If you have diabetes, with some advance planning you can generally have a successful pregnancy and a healthy baby. The most important step you can take is to keep your blood glucose tightly controlled and your A1c on target for several months before the baby is even conceived.
Low blood glucose generally does not cause health problems for your baby. However, even an occasional episode of high blood glucose can affect your baby. The first trimester is a critical time for your developing baby's health.
- During the first three months of pregnancy, there is a higher risk of miscarriage. If the mother has high blood glucose, the fetus may develop breathing problems at birth or deformities of the spine, skeleton, kidneys, heart and circulatory system.
- In months four through nine, the major risks are an overly large baby (called Macrosomia) or a stillbirth. About one third of babies born to mothers with diabetes have Macrosomia. Aside from their large size, these babies are otherwise generally healthy.
During pregnancy, you may face three diabetes-related health risks:
- Vision and kidney complications. Vision problems due to retinopathy can sometimes worsen during pregnancy. In addition, some women experience high blood pressure by the third trimester of pregnancy. High blood pressure can lead to kidney damage. Keeping your blood glucose under tight control before and during pregnancy can help prevent these complications.
- Childbirth problems. If your baby is larger than normal, your doctor may ask you to give birth a little earlier or to have a cesarean delivery. This is because a very large baby can be bigger than the actual birth canal, so a standard childbirth approach might cause injury to you and your baby.
- Hypoglycemia. If you are trying to keep your blood glucose in tight control, you may sometimes have hypoglycemia. Although low blood glucose does not harm your developing baby, repeated hypoglycemia episodes might create health problems for you.
- Plan for the pregnancy. Keep your blood glucose close to normal before and during the pregnancy to protect your health and the baby's well being. Your blood glucose and A1c should be within target for a number of months before you try to conceive.The American Diabetes Association recommends that women achieve the following stable blood glucose levels:
During pregnancy, your doctor may want to check your A1c level more often. Your A1c goal may also be set to less than 6%. Women with type 1 diabetes may need to test and inject three or more times a day in order to achieve this goal. The good news: today's thin lancets, syringes and insulin pen needles make it easier to test and inject with less pain.
- Plasma glucose 80-110 mg/dL before meals
- Plasma glucose less than 155 mg/dL 2 hours after meals
- During the preconception period and the first trimester, obtain the lowest A1c test level possible without undue risk of hypoglycemia in the mother.
You will need to visit the doctor and have ultrasound tests more often than nondiabetic women do. These check-ups will help to ensure a healthy pregnancy.