Diabetes
is a disease in which your blood glucose, or
sugar, levels are too high.
When you are pregnant, too much glucose is not good for your baby. Out
of every 100 pregnant women in the United States, between three and
eight get
gestational diabetes. Gestational diabetes is diabetes that happens for
the first time when
a woman is pregnant. Gestational diabetes goes away when you have your
baby, but it does
increase your risk for having diabetes later.
If you already have diabetes before you get pregnant, you need to monitor and
control your blood sugar levels.
Either type of diabetes during pregnancy raises the risk of problems for the baby and
the mother. To help reduce these risks, you should follow your meal plan, exercise, test your blood sugar and take your medicine.
On this page:
- Introduction
- Taking Care of Your Baby and Yourself
- Your Diabetes, Before and During Your Pregnancy
- Checking Your Baby's Health During Pregnancy
- About Labor and Delivery
- After Your Baby Arrives
- For More Information
- My Daily Blood Glucose Record
- My Daily Food Record
- My Daily Physical Activity Record
Introduction
You have type 1 or type 2 diabetes and you are pregnant or hoping
to get pregnant soon. You can learn what to do to have a healthy baby.
You can also learn how to take care of yourself and your diabetes
before, during, and after your pregnancy.
Pregnancy and new motherhood are times of great excitement, worry,
and change for any woman. If you have diabetes and are pregnant, your
pregnancy is automatically considered a high-risk pregnancy. Women
carrying twins-or more-or who are beyond a certain age are also
considered to have high-risk pregnancies. High risk doesn't mean you'll
have problems. Instead, high risk means you need to pay special
attention to your health and you may need to see specialized doctors.
Millions of high-risk pregnancies produce perfectly healthy babies
without the mom's health being affected. Special care and attention are
the keys.
Taking Care of Your Baby and Yourself
Keeping your blood glucose as close to normal as possible before
you get pregnant and during your pregnancy is the most important thing
you can do to stay healthy and have a healthy baby. Your health care
team can help you learn how to use meal planning, physical activity, and
medications to reach your blood glucose goals. Together, you'll create a
plan for taking care of yourself and your diabetes.
Pregnancy causes a number of changes in your body, so you might
need to make changes in the ways you manage your diabetes. Even if
you've had diabetes for years, you may need changes in your meal plan,
physical activity routine, and medications. In addition, your needs
might change as you get closer to your delivery date.
"I took good care of my diabetes before and throughout my pregnancy. And now I have a healthy little girl!"
How Diabetes Can Affect You and Your Baby
High blood glucose levels before and during pregnancy can
- worsen your long-term diabetes complications, such as vision problems, heart disease, and kidney disease
- increase the chance of problems for your baby, such as being born too early, weighing too much or too little, and having low blood glucose or other health problems at birth
- increase the risk of your baby having birth defects
- increase the risk of losing your baby through miscarriage or stillbirth
However, research has shown that when women with diabetes keep
blood glucose levels under control before and during pregnancy, the risk
of birth defects is about the same as in babies born
to women who don't have diabetes.
If your blood glucose level is too high, then your baby also gets too much glucose.
Glucose in a pregnant woman's blood passes through to the baby. If
your blood glucose level is too high during pregnancy, so is your baby's
glucose level before birth.
Your Diabetes, Before and During Your Pregnancy
As you know, in diabetes, blood glucose levels are above normal.
Whether you have type 1 or type 2 diabetes, you can manage your blood
glucose levels and lower the risk of health problems.
A baby's brain, heart, kidneys, and lungs form during the first 8
weeks of pregnancy. High blood glucose levels are especially harmful
during this early part of pregnancy. Yet many women don't realize
they're pregnant until 5 or 6 weeks after conception. Ideally, you will
work with your health care provider to get your blood glucose under
control before you get pregnant.
If you're already pregnant, see your health care provider as soon
as possible to make a plan for taking care of yourself and your baby.
Even if you learn you're pregnant later in your pregnancy, you can still
do a lot for your baby's health and your own.
The checklist below can help you make a plan for a safe and healthy
pregnancy. More information on each topic then follows. Your health
care team can help you with tasks that are difficult for you. Tackle one
thing at a time to keep from being overwhelmed.
