Managing Diabetes Magazine - diabetes
Planning for Pregnancy When You Have Diabetes
Preconception planning makes a difference
Women who have type 1 or type 2 diabetes have a higher risk of problems in pregnancy than women who do not. These problems can be very serious for both mother and baby. Care of diabetes in pregnancy is much better now than it used to be, but there is still some risk. It has been known for years that a woman with type 1 diabetes can lower her risk by going to a diabetes clinic before she gets pregnant for preconception counselling. Studies now show that counselling before pregnancy is just as important for women with type 2 diabetes.
What are the goals of preconception counselling?
With preconception counselling and care, the goals are to:
- have the best possible blood glucose (sugar) control with as little hypoglycemia (low blood glucose) as possible
- keep any diabetes complications as stable as possible.
Until these goals are met, it is safer not to get pregnant. The diabetes care team will provide care and support before, during, and after pregnancy.
What are the benefits of preconception counselling?
There are several good reasons to visit the diabetes clinic before getting pregnant.
- If blood glucose levels are high when pregnancy starts and while the baby is forming, there is a higher risk of early pregnancy loss and birth defects. Defects are most often seen in the heart, brain, spinal cord, and skeleton and can lead to the death of the infant. Good blood glucose control can reduce the risk of these defects. Taking folic acid before and during pregnancy can reduce the risk of brain and spinal cord defects.
- Diabetes can be very hard to manage. Pregnant women will have to make big changes in their diabetes management. Even women who are good at taking care of their diabetes can have more trouble when they are pregnant. If a woman gets the help she needs before becoming pregnant, the changes that occur in pregnancy are much easier to handle. Problems are less likely if blood glucose control during pregnancy is good.
- Many women with diabetes who are thinking about having a baby may already have some kidney, eye, and nerve damage. It is important for them to know exactly how much damage is present before becoming pregnant. The diabetes team can then give the best information about her health, pregnancy risks and necessary treatment. If complications are kept as stable as possible, there is less risk to mother and baby and less chance of a hospital stay before the birth. It is important for women taking medications to treat the complications of diabetes (for example high blood pressure) to discuss their use with the doctor. Some medications are not safe to take during pregnancy.
- Almost all women with type 2 diabetes need insulin during pregnancy (if not before) in order to control their blood glucose. Many may already be taking diabetes medications like metformin or glyburide (oral hypoglycemic agents). In most cases these medications should be stopped before conception. It is not known how safe their use is during pregnancy. In contrast, insulin is not only safe, but it is easier to have good blood glucose control in pregnancy by using insulin.
Who is on the diabetes care team?
For the best possible care, a woman needs a team experienced with diabetes in pregnancy. The most important member of the diabetes team is the woman herself. Your team may include:
- diabetes nurse educator
- diabetes doctor (endocrinologist)
- family doctor
- doctor for pregnancy, labour and delivery (obstetrician)
- baby doctor (pediatrician)
- social worker
The team will work with you to set goals and make plans to meet them. This is a good time to learn more about both managing diabetes and diabetes in pregnancy.
What does the diabetes care team actually do?
Usually the nurse, diabetes doctor, dietitian, and physiotherapist will all see you during a first visit to the clinic. The team will need to know your diabetes history. This includes the type of diabetes, date of diagnosis, and the presence of any eye, kidney, nerve, or heart disease. Details about your diabetes care, such as type of blood glucose meter, amount of testing, diet, activity, and insulin or diabetes medications routine are also necessary. Other things to discuss that may affect your diabetes care include employment and family support.
The diabetes doctor will likely order some lab tests. These might include: an A1c (a measurement of blood glucose control over the past two to three months); a urine test to check the microalbumin / creatinine ratio (a measurement of kidney damage); and a blood test to measure serum creatinine (a measurement of kidney function). An eye exam by an ophthalmologist (eye doctor) is also necessary. You may need other tests or referrals to specialists.
All of this information is used to evaluate your health, knowledge of diabetes care, and ability to care for your diabetes. The team can then give you the information you need to decide the best timing for a pregnancy. Some things to discuss are:
- responsibilities of all team members
- risks to you from diabetes and from pregnancy
- risks to the baby
- how pregnancy affects diabetes
- the importance of balancing diet, activity, and insulin
- how the team can help you care for your diabetes before, during, and after pregnancy
- the importance of reliable birth control until good blood glucose control is achieved.
You will be encouraged to bring along anyone you would like to have with you. It is important to be comfortable about asking questions and discussing all of your concerns. The team will help you use new information to care for yourself and make any needed lifestyle changes. They will decide with you how often you need to be in touch with the clinic about your blood glucose levels. You will also need to make regular visits to the clinic. If you live out of town, the team will make arrangements for phone contact and visits. This allows everyone to review progress, and helps you change your plan of care if needed. The team will continue to provide ongoing care and education.
Some women also look for other sources of information on diabetes in pregnancy, such as the Internet. While these other sources may give good information, there is also a chance of getting incorrect information. If you are concerned about the accuracy of what you have read (or been told by well-meaning friends), check with your diabetes team.
When is it okay to get pregnant?
Ideally, before getting pregnant, a woman will have:
- two to three months of good daily blood glucose levels with as few ‘lows’ as possible
- A1c values in the normal range
- all diabetes complications stabilized
- ability to care for her diabetes with help from the team
- a commitment to maintain all of the above for the entire pregnancy.
For many reasons, this is more difficult for some women than for others. Each woman can set her own goals with the help of her diabetes team.
What if I am already pregnant?
Women who become pregnant and have not yet seen the diabetes team need to do so as soon as possible. Your family doctor will arrange an appointment with the diabetes clinic on an urgent basis. Since some pregnancies are not planned, it is even more important to have good blood glucose control all of the time. If you are of childbearing age and are sexually active, discuss these issues with your doctor or diabetes nurse educator.
Finally . . .
It is rare that a woman with diabetes is advised against having a baby. With a lot of hard work to keep yourself and your baby healthy, a happy outcome to your pregnancy is very likely. The team at your local diabetes and pregnancy clinic can work with you to make this possible.
While effort is made to reflect accepted medical knowledge and practice, articles in Family Health Online should not be relied upon for the treatment or management of any specified medical problem or concern and Family Health accepts no liability for reliance on the articles. For proper diagnosis and care, you should always consult your family physican promptly. Copyright 2012, Family Health Magazine, a special publication of the Edmonton Journal, a division of Postmedia Network Inc., 10006 - 101 Street, Edmonton, AB T5J 0S1 [DI_MDc04]