Expert / 20 December, 2019 / Maria Muccioli

Can I Have a Normal Pregnancy with Pre-Existing Diabetes?

If you have pre-existing diabetes, you may be wondering, “Can I have a healthy pregnancy?” While the simple answer to this question is a resounding “yes!” there are some special considerations for women with diabetes who wish to become pregnant.

What is the difference between type 1 and type 2 diabetes?

All types of diabetes are characterised by high blood glucose levels. Type 1 diabetes is an autoimmune condition that destroys the insulin-producing cells in the pancreas. Insulin is the hormone that helps glucose (sugar) get into cells to be used for energy, which is vital for physiological function. So, women with type 1 diabetes must administer insulin by injection or insulin pump infusion to control their condition. Type 2 diabetes is a multifactorial disorder that results in problems with utilizing insulin effectively and has a close connection to overweight and obesity. Sometimes, type 2 diabetes can be controlled via lifestyle changes, like diet and exercise habits. In other cases, people with this condition may need to take medications, like pills, and/or insulin injections to manage their disease.

Regardless of the type of diabetes you have, it is imperative to talk to your healthcare team ahead of time if you are planning to become pregnant. This is because uncontrolled high blood glucose levels can cause health complications for both the mother and child during pregnancy. However, ensuring that your diabetes is well-controlled ahead of time can help minimise these risks and will go a long way in helping you achieve a healthy pregnancy outcome.

Pre-conception counseling

Women with diabetes face greater risks during pregnancy than the general population. Some common issues that can arise include a higher risk of birth defects, miscarriage, pre-term labor, pre-eclampsia, macrosomia (large baby) and stillbirth, as well as complications for the baby after delivery, such as low blood glucose levels and jaundice.

The good news is that being is excellent control of your blood sugar levels well ahead of conception and throughout the pregnancy can greatly minimize these risks. This is why all women with diabetes are encouraged to seek appropriate pre-conception counseling to ensure that their diabetes is well-managed and that any other health issues are known and appropriately addressed prior to the pregnancy. Regardless of your specific circumstances, it is imperative to have healthcare providers who are experienced and comfortable with managing pregnancy in women with pre-existing diabetes.

You can learn more about optimal pre-conception counseling for women with pre-existing diabetes here.

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What should I expect during pregnancy with diabetes?

Pregnancies in women with pre-existing diabetes are automatically considered “high-risk” and typically receive additional fetal monitoring. Your doctor may recommend extra ultrasounds, such to check on the baby’s heart development in the second trimester, as well as prescribe extra monitoring to access growth and fetal wellbeing in the third trimester.

The specific protocols and recommendations may vary depending on the obstetrical practice, as well as whether you are choosing to see a regular obstetrician (OB) or a maternal-fetal medicine specialist (high-risk doctor). You may also be seeing an endocrinologist or a diabetes educator throughout your pregnancy.

Your healthcare provider(s) will work closely with you to help you adjust your medication doses throughout the pregnancy. They will also be on the lookout for any complications that are more common in women with diabetes, including high blood pressure, pre-eclampsia, a large-for-gestational-age baby, or deteriorating placental function.

To learn even more about what you can expect in each trimester of your pregnancy with diabetes, you can check out this comprehensive resource.

Labour and delivery with diabetes

It is commonly recommended that women with pre-existing diabetes deliver their babies at between 39 and 40 weeks of gestation, especially if using insulin, unless complications warrant an even earlier delivery. This means that many women with diabetes will have their labor induced on or shortly before their due date if they don’t go into labor on their own.

Preventing the pregnancy from progressing past the due date is a commonly accepted clinical practice that strives to avoid many of the end-of-pregnancy complications, for which women with diabetes are at higher risk. Keep in mind that 39 weeks is considered full-term. You may be additionally reassured to know that a recent research study showed that inducing labor at 39 weeks was not associated with any risks and may actually reduce the probability of having a C-section delivery.

Ask you healthcare team ahead of time about their specific labor induction protocols as far as timing and methods, as well as what circumstances would warrant a recommendation for a C-section. It is also important to discuss your diabetes management plan for during and after labor and delivery ahead of time.

Check out this guide to labor and delivery with pre-existing diabetes for even more detailed information on what to expect during your hospital stay. 

Postpartum Considerations

Just because you have delivered your baby, it doesn’t mean your health and diabetes management are any less important than they were during your pregnancy. Maintaining healthy blood glucose levels can help you have a faster recovery from childbirth. As high blood glucose levels can increase your risk for infection, especially if you’ve had a C-section, take care to schedule your follow up appointments with your OB as well as your diabetes specialist.

Also, note that if you are planning to breastfeed your child, you may need to have your blood-glucose-lowering medication(s) adjusted appropriately to prevent episodes of low blood glucose (hypoglycemia).

Finally, just because you have diabetes doesn’t mean that other health parameters, and especially your mental health, are somehow less important. Make sure you follow the appropriate recommendations for postpartum follow-up to be screened for complications, like depression, and receive the appropriate assessments and treatments to stay at your healthiest.

In summary, it is certainly possible to have a healthy pregnancy outcome with pre-existing diabetes. However, women are encouraged to plan ahead and be in very close contact with their healthcare teams before, during, and after pregnancy, to minimize the risks and identify and treat any complications promptly. Making the time to make your healthcare a priority for yourself and your new addition is worth it before, during, AND after pregnancy!

Article by Dr. Maria Muccioli, Diabetes Daily

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