My Diabetes Care Plan for Pregnancy
Things I can do to get ready for a healthy pregnancy and continue to do during my pregnancyPlanning Ahead
- I'll get my diabetes under control 3 to 6 months before I try to get pregnant.
- If I'm already pregnant, I'll see my health care provider right away.
- I'll make sure I have the right team of health care providers.
- I'll meet with members of my team.
- I'll set goals with my health care team for my daily blood glucose levels.
- I'll set a goal with my health care team for my A1C test result.
- I'll learn how and when to check my blood glucose on my own.
- I'll learn what to do if my blood glucose is too low.
- I'll make sure my family or friends know how to give me glucagon for low blood glucose.
- I'll learn what to do if my blood glucose is too high.
- I'll learn how and when to check my urine or blood for ketones.
- I'll learn what to do if I have ketones in my urine or blood.
I'll get the recommended checkups and laboratory tests for
- blood pressure
- eye disease
- heart and blood vessel disease
- nervous system disease
- kidney function
- thyroid disease
- average blood glucose level-the A1C test
- If I smoke, I'll quit.
- I'll see a dietitian or diabetes educator about what, when, and how much to eat.
- I'll ask whether I need vitamin and mineral supplements and will take them as directed.
- I'll skip alcoholic beverages.
- I'll talk with my health care team about what physical activities are safe for me.
- I'll make a plan with my health care team for regular physical activity.
- I'll talk with my health care team about my diabetes medications-what kinds, how much, how to take them, and when to take them.
- I'll talk with my health care team about my other medications-what to keep taking and what to stop taking.
- I'll make a plan for taking care of myself when I'm ill-what to do about food, insulin, blood glucose testing, and ketone testing.
- I'll make a plan for what I need to have with me when I'm away from home-for several hours or for a longer trip.
Planning Ahead
Before you get pregnant, talk with your health
care team about your wish to have a baby. Your team can work with you to
make sure your blood glucose levels are on target. If you have
questions or worries, bring them up. If you're already pregnant, see
your doctor right away.
My Health Care Team
Regular visits with health care providers who are experts in
diabetes and pregnancy will ensure you get the very best care. Your team
may include
- a medical doctor who specializes in diabetes care, such as an endocrinologist or a diabetologist. You will continue to need monitoring and advice on glucose control throughout your pregnancy and after.
- an obstetrician-gynecologist, or "OB/GYN," who has managed
pregnancies of women with diabetes. Ask for a referral if your current
gynecologist does not also deliver babies, as not all gynecologists do.
When calling around to find an OB/GYN, ask about experience with women
with diabetes. Maternal-fetal medicine specialists, also called
perinatologists, have special training to take care of women with
high-risk pregnancies. You will see your OB/GYN regularly throughout
your pregnancy.
"I'm working with my health care team to take good care of myself and my diabetes. We're doing all we can to make sure I have a healthy baby and a safe pregnancy. It's not always easy, but I'm so motivated!" - a nurse educator or nurse practitioner, who provides prenatal care and advice on managing diabetes.
- a registered dietitian to help with meal planning. A good diet-for glucose control and nutrition-has never been more important than now. The phrase "You're eating for two" is not about quantity as much as food choices.
- specialists who diagnose and treat diabetes-related complications, such as ophthalmologists and optometrists for vision problems, nephrologists for kidney disease, and cardiologists for heart disease. If you are already experiencing complications from diabetes, you'll need those conditions monitored throughout your pregnancy as well.
- a social worker or psychologist to help you cope with stress, worry, and the extra demands of pregnancy. You may already have this kind of support, or you may suddenly need it. If anxiety mounts, do not hesitate to mention your uneasiness to your OB/GYN. Ask for a referral if you need more help working through issues.
- a pediatrician-a doctor who cares for children. You might want to ask friends, family, or your health care team for recommendations. Many pediatricians visit their newest patients at the hospital soon after their arrival.
- a neonatologist-a doctor who cares for newborn babies. The hospital will assign a neonatologist if urgent care for your baby is needed at the hospital.
You are the most important member of the team.
Your health care providers can give you expert advice. But you'll be
responsible for the day-to-day actions needed to keep your diabetes
under control.
My Blood Glucose Levels
Daily Blood Glucose Levels
You'll check your blood glucose levels using a blood glucose meter
several times a day. Most health care providers recommend testing at
least four times a day. Ask your health care provider when you should
check your blood glucose levels and check off the answers using the
chart below.
