It's always important for women with diabetes to properly manage the
condition, but even more so when they're pregnant.
"If high blood glucose levels aren't controlled, they can pose
serious risks for both mother and child," says
Lina Wong, DO, a board-certified OB/GYN at
St. Jude Heritage Medical Group. "Babies have a higher chance of birth defects, premature birth,
miscarriage risk and breathing problems. Expectant mothers may experience
worsening diabetic eye and kidney problems, bladder infections and preeclampsia."
But even though diabetic women generally fall into the high-risk pregnancy
category, it doesn't mean they can't have a healthy pregnancy.
Dr. Wong offers the following guidelines:
1. Prepare for pregnancy far in advance.
"It's recommended that diabetic women ensure their blood sugar
levels are steady and at a healthy number around three to six months before
conceiving," Dr. Wong says. "That's because high blood sugar
can cause birth defects in the earliest stages of pregnancy, as the baby's
body is developing. Also, women should have an eating and exercise plan
in place to maintain a healthy pre-pregnancy body weight."
2. Start planning medical care.
Another thing a woman should do early on is schedule a pre-pregnancy visit
with her doctor. "The doctor can assess blood glucose levels, adjust
medication if it shouldn't be taken during pregnancy and examine any
other health factors specific to the patient," Dr. Wong says. "In
addition to the doctor who is treating the diabetes and the obstetrician,
a woman may also want to include on her medical team a dietitian who can
monitor her diet during pregnancy, specialists who can care for diabetes-related
issues such as an optometrist or cardiologist and medical professionals
with expertise in diabetes and pregnancy."
3. Be vigilant about testing blood glucose levels.
"The physician will generally recommend how many times a woman should
test her levels each day during pregnancy, and at what time of day--fasting,
before a meal or at night, for example. It may be helpful to make a log
to write down the numbers for easier tracking," Dr. Wong says. "The
doctor will also set target numbers for patients; the American Diabetes
Association recommends readings between 60 and 99 before eating or sleeping,
or during the night, and between 100 and 129 about one to two hours after
a meal, but those numbers may be adjusted by the doctor depending on the
patient's particular case."
4. Test for ketones.
If a woman isn't taking care of her blood glucose levels or her diet,
her body can burn fat instead of glucose. "That produces ketones,
which, if not treated, can cause ketoacidosis--that can result in nausea,
trouble breathing, stiff muscles, and, in the worst cases, death,"
Dr. Wong says. "If this is an issue, a doctor will show the patient
how to test her urine for ketones, possibly on a daily basis."
5. Eat well and exercise.
If a woman's been on top of her diet and workouts before pregnancy,
she'll be ahead of the game once she's expecting. "A healthy
diet is centered on fruits, vegetables, lean proteins, whole grains and
low-fat dairy. Working with a dietitian will help a woman plan her meals
and snacks and make sure she's getting enough calories and nutrients
to nourish her baby while maintaining a healthy weight gain," Dr.
Wong says. "A food diary can help in this--if a woman experiences
spikes or drops in her blood sugar, she can go over the diary with the
dietitian to pinpoint the issue and make necessary changes." When
it comes to physical activity, 30 minutes of moderate exercise, such as
walking, can help keep blood sugar in check. "A woman can consult
with her doctor on appropriate workouts and the best times of day to do
them, and whether blood sugar needs to be monitored pre- or post-workout."
6. Look ahead to labor and delivery.
"A woman should start talking with her doctor about the birth well
ahead of time," Dr. Wong says. "That can include the possibility
of c-section, how blood glucose will be monitored and affected during
labor, and how to adapt the patient's diet if she chooses to breastfeed
7. Don't miss a medical appointment.
"Keeping up with all her doctor visits will help a woman ensure her
pregnancy is going smoothly and her body is in optimum health; it's
also a good time to address any concerns and make changes to the pregnancy
care plan," Dr. Wong says. "The obstetrician will also want
to run tests on the baby's health, such as ultrasounds and blood tests."
Expectant mothers of every kind, including those with diabetes, can find
support and resources through classes offered at the following St. Joseph
Wellness Center at Queen of the Valley Medical Center
St. Joseph Heritage Medical Group
St. Joseph Health Medical Group
St. Joseph Hospital, Orange
St. Jude Medical Center