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Article by Dr. Sheri Colberg, Phd, FACSM

 

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TYPE 2 DIABETES AND PREGNANCY


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Women with type 2 diabetes used to be discouraged from becoming pregnant out of concern for both mother and child.

But knowledge and treatment of diabetes has advanced considerably and a healthy pregnancy for individuals with diabetes is a perfectly normal occurrence now, though precautions still have to be taken.

The key factor is to be especially careful to keep blood glucose (sugar) levels in the healthy target range both before a woman with diabetes becomes pregnant and during her pregnancy, especially 3 months prior to conception and in the first 12 weeks of pregnancy.

Pregnant woman standing on a beach next to the water.Pregnant women with diabetes, who are risk of having larger than normal babies, are encouraged to check their blood sugars often, namely 4-8 times a day. (1)

To keep blood glucose in the target range, persons with diabetes need a treatment plan that balances a nutritious diet with insulin and exercise. The plan will change as you change with pregnancy and your blood glucose levels vary.

You will need to check your blood glucose often and keep a record of your results. With your blood glucose in the target range and good medical care, your chances of a trouble-free pregnancy and a healthy baby are almost as good as they are for a woman without diabetes.

However, babies born to women with diabetes, especially those with poor diabetes control, are still at greater risk for birth defects. High blood glucose levels and ketones (substances that in large amounts are poisonous to the body) pass through the placenta to the baby, increasing the chance of problems.

For this reason, good blood glucose control before you become pregnant is very important.

Most women do not know they are pregnant until the baby has been growing for two to four weeks. During the first six weeks of pregnancy, the baby's organs are forming. Blood glucose levels during these early weeks affect the baby's growing organs and high blood levels can lead to birth defects.

During pregnancy, small vessel disease can be experienced, so having your eyes and kidney function checked before pregnancy is important.

Proper nutrition is also important in preventing birth defects. In a study, the use of a multivitamin 3 months prior and 3 months after conception reduced the risk of birth defects in newborns of mothers with diabetes. (1)

Pregnant woman standing with a man in a kitchen slicing oranges.These early weeks are very important to the baby's development, so you'll need to plan the timing of your pregnancy. If your blood glucose levels are not under good control, you should work to bring your diabetes under control before becoming pregnant. It is a good idea to be in good control of your blood glucose at least three to six months before you plan to get pregnant. You'll want to maintain excellent blood glucose control both during and after pregnancy.

Because your baby is getting extra sugar from you, your baby's pancreas makes extra insulin. After birth, it's hard for the baby to stop putting out this extra insulin. The baby must be watched, therefore, and treated if the blood glucose level drops too low.

For some reason, jaundice happens more often in babies of women with diabetes. Jaundice is a build-up of liver-breakdown products that the body can't process fast enough. This condition is usually easily treatable.

For the best pre-natal care, work to keep your diabetes under control with a doctor trained to care for women with diabetes and an obstetrician experienced with dealing with higher-risk pregnancies and pregnant women with diabetes. You will also want to consult a pediatrician (children's doctor) or neonatologist (doctor for newborn babies) who knows about and can treat special problems that can happen in babies of women with diabetes. A registered dietitian can change your meal plan as your needs change during and after pregnancy.

Your body changes as the baby grows and, as someone with diabetes, these changes will affect your blood glucose level. Pregnancy can also make symptoms of low blood glucose hard to detect.

Diabetes control requires more work during pregnancy and the blood glucose checks you do at home are a key part of taking good care of yourself and your baby before, during and after pregnancy. Pregnancy will affect your insulin treatment plan, with your body's need for insulin increasing during gestation. This is especially true during the 2nd and 3rd trimesters.

Doctor examining a baby in the office.The need for more insulin is caused by the hormones made by the placenta which help the baby grow. At the same time, these hormones block the action of the mother's insulin, creating the extra need.

Blood checks will help you keep your blood glucose on target. Your doctor may advise that you check your blood glucose levels as many as eight tests a day, including after meals.

Write down your results, keep notes on your meal plan and exercise regime and make changes in your meal plan and insulin only with the advice of your diabetes experts.

Pregnancy and Weight

During pregnancy you and your dietitian or doctor may need to change your meal plan to avoid problems with low and high blood glucose levels. This is the most important reason for keeping track of your blood glucose results.

If you start pregnancy weighing too much, you should not try to lose weight. Instead, work with your dietitian or doctor to curb how much weight you gain during pregnancy. Your dietitian will keep track of your weight gain.