"I check my blood glucose
at least four times a day. The results show whether I need to change my
meal plan or insulin to keep my blood glucose on target."
I should check my blood glucose levels
- fasting-when I wake up, before I eat or drink anything
- before each meal
- 1 hour after the start of a meal
- 2 hours after the start of a meal
- before bedtime
- in the middle of the night-for example, at 2 or 3 a.m.
The daily goals recommended by the American Diabetes Association
for most pregnant women are shown below. Write down the goals you and
your health care team have chosen.
| When | Plasma Blood Glucose (mg/dL) |
My Goals |
|---|---|---|
| Before meals and when you wake up | 80 to 110 | |
| 2 hours after the start of a meal | Below 155 |
Source: American Diabetes Association. Preconception care of women with diabetes. Diabetes Care. 2004;27(Supplement 1):S76-78.
See the chart below for goals recommended by the American College of Obstetricians and Gynecologists.
| When | Plasma Blood Glucose (mg/dL) |
My Goals |
|---|---|---|
| Fasting | 105 or less | |
| Before meals | 110 or less | |
| 1 hour after the start of a meal | 155 or less | |
| 2 hours after the start of a meal | 135 or less | |
| During the night | Not less than 65 |
Source: American
College of Obstetricians and Gynecologists (ACOG) Committee on Practice
Bulletins. ACOG Practice Bulletin Number 60: Pregestational diabetes
mellitus. Obstetrics and Gynecology. 2005;105(3):675-685.
You can keep track of your blood glucose levels.
Write down the results every time you check your blood glucose. Your
blood glucose records can help you and your health care team decide
whether your diabetes care plan is working. You also can use this form
to make notes about your insulin and ketones.
The A1C Test
Another way to see whether you're meeting your goals is to have an A1C blood test.
Results of the A1C test show your average blood glucose levels
during the past 2 to 3 months. Write the goal you and your health care
team have chosen below.
Goal for My A1C Test
| Source of Recommendation | Target Number | My Goal |
|---|---|---|
| American Diabetes Association | 4 to 6 percent-normal* or Less than 1 percent above the upper limits of normal* |
|
| American College of Obstetricians and Gynecologists | No higher than 6 percent |
*Normal values vary according to laboratory; check with your doctor.
Low Blood Glucose
When you're pregnant, you're at increased risk of having low blood
glucose, also called hypoglycemia. When blood glucose levels are too
low, your body can't get the energy it needs. Usually hypoglycemia is
mild and can easily be treated by eating or drinking something with
carbohydrate. But left untreated, hypoglycemia can make you pass out.
Although hypoglycemia can happen suddenly, it can usually be
treated quickly, bringing your blood glucose level back to normal. Low
blood glucose can be caused by
- meals or snacks that are too small, delayed, or skipped
- doses of insulin that are too high
- increased activity or exercise
Low blood glucose also can be caused by drinking too much alcohol.
However, women who are trying to get pregnant or who are already
pregnant should avoid all alcoholic beverages.
"I keep a box of crackers
on my bedside table. If I have low blood glucose during the night, I eat
some crackers right away to bring my blood glucose back up to normal."
Using Glucagon for Severe Low Blood Glucose
If you have severe low blood glucose and pass out, you'll need help
to bring your blood glucose level back to normal. Your health care team
can teach your family members and friends how to give you an injection
of glucagon, a hormone that raises blood glucose levels right away.
High Blood Glucose
High blood glucose, also called hyperglycemia, can happen when you
don't have enough insulin or when your body isn't able to use insulin
correctly. High blood glucose can result from
- a mismatch between food and medication
- eating more food than usual
- being less active than usual
- illness
- stress
In addition, if your blood glucose level is already high, physical
activity can make it go even higher. Symptoms of high blood glucose
include
- frequent urination
- thirst
- weight loss
Talk with your health care provider about what to do when your
blood glucose is too high-whether it happens once in a while or at the
same time every day for several days in a row. Your provider might
suggest a change in your insulin, meal plan, or physical activity
routine.
My Ketone Levels
When your blood glucose is too high or if you're not eating enough,
your body might make chemicals called ketones. Ketones are produced
when your body doesn't have enough insulin and glucose can't be used for
energy. Then the body uses fat instead of glucose for energy. Burning
fat instead of glucose can be harmful to your health and your baby's
health. Harmful ketones can pass from you to your baby. Your health care
provider can teach you how and when to test your urine or blood for
ketones.
