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How you should prepare for pregnancy when you have diabetes

Erika F. Werner M.D., M.S. Women & Infants Hospital of Rhode Island, The Warren Alpert Medical School of Brown University
How you should prepare for pregnancy when you have diabetes

Diabetes mellitus (DM) is a disease in which there is not enough insulin either due to decreased production (type I DM) or cellular resistance (type II DM). This means that glucose levels in the blood are elevated.

DM can cause significant problems for women who are considering pregnancy. It may be more difficult to get pregnant and stay pregnant if you have poorly controlled DM. Even once you achieve pregnancy, you are more likely to have a baby with an anomaly, have a baby early or develop other pregnancy problems if your DM is not well managed.


Do

Do find out if you have DM

Frequent urination and constant thirst are often signs of DM. Dizziness, tremors and weight loss can also be symptoms of DM. If you see a primary care doctor regularly, they have probably screened you for DM. If you do not, considering going and asking if you may be at risk for DM.

Do optimize your glucose control prior to getting pregnant

Many of the fetal organ systems are completely formed before a woman sees her OB doctor for the first time. DM increases the risk that fetal organ systems will not form properly. If you maximize your glucose control prior to getting pregnant, it is much more likely your fetus will form and grow normally. HgbA1c can be measured in your blood to see how high your glucoses have been over the past 3 months. It is a great predictor of your risk in pregnancy. Work with your doctor to get your HgbA1c as low as you can before trying to get pregnant. An endocrinologist or primary care doctor is the ideal type of doctor to help manage your blood sugar.

Do check your blood sugars regularly

To achieve good glucose control before and during pregnancy, you often need to prick your finger and check your sugar at least 4 times per day. This can be very difficult, but it is vital. Your doctor will use this information to adjust your medication.

Do tell your doctor if you are considering getting pregnant

Doctors manage DM more aggressively in women who are or who are considering getting pregnant. Your doctor may use different medications, such as insulin if he/she knows your are interested in conceiving.

Do eat a healthy diet and continue to exercise

In pregnancy, your blood sugars will be even worse than when you are not pregnant. Unfortunately, pregnancy is not a time to stop your diabetic diet.


Don't

Do not forget that clinicians can help

Do not avoid going to the doctor because you are concerned you may have DM. Not knowing you have the disease is risky for your fetus and pregnancy, and your overall health. Women with DM are often thirsty all the time, urinate frequently, lose weight and may feel tired and dizzy. If you are concerned that you have DM, your primary care doctor can screen for the disease. If you don’t have a primary care doctor, your insurance company can tell you who is available in your area

Do not forget to tell any doctor you are seeing for pregnancy if you think you have DM

Early in pregnancy, doctors cannot tell who has DM and who does not. If you have been told before that DM may be an issue, tell your doctor. Women with DM are managed differently in pregnancy (more ultrasounds, more baseline screening tests).

Do not get frustrated if you need more medicine in pregnancy to control your DM

All women develop some insulin resistance in pregnancy. For women with DM this can make your sugars go even more out of control. Don’t be discouraged if this means you need more medication.

Do not gain more than the recommended amount of weight

Most women can gain up to 30 pounds in pregnancy. If you are overweight or obese, you should gain less than this. Talk to your doctor and do your best with diet and exercise to stay within the recommended parameters. Nutritionists can help if you have not previously met with a provider to review dietary strategies.

Do not ignore other symptoms in pregnancy

Women with DM are at higher risk for several pregnancy complications. If you experience something unusual, let your doctor know. For example, women with DM are more likely to have urinary tract infections in pregnancy. If you have burning with urination, this could be a sign. Women with DM are also more likely to develop high blood pressure in pregnancy. If you develop headaches, vision changes, or abdominal pain, talk to your clinician immediately.


Summary
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Monitoring diabetes is even more important leading up to and during pregnancy. In order to ensure the health of you and your baby during pregnancy, you should work closely with your doctor beginning before you conceive. Controlling your sugars before you get pregnant and continuing to manage them in pregnancy will help you avoid many of the complications that diabetes can cause in pregnancy.


More expert advice about Pregnancy

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Erika F. WernerM.D., M.S.

Erika Werner, MD, MS, is a maternal-fetal medicine specialist in the Integrated Program for High-Risk Pregnancy and the Division of Maternal-Fetal Medicine at Women & Infants Hospital of Rhode Island. A graduate of the University of Virginia wit...

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