If you start pregnancy at a normal weight, expect to add between 25-35 lbs before giving birth. If you are obese at the start of your pregnancy, work with your dietitian to limit your weight gain to about 15-25 pounds. Conversely, women who start pregnancy too thin need to gain more weight.

Pregnancy and Exercise

Regular exercise is a crucial part of diabetes treatment. Just as you need to get your blood glucose levels under control before getting pregnant, it's best to get fit before you become pregnant. Talk to a doctor about a suitable exercise program for the duration of your pregnancy.

Do not begin a newly-strenuous exercise regime while you are pregnant. Good exercise choices for pregnant women include walking, low-impact aerobics, swimming or water aerobics.

Exercise can help you stay healthy during pregnancy. But if you have any of the following conditions, you will need to talk to your diabetes experts about the risks of exercise during pregnancy.

  • high blood pressure
  • eye, kidney or heart problems
  • damage of the small or large blood vessels
  • nerve damage

Delivery and Blood Glucose Levels

Pregnant woman standing on a beach at sunset.

As your due date nears, your doctors will study your health and that of your growing baby. They will also discuss with you the best time and method for delivery.

Your labor may start on its own. Or you may decide to have labor induced or have a planned cesarean section (C-section). During a cesarean birth, an incision is made through the abdomen and uterus, through which the baby is removed. Because of the surgery, your recovery time may be longer than if you delivered your baby vaginally.

No matter how you deliver your baby, your doctors will be working during labor and delivery to keep your blood glucose level under control. At the start of active labor, your insulin needs will drop. You will most likely not need any insulin during labor and for 24 to 72 hours after delivery.

To help you prepare for labor, many hospitals and other organizations offer classes to help you have a smooth delivery. They teach what to expect during delivery and techniques to improve delivery and relieve pain during labor as well as how to care for your baby after birth.

Because of the care needed for both mother and baby during and after delivery, home births are not advised for women with diabetes.

After Delivery

Pregnant woman creating a list of baby names.Some new mothers have better blood glucose control in the first few weeks after delivery. But for many, it's a period of blood glucose swings.

Breastfeeding is good for women with diabetes, though it may make your blood glucose levels a little harder to predict. During the first weeks at home with your baby, you are likely to be tired and stressed from lack of sleep.

Changeable sleep patterns during this period increase the danger of napping through a snack or mealtime, with resulting low blood glucose levels being a real danger as a result. Remain vigilant and check your blood glucose levels often during this time. Your records will help you and your doctor adjust your insulin dose if required.

Your new baby will, of course, be your prime concern. But keep in mind that you need to take good care of yourself to take good care of your child. Stick to the good habits that helped you keep your blood glucose levels on target during pregnancy.

Breastfeeding

To help prevent low blood glucose levels due to breastfeeding:

  • plan to have a snack before or during nursing
  • drink enough fluids – sip a glass of water or a caffeine-free drink while nursing
  • keep something to treat low blood glucose nearby when you nurse, so you don't have to stop feeding to go and get something to treat low blood glucose levels. Try some trail mix (with more raw nuts than dried fruit), which is easy to carry around and is won't spike glucose levels as high as a glass of orange juice or crackers. Other ideas: hard boiled eggs, cheese stick, cold cuts, sugar-free Jell-O gelatin (without maltodexrin), hummus and veggies, celery and nut butter, protein shakes (carry a small baggie of powder and a shaker cup in your bag). If your blood sugar is greater than 10 mg/dl below your target then using glucose tablets is suggested.

Man resting his head against a pregnant tummy.On average women who breastfeed should increase their calorie-intake to about 500 calories above what they ate before becoming pregnant. What you drink and eat can affect your milk supply, as well as your blood glucose level. You will need to work with your doctor and dietitian to adjust your meal plan according while you are nursing.

The Insulite Diabetes Advanced Management System is a scientific breakthrough that could improve your health by increasing the insulin sensitivity of the walls of your cells. Greater sensitivity can result in a huge improvement in the efficient processing of glucose and insulin, thereby reducing the amount of insulin you require to manage your diabetes.

By lowering your insulin intake and dependency through more effective management, you are likely to experience a greater sense of long-term well being. You can also reduce your risk of developing such serious insulin-linked complications as the need for amputation, failing eyesight and kidney disease.

However, we advise you to stop taking the Insulite Diabetes Advanced Management System once you have become pregnant.

(1) "Do Multivitamin Supplements Attenuate the Risk for Diabetes-Associated Birth Defects?", Pediatrics. A. Correa et al. 2003, 111(5), May: 1146-1151

Read about Diabetes and Body Mass Index (BMI).

 

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