Whether a woman is already living with diabetes and decides to have a child or she develops gestational diabetes during pregnancy, women with diabetes can, and do, have healthy babies. However, because mother and baby are both at risk for complications, these pregnancies are deemed “high risk”. Both mother and baby will need to be closely monitored throughout the pregnancy by a specialist called a perinatologist. Thanks to a special collaboration with UCSF and Marin General Hospital, Braden Diabetes Center patients can now be followed by a perinatologist without leaving Marin.
Weight gain and hormonal changes are a normal part of pregnancy. These changes cause a woman’s body to make less insulin, a hormone that helps the body use glucose for energy and maintain healthy levels of blood glucose. What’s more, the body uses insulin less effectively during pregnancy, a condition known as insulin resistance. By late pregnancy, all women experience a degree of insulin resistance. 9.2% of these women will develop gestational diabetes.1
Pregnant women are routinely tested for gestational diabetes some time between weeks 24 and 28 of pregnancy. If a woman is diagnosed with gestational diabetes, she must take immediate action to manage her blood sugar. Her OB/GYN or nurse midwife will likely collaborate with an endocrinologist, a diabetes educator, and a dietitian to help her with meal planning. It’s essential to have a blood glucose test 6 to 12 weeks post-partum to see if blood glucose is still elevated. Most women’s blood glucose levels return to normal. However, in 5 to 10 percent of women, blood glucose levels do not return to normal, and they are then diagnosed with diabetes.
If gestational diabetes is not well managed, mother and baby will both have high blood glucose. This can lead to a variety of complications:
Whether a woman has type 1 or type 2 diabetes, she will need to plan her pregnancy and work closely with her doctor to closely manage her blood glucose before conceiving. Gestational diabetes does not occur until the third trimester, when the fetus is fully formed. When a woman with un-managed diabetes gets pregnant, she can expose her baby to high blood glucose and ketones, a toxic byproduct of excess blood glucose, early in her first trimester. This increases the risk of birth defects and miscarriage, because the first 7 weeks are when the baby’s organs are forming. That’s why it’s essential to bring diabetes under good management at least three to six months before conception, and maintain excellent blood glucose management throughout pregnancy.
Women with diabetes who become pregnant face some of the same risks as women with gestational diabetes: High blood pressure, preeclampsia, and possible cesarian delivery if the baby is too large. In addition, women who have diabetes and choose to get pregnant are at risk for these complications:
Women who were diagnosed with diabetes before getting pregnant should already have a testing regimen. The American Diabetes Association recommends testing 3 or more times a day for both people with type 1 diabetes and people with type 2 diabetes who are insulin-dependent. If you have Type 2 diabetes and are insulin-dependent, or if you have type 1 diabetes, ask your doctor whether you need to change your testing regimen.
These tests are used in combination to determine whether a woman has gestational diabetes.