Preparation for pregnancy when you have diabetes
Women who have type 1 or type 2 diabetes need to prepare for pregnancy to assure their health and that of their baby. If you are planning to conceive, you should meet with your health professional before doing so because pregnancy will require some fine-tuning of your diabetes care.
It is critical that diabetes be well-managed before conception because of the high risk for birth defects in the babies of women whose blood sugars are high at the time of conception. Also, poorly controlled diabetes during pregnancy can cause diabetes complications to rapidly become worse.
You will need to keep your blood sugar levels within a safe range. To achieve this, you may require additional insulin, stricter adherence to your meal plan, more frequent blood sugar testing, and additional education on topics such as the:
- Effect of insulin, food, activity, and stress on your blood sugar.
- Self-adjustment of insulin dosages.
- Appropriate treatment for low blood sugar (hypoglycemia).
For women with type 2 diabetes, insulin injections will need to replace oral diabetes medications, because the effects of these on the developing fetus are not known. For women who are able to manage their type 2 diabetes by diet and exercise alone, home blood sugar monitoring needs to be performed frequently throughout the pregnancy. If blood sugar levels are not maintained at optimal levels to promote the healthy development of your baby, insulin injections may become necessary.
Meal planning
A meal plan may be developed and implemented during the preconception period that will be adequate to meet your and your baby's needs through the end of the first trimester. Changes in the meal plan may not need to be made until the second trimester begins.
The meal plan in preparation for conception will provide appropriate caloric intake to meet your weight goal (to achieve or maintain a reasonable body weight). If you are overweight, a weight loss of 5% to 10% of body weight can significantly improve blood sugar levels, and therefore improve your chances of becoming pregnant and giving birth to a healthy baby. The diet will also provide sufficient quantities of all essential nutrients and micronutrients, such as folic acid and other vitamins and iron, that you and your baby will need.
Folic acid supplements (of 400 micrograms per day) need to be taken before becoming pregnant and throughout pregnancy to prevent neural tube defects in the baby.
When you are trying to become pregnant, eliminate alcohol or limit your intake to no more than one drink per day. However, once you are pregnant, don't drink. No amount of alcohol has been shown to be safe for a fetus.
Blood sugar monitoring and lab tests
Consistency in checking and recording blood sugar levels is important. This information will help you and your doctor to determine reasons and solutions for blood sugar levels outside of a safe range and treat episodes of low blood sugar (hypoglycemic).
Maintaining normal blood sugar levels, as shown by your home blood sugar tests and by the results of glycosylated hemoglobin testing, will increase your likelihood of becoming pregnant and will promote your baby's healthy development.
Laboratory tests evaluating the status of conditions, such as high blood pressure, eye problems, kidney problems, gastroparesis, and other neuropathies that can be affected by diabetes and pregnancy, will likely be performed to determine whether those conditions need to treated before conception.
Medications
Talk with your health professional about whether the medications you are taking, including non-prescription medications, are safe during pregnancy.
Consistency of physical activity
All components of your diabetes management, including physical activity, should be consistent. Variations in exercise patterns can cause fluctuations in blood sugar levels because exercise lowers blood sugar.
Managing stress
Physical and mental stress can raise blood sugar levels. You may need to work with a social worker or psychologist before conception to help you address the stressful aspects of your life.
| Author: | Alison Allen Caroline Rea, RN, BS, MS | Last Updated: November 14, 2007 |
| Medical Review: | Anne C. Poinier, MD - Internal Medicine Caroline S. Rhoads, MD - Internal Medicine Matthew I. Kim, MD - Endocrinology & Metabolism David C.W. Lau, MD, PhD, FRCPC - Endocrinology & Metabolism | |
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