If ketones build up in your body, you can develop a condition
called ketosis. Ketosis can quickly turn into diabetic ketoacidosis,
which can be very dangerous. Symptoms of ketoacidosis are
- stomach pain
- frequent urination or frequent thirst, for a day or more
- fatigue
- nausea and vomiting
- muscle stiffness or aching
- feeling dazed or in shock
- rapid deep breathing
- breath that smells fruity
Checking Your Urine or Blood Ketone Levels
Your health care provider might recommend you test your urine or
blood daily for ketones and also when your blood glucose is high, such
as higher than 200 mg/dL.
You can prevent serious health problems by checking for ketones as
recommended. Ask your health care team about when to check for ketones
and what to do if you have them. Then check off the instructions below
and fill in the blanks.
I should test my urine or blood for ketones
- every day before breakfast
- when I'm sick
- when my blood glucose is _____________ or higher
- other times: _________________________________
If you use an insulin infusion pump, your health care provider
might also recommend that you test for ketones when your blood glucose
level is unexpectedly high.
Your health care provider might teach you how to make changes in
the amount of insulin you take or when you take it. Or your provider may
prefer that you call for advice when you have ketones.
My Checkups
Pregnancy can make some diabetes-related health problems worse.
Your health care provider can talk with you about how pregnancy might
affect any problems you had since before pregnancy. If you plan your
pregnancy enough in advance, you may want to work with your health care
provider to arrange for treatments, such as laser treatment for eye
problems, before you get pregnant. Your diabetes-related health
conditions can also affect your pregnancy.
"I check my urine every morning for ketones. That's one of the things I do to keep my baby and myself safe and healthy."
Have a complete checkup before you get pregnant or at the start of your pregnancy. Your doctor should check for
- high blood pressure, also called hypertension
- eye disease, also called diabetic retinopathy
- heart and blood vessel disease, also called cardiovascular disease
- nerve damage, also called diabetic neuropathy
- kidney disease, also called diabetic nephropathy
- thyroid disease
You'll also get regular checkups throughout your pregnancy to check
your blood pressure and average blood glucose levels and to monitor the
protein in your urine.
Smoking
Smoking can increase your chance of having a stillborn or premature
baby. Smoking is also especially harmful for people with diabetes. If
you smoke, talk with your health care provider about how to quit.
My Meal Plan
If you don't already see a dietitian, now would be an excellent
time to start. Your dietitian can help you learn what to eat, how much
to eat, and when to eat. Together, you'll create a meal plan tailored to
your needs, usual schedule, food preferences, medical conditions,
medications, and physical fitness routine.
Many women need changes in their diet, such as extra calories and
protein, during pregnancy. You might need to see your dietitian every
few months during pregnancy as your needs change. Eating a well-balanced
diet helps ensure that you and your baby are healthy.
How Much to Eat
"My dietitian helped me include my favorite foods in my meal plan."
Talk with your dietitian about how many servings to have at each
meal and snack. Your dietitian can also provide advice about portion
sizes. Your meal plan will be based on how many calories you need for
pregnancy and your goals for weight gain during the pregnancy. For most
women whose weight is in the normal range before pregnancy, gaining 25
to 35 pounds is recommended. If you're underweight or overweight at the
start of your pregnancy, your weight goal may differ. For overweight
women, the recommended weight gain is no more than 15 pounds.
"Eating small meals and snacks throughout the day helps keep my blood glucose under control."
Vitamin and Mineral Supplements
Your health care team will tell you whether you need to take a
vitamin and mineral supplement before and during pregnancy. Many
pregnant women need supplements because their diets don't supply enough
of the following important vitamins and minerals:
- iron-to help make extra blood for pregnancy and for the baby's supply of iron
- folic acid-to prevent birth defects in the brain and spinal cord
- calcium-to build strong bones
Alcoholic Beverages
You should avoid alcoholic beverages while you're trying to get
pregnant and throughout pregnancy. When you drink, the alcohol also goes
to your baby. Alcohol can lead to serious, lifelong problems for your
baby.
You can keep track of what you eat and drink using My Daily Food Record. Your food records can help you and your health care team see whether your diabetes care plan is working.
