What you do before conceiving can make all the difference.

Think about the last thing you had to do that was really important.  Perhaps it was making a key presentation at a business meeting.  Or taking a major exam.  Or running in a big race.  Or maybe just keeping your dignity during the first dance at your wedding.  In all likelihood, what helped you get through it successfully was the preparation you put in.  Training, studying, practicing, and basically “doing your homework” are all forms of preparation.  And preparation is what gives most people the confidence and skills necessary to perform even under the most difficult circumstances.

Now, it’s time for the performance of a lifetime.  Bringing a new life into the world.

Sure, women with diabetes can conceive and go on to deliver healthy, beautiful babies.  But before you start preparing the baby’s room and making lists of possible names, there is some preparation of your own that you need to tend to.

R  (Modest) Tightening of BG Control

During the first four to eight weeks of pregnancy, the baby’s major organs develop and the body begins to take shape.  It is during this phase that serious birth defects can occur – particularly involving the brain/nervous system and heart/circulatory system.  Paradoxically, most women don’t even realise that they are pregnant until this early developmental phase is almost if not completely over.

Elevated blood glucose levels during the early developmental phase greatly increase the risk for fetal defects and malformation.  For this reason, it is essential that blood glucose be under reasonably tight control at the time of conception.  Ideally, A1c should be as low as possible (without experiencing too many hypoglycemic events), but certainly below 7%, prior to conceiving.  This will give your baby the best chance possible for healthy development.

In fact, the chances for conceiving in the first place may hinge on your blood glucose control.  High glucose levels can cause problems with the endometrial lining of the uterus.  If this lining is unstable, the fertilised egg may not “nest” properly, and the baby will never have a chance to develop.

R  Weight Control

Women who are extremely overweight (BMI greater than 30*) should receive counselling on weight loss before conceiving.  Carrying excessive body fat increases the risk for hypertension, insulin resistance, pre-eclampsia and a more complicated delivery.  The need for a caesarean procedure is also much more common in women who are overweight. 

Weight loss diets are generally not recommended during pregnancy due to the risk of malnutrition for the unborn child, so the time to lose weight is before conceiving.  Losing 5-10% of body weight through a sensible nutrition and exercise program can produce significant health benefits for you and your future baby, and may also increase your chances for becoming pregnant. 

* To calculate your body mass index, go to http://www.freebmicalculator.net/

R  Medication Review

If you have type-2 diabetes that is treated with oral medications, or type-1 and use medications in addition to insulin, you may need to discontinue the medications prior to conceiving.  Most oral diabetes medications will be passed along to the developing baby and may pose a risk.  Certain other medications, including ACE inhibitors (for blood pressure and/or kidney protection) and statins (for cholesterol control), are also considered unsafe during pregnancy and should be discontinued prior to conceiving.  In other words, before you even think about becoming pregnant, speak to your physician about all of the medications you take and whether any should be halted.

Also, talk to your doctor about starting prenatal vitamins along with a folic acid supplement.  Many prenatal vitamins lack sufficient folic acid for preventing birth defects (generally 400-800 mg daily).  It is usually a good idea to start both folic acid and prenatal vitamins three months prior to conceiving.

R  Medical Care/Screenings

Make sure you’re up to date on your immunisations.  Contracting a serious illness during any phase of pregnancy may cause you to lose your baby.  Thyroid levels should also be checked before conception.  Hypothyroidism is very common in people with diabetes, and the baby’s nervous system can be affected if your thyroid level is too low.  If you already have thyroid disease, your dose of thyroid medication may need to be increased during pregnancy.

Carrying a baby places particular strain on the small blood vessels of the eyes and kidneys. 

Be sure to have a comprehensive eye exam (including a dilated retinal screening) prior to conceiving.  Any pre-existing blood vessel problems in the retina should be treated prior to conception, since eye disease can worsen quickly during pregnancy.  Likewise, have your kidney function checked by measuring the amount of protein (microalbumin) in your urine.  Significant kidney problems may make you a poor candidate for pregnancy.

Ask any painter, what’s the most important part of the job… the answer will always be “the preparation”.  The same can be said about having a healthy baby.  Just take a few basic steps to prepare for pregnancy:  Get the blood sugars in good control, work to achieve a healthy weight, cut out potentially harmful medications, and receive the necessary medical screenings.  It can make all the difference in the world!

Note:  Gary Scheiner MS, CDE is owner and clinical director of Integrated Diabetes Services, a private practice specializing in blood glucose regulation and advanced self-management training for people who utilize intensive insulin therapy.  One of the specialties of his practice is pregnancy and type-1 diabetes.  He and his staff of CDEs offer their services remotely via phone and the internet for clients throughout the world.  A devoted husband and father of four, Gary has had type-1 diabetes for 28 years and makes extensive use of both pump and CGM technology.  For more information, contact him at gary@integrateddiabetes.com, or call him in the US: 877-735-3648, or outside the US: +1-610-642-6055.