During the mid-20th century, it was common for women with type 1 diabetes to be discouraged from having children. Thankfully, advancements in medicine have transformed this outlook. While some adaptations may be necessary during pregnancy, it is now possible for women with type 1 diabetes to have safe pregnancies and deliver healthy babies without significant risk.
It is essential to prepare well in advance. Although diabetes care has significantly improved over time, the fundamental processes of fetal development remain the same. Vital organs are formed quite early in pregnancy, within eight weeks after your last menstrual period. During this short period, crucial organs such as the neural tube (which consists of the brain and spinal cord) and the heart are developed.
Before Conception
Ensuring a healthy pregnancy necessitates consulting your healthcare provider months before attempting to conceive, given the significance of early development. High A1C levels (10% or more) heighten the risk of birth defects in crucial organs, including the heart, kidneys, brain, and spinal cord. However, if your blood glucose falls within the target range and your A1C is 6.5% or less before conception, your likelihood of having a baby with a birth defect is comparable to that of a non-diabetic woman.
If high A1C levels worry you, obtain guidance from your doctor, diabetes educator, or a registered dietitian on modifying your diet, exercise, and medication plan. Take prenatal vitamins with folic acid to further decrease the likelihood of birth defects, regardless of your A1C level.
If you possess type 2 diabetes risk factors but do not have the condition, it’s advisable to undergo screening now. The American Diabetes Association (ADA) recommends checking for undiagnosed diabetes at the initial prenatal consultation. Uncertain about your vulnerability? Take the type 2 diabetes risk test.
Before attempting to conceive, ensure your weight is in a healthy bracket, since obesity can heighten the likelihood of complications. If you’re overweight, concentrate on shedding pounds prior to conception. Additionally, your ob-gyn or endocrinologist should assess your thyroid function, as thyroid issues are prevalent among women with diabetes, and maintaining appropriate thyroid hormone levels is crucial for the baby’s development.
Arrange a consultation with an ophthalmologist to evaluate and manage possible retinopathy prior to pregnancy, since it could deteriorate during this period. If you exhibit retinopathy symptoms, plan trimester-specific eye checkups. Additionally, diabetic kidney disease (nephropathy) may worsen, so confirm that you undergo proper screening before conceiving.
In conclusion, take advantage of this period to assemble an appropriate pregnancy care team. If your existing diabetes care team is not proficient in this field, think about seeking specialists with expertise or a perinatologist (a maternal-fetal medicine specialist) with experience in managing diabetes in pregnant women.
The Initial Trimester
Congratulations on your pregnancy! It’s crucial to continue taking your diabetes medication unless a specialist has changed it to another. Although certain diabetes medications may lack official approval for pregnancy use, there’s no significant association with major complications. Halting your medication and experiencing a sudden blood sugar increase would be much worse.
According to the ADA’s Standards of Medical Care in Diabetes, insulin is the preferred medication for blood glucose control during pregnancy for individuals with all types of diabetes. Insulin is the safest choice since it does not cross the placenta and affect the developing baby. Additionally, oral diabetes medications are generally inadequate for managing insulin resistance in pregnant women with type 2 diabetes. As a result, doctors frequently transition women with type 2 diabetes to insulin, even if their preconception blood glucose was well regulated on a different medication.
Regardless of your experience with insulin, it’s vital to continuously adjust your dosage. During the first trimester, individuals with type 1 diabetes may need to decrease their insulin intake. Failing to modify your dosage could result in hypoglycemia, which is detrimental to both you and your developing baby’s brain. Moreover, the target blood glucose level during pregnancy is lower than what you’re used to, as high blood glucose is extremely hazardous to the baby. According to the Standards of Medical Care in Diabetes, the target is a fasting glucose level under 95 mg/dL, a reading below 140 mg/dL an hour after eating, and a reading under 120 mg/dL two hours after eating. If you’re struggling to meet these objectives, collaborate with your physician or diabetes educator to assess your individual blood glucose goals and develop a strategy for managing your high and low levels.
To maintain your blood glucose as near to the target range as feasible, keep track of your blood glucose when you wake up, before meals, and one or two hours after meals. Consult your physician or diabetes educator for precise recommendations.
The efficacy of continuous glucose monitors (CGMs) during pregnancy is still under evaluation, so utilize a blood glucose meter to make treatment adjustments, such as insulin dosing. However, a real-time CGM can monitor your glucose levels round the clock, and if your levels dip while you sleep, an alarm will alert you. This is a significant advantage, particularly for women with type 1 diabetes, who are more susceptible to hypoglycemia.
A registered dietitian or diabetes educator can aid in modifying your diet. For the most part, the same healthy eating regimen recommended before pregnancy still applies, but a professional can assist you in making adjustments or creating a new plan if you were previously deviating from it.
It is important to recognize that the notion of “eating for two” is not entirely accurate. In fact, additional calorie intake is not required during the first trimester of pregnancy. While monitoring blood glucose levels and nutrition is a significant concern for women with diabetes, taking preventative measures against preeclampsia is also crucial. Preeclampsia is a pregnancy complication characterized by high blood pressure and damage to organs in the later stages of pregnancy. Women with diabetes are at a higher risk of developing preeclampsia. However, the American College of Obstetricians and Gynecologists suggests that taking a low-dose aspirin daily after the 12-week mark can lower the risk.
Pregnancy’s Second Stage
As you enter the second trimester of pregnancy, you may begin to experience relief from morning sickness and fatigue, which could allow you to increase your food intake slightly. While this may be beneficial, it’s crucial to avoid overeating. Typically, women require an extra 300 calories per day during the second and third trimesters.
