aerobic exercise most days of the week. Stretching and strength training exercises are important, too. If you haven't been active for a while, start slowly and build up gradually.
See your obstetrician for regular prenatal checkups. Your obstetrician may recommend regular ultrasounds or other prenatal screening tests to monitor your baby's growth and development.

Remember, your health care team is there to help you manage your blood sugar level and prevent complications. If you have questions or concerns, don't hesitate to ask for help.

Labor and delivery: What to expect

Your health care team will help you determine the best time and safest way to deliver your baby. Sometimes labor is allowed to begin naturally. In other cases, labor is induced early to reduce the risk of complications for mother or baby. During labor, your health care team will closely monitor your blood sugar level and adjust your insulin dosage accordingly. If your baby is too large, the induction isn't successful or you develop complications, you may need to deliver your baby by C-section.

After delivery, your attention will turn to your baby — but it's still important to take good care of yourself. Continue to check your blood sugar level often, especially if you're breast-feeding. After all, keeping yourself healthy is the best thing you can do for your baby.