Make a copy of this form for each week of your
pregnancy. Use this form to keep track of what, when, and how much you
eat and drink.
| Week Starting: ________________________ | Breakfast | Mid-morning Snack | Lunch | Mid-afternoon Snack | Dinner | Bedtime Snack |
|---|---|---|---|---|---|---|
| Monday | � | � | � | � | � | � |
| Tuesday | � | � | � | � | � | � |
| Wednesday | � | � | � | � | � | � |
| Thursday | � | � | � | � | � | � |
| Friday | � | � | � | � | � | � |
| Saturday | � | � | � | � | � | � |
| Sunday | � | � | � | � | � | � |
Artificial Sweeteners
Artificial sweeteners can be used in moderate amounts. If you
choose to use sweeteners, talk with your dietitian about how much to
have.
My Physical Activity Routine
Daily physical activity can help you reach your target blood
glucose levels. It can also help you reach your blood pressure and
cholesterol target levels, relieve stress, improve muscle tone,
strengthen your heart and bones, and keep your joints flexible. Talk
with your health care team about moderate physical activity, such as
walking or swimming. Consider whether you have any health problems and
which exercises would be best for you. Your health care team may advise
you to avoid exercises that increase your risk of falling, such as
downhill skiing.
A sensible goal for most women is to aim for 30 minutes or more of
activity, most days of the week. If you've been active before pregnancy,
you may be able to continue with a more moderate version of your usual
exercise routine. But if you haven't been active, start with an activity
such as walking. Vigorous physical activity, such as walking briskly,
can lead to low blood glucose. Pregnant women sometimes do not have the
typical signs of low blood glucose.
"I wasn't very active
before I got pregnant. But my doctor said that walking every day would
be safe and good for me and my baby."
My Medications
Medications for Diabetes
During pregnancy, the safest diabetes medication is insulin. Your
health care team will work with you to make a personalized plan for your
insulin routine. If you've been taking diabetes pills to control your
blood glucose levels, you'll need to stop taking them. Researchers have
not yet determined whether diabetes pills are safe for use throughout
pregnancy. Instead, your health care team will show you how to take
insulin.
If you're already taking insulin, you might need a change in the
kind, the amount, and how or when you take it. The amount of insulin you
take is likely to increase as you go through pregnancy because your
body becomes less able to respond to the action of insulin, a condition
called insulin resistance. Your insulin needs may double or even triple
as you get closer to your delivery date. Insulin can be taken in several
ways. Your health care team can help you decide which way is best for
you.
Other Medications
Some medications are not safe during pregnancy and should be
discontinued before you get pregnant. Tell your health care provider
about all the medications you currently take, such as those for high
cholesterol and high blood pressure. Your provider can tell you which
medications to stop taking.
Changes in My Daily Routine
Sick Days
When you're ill, your blood glucose levels can rise rapidly.
Diabetic ketoacidosis, a dangerous condition for you and your baby, can
occur. Talk with your health care team about what you should do if you
get sick. Be sure you know
- what to do if you're nauseated or vomiting
- how often you should check your blood glucose
- how often you should check your urine or blood for ketones
- when you should call your health care provider
Being Away from Home
When you're away from home-for several hours or for a longer
trip-you'll want to be prepared for problems. Make sure you always have
the following with you:
"When I'm not feeling well,
I check my blood glucose more often than usual. I know that being sick
can make my blood glucose level go too high."
- a snack or a meal
- food or drinks to treat low blood glucose
- your diabetes medicines and supplies
- your blood glucose meter and supplies
- your glucagon kit
- your health care team's phone numbers for emergencies
Checking Your Baby's Health During Pregnancy
You are likely to have tests all through your pregnancy to check
your baby's health. Your health care team can tell you which of the
following tests you'll have and when you might have them. Your health
care provider might also suggest other tests. If certain diseases or
conditions run in your family, you might meet with a genetic counselor.
The counselor may recommend tests based on your family history and can
explain the risk of certain conditions for your baby.
Maternal Blood Screening Test
The maternal blood screening test is also called the multiple
marker screen test, the triple screen, or quad screen. It measures
several substances in your blood. Results can tell you whether your baby
is at risk for spinal cord and brain problems, Down syndrome, and other
birth defects. If the results show an increased risk for problems,
additional tests such as ultrasound or amniocentesis can provide more
information.