With an improvement in your overall wellbeing during the second trimester, you’ll likely find it easier to engage in physical activity. Exercise can provide benefits such as reducing stress, regulating blood glucose levels, and preparing your body for labor. It’s recommended to remain active during this time, whether it involves taking a short walk after meals or engaging in more vigorous workouts, provided you were previously accustomed to that level of activity. Aiming for at least 150 minutes of moderate activity per week, such as brisk walking, is a good target to set.
It’s important to note that some precautions apply to all pregnant women. This isn’t the ideal time to begin training for a marathon or participate in contact sports. Activities that increase the risk of falling, such as outdoor cycling, should also be avoided. Additionally, it’s best to steer clear of exercises that may lead to a significant rise in body temperature, like hot yoga or running on very hot days, as well as heavy lifting. If you’re unsure whether a particular exercise or activity is safe, it’s always best to consult with your doctor.
Although weight gain is typical during pregnancy, it’s recommended that women with a normal BMI aim to gain no more than 25 to 30 pounds. If you’re already overweight or obese, it’s advised to gain less weight than this. BMI is a ratio of weight to height and is used to estimate how close a person is to a healthy weight.
Being obese during pregnancy increases the likelihood of experiencing pregnancy complications such as preeclampsia, stillbirth, and giving birth to a large baby. Research studies have indicated that children born to mothers who were obese during pregnancy are at a higher risk of developing health conditions such as heart disease, asthma, and type 2 diabetes.
It’s essential to remember that your insulin requirements will increase as your baby grows during pregnancy. This is because the body becomes more insulin resistant due to hormones required for the baby’s development.
During this trimester, several significant screening tests are conducted, including a fetal echocardiogram at 18 weeks to ensure that the baby’s heart is healthy. You’ll also have regular ultrasounds, including the anatomy scan between 18 and 22 weeks, which provides a comprehensive evaluation of all the baby’s body parts.
The Concluding Trimester of Pregnancy
Towards the end of the third trimester, you may require up to twice your regular insulin dose. It’s crucial to maintain a close working relationship with your doctor to ensure that your medication is adjusted accordingly.
Starting at 28 weeks, it is likely that your physician will suggest a growth scan every four weeks to monitor your baby’s size. If you have diabetes, there is an increased chance that your baby may be larger than average, a condition referred to as fetal macrosomia. This can complicate vaginal delivery, as the baby’s shoulders might become stuck in the mother’s pelvis, potentially requiring a C-section. Additionally, infants with high birth
weights are more prone to childhood obesity and have a higher risk of developing heart disease, stroke, and type 2 diabetes later in life. Besides tracking your baby’s size, growth scans also examine the amniotic fluid that encases the developing fetus within the uterus. When a mother’s glucose levels are not adequately controlled, the amniotic fluid volume can increase, as the fetus attempts to eliminate the excess glucose. Excessive amniotic fluid may lead to premature labor, so if your fluid levels are elevated, further testing might be necessary.
Between 30 and 32 weeks, you may begin undergoing nonstress tests, possibly as often as twice a week. In these tests, you’ll wear a monitor and keep track of your baby’s movements. Additionally, you could undergo a biophysical profile, which combines a nonstress test with an ultrasound examination.
Diabetic women frequently undergo labor induction earlier, around 37 to 38 weeks, while full term is now officially considered to start at 39 weeks. Early induction of labor can lower risks for both mother and baby, including the possibility of stillbirth—particularly if the baby exhibits signs of distress, the mother is unable to achieve her blood glucose goals, or if she is experiencing preeclampsia.
Navigating Life After Childbirth
Immediately after delivery, your newborn will be evaluated by a pediatrician, preferably in a hospital equipped with a reliable neonatal intensive care unit, to check for signs of low blood
glucose. Since your baby was receiving glucose from you during pregnancy and producing extra insulin to balance the glucose levels, it may take some time for your baby to adjust to the new environment outside the womb.”
After delivery, your insulin requirements will decrease significantly, which increases the risk of hypoglycemia. In just a few hours, your blood glucose levels may return to the levels they were before pregnancy.
It is recommended to schedule a checkup with your Endocrinologist within two weeks after delivery. If you have type 2 diabetes and were not taking insulin before, your healthcare provider may suggest switching back to oral medication. However, some women prefer to continue using insulin for a longer period as it does not pass into breast milk.
Most healthcare providers strongly recommend breastfeeding, regardless of the treatment you choose. Breastfeeding can help reduce your blood glucose levels and lower the chances of your child developing type 2 diabetes if they are exclusively breastfed. Furthermore, studies suggest that mothers who have had gestational diabetes may have a decreased risk of developing type 2 diabetes in the future if they breastfeed.
However, the downside to nursing is that it demands a significant amount of energy. To avoid potentially harmful drops in your blood glucose levels, it is crucial to check your levels before breastfeeding and consume a snack unless your levels are already high.
It’s important to be aware that postpartum depression is a relatively common occurrence in women with diabetes. Balancing diabetes management, newborn care, lack of sleep, and significant hormonal changes can lead to a potentially severe mood disorder. If your initial feelings of sadness and anxiety persist beyond two weeks or intensify, and you experience thoughts of harming yourself or your baby, it’s crucial to inform your doctor or a mental health professional immediately. Seeking treatment can help you recover and improve your overall well-being.
Although it may appear daunting, diabetes does not have to impede your desire to start a family. For women with diabetes, the process of having a baby necessitates significantly more effort than it does for those without the condition. However, if you put in the effort required, you can anticipate achieving an equally favorable outcome.
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