Ultrasound
Ultrasound uses sound waves to provide a picture of areas inside
the body. The picture produced by ultrasound is called a sonogram.
Ultrasound can show the baby's size, position, structures, and sex. It
can also help estimate age, evaluate growth, and show some types of
birth defects.
Fetal Echocardiogram
The fetal echocardiogram uses ultrasound to check for problems in the structures of the baby's heart.
Amniocentesis
Amniocentesis uses a thin needle inserted through the abdomen into
the uterus to obtain a small amount of the fluid that surrounds the
baby. Cells from the fluid are grown in a lab and then analyzed.
Amniocentesis can help tell whether your baby has health problems and if
your baby's lungs have finished developing. Developed lungs are needed
for the baby to breathe without help after delivery.
Chorionic Villus Sampling (CVS)
CVS involves a thin needle inserted into the placenta to obtain
cells. Cells then are analyzed to look for health problems. Ultrasound
is used to guide the needle into the placenta, either through the vagina
and cervix or through the abdomen and uterus. The placenta is composed
of tissue and blood vessels that develop to attach the baby to the
mother's uterus so the developing baby can get nutrition from mom.
Kick Counts (Fetal Movement Counting)
Counting kicks is an easy way to keep track of your baby's
activity. You'll count how many times the baby moves during a certain
period of time.
Nonstress Test
A fetal monitor checks whether your baby's heart rate increases as it should when the baby is active.
Biophysical Profile
Ultrasound checks your baby's muscle tone, breathing, and movement
to obtain a biophysical profile. Ultrasound also estimates the amount of
amniotic fluid surrounding the baby.
Contraction Stress Test
This test measures the baby's heart rate during contractions using a
fetal monitor. The results can help your doctor decide whether the baby
needs to be delivered early.
About Labor and Delivery
Timing of Delivery
Your health care team will consider your health, your baby's
health, and the state of your pregnancy in deciding how and when
delivery should occur. Some doctors prefer to deliver babies of women
with diabetes 1 or 2 weeks before their due dates to lower the risk of
problems. Your doctor may recommend inducing labor before your due date
or delivering the baby surgically using a cesarean section, also called a
c-section. However, most women with diabetes have the option of
delivering vaginally. You'll want to talk with your health care team
about your options well ahead of time.
The factors your health care team will consider in deciding what type of delivery is best for you and your baby may include
"I talked with my doctor way before I was due about my options for delivering my baby."
- your baby's size and position
- your baby's lung maturity
- your baby's movements
- your baby's heart rate
- the amount of amniotic fluid
- your blood glucose and blood pressure levels
- your general health
Blood Glucose Control During Labor and Delivery
Keeping your blood glucose levels under control helps ensure your
baby won't have low blood glucose after birth. Because you'll be
physically active when you're in labor, you may not need much insulin.
Hospital staff will check your blood glucose levels frequently. Some
women take both insulin and glucose, as well as fluids, through an
intravenous (IV) line during labor. Infusing insulin and glucose
directly into your bloodstream through a vein provides good control of
blood glucose levels. If you are using an insulin pump, you might
continue to use it throughout labor.
If you are having a c-section, your blood glucose levels may
increase because of the stress of surgery. Your health care team will
closely monitor your blood glucose levels and will likely use an IV for
insulin and glucose to keep your levels under control.
After Your Baby Arrives
About Breastfeeding
Breastfeeding is highly recommended for the babies of women with
diabetes. Breastfeeding provides the best nutrition and helps your baby
stay healthy.
"Even though I have diabetes, I can still breastfeed my baby. My milk gives my baby exactly what he needs."
Your Meal Plan
If you're breastfeeding, you might need more calories each day than
you needed during your pregnancy. Your dietitian can provide
personalized recommendations and answer any questions you have about
what, when, and how much to eat.
Your Medications
After you've given birth, you might need less insulin than usual
for several days. Breastfeeding can also lower the amount of insulin you
need. Diabetes pills are not recommended during breastfeeding.
Low Blood Glucose
You'll be at increased risk for low blood glucose, especially if
you're breastfeeding. You might need to have a snack before or after you
breastfeed your baby. Your health care team may suggest that you check
your blood glucose more often than usual.
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