Managing pregestational diabetes and pregnancy

pregestational diabetes and pregnancy

Pregnancy is an adjustment for anyone — you may need to alter your diet, change your exercise and modify the medications you take. 

But if you’re also managing pre-existing, or pregestational, Type 1 or Type 2 diabetes, your pregnancy playbook gets a little more complicated. How you typically manage your diabetes will likely change. And mismanagement can pose problems for both you and your unborn baby.

The good news is that when you work with your health care provider and know what to expect, you can enjoy a happy and healthy pregnancy. 

Here’s what you need to know:

Risks associated with pregestational diabetes and pregnancy

Managing blood glucose (sugar) levels while pregnant can help avoid serious risks to an unborn child. High blood sugar during the first 10 weeks of pregnancy can interfere with fetal development — the baby’s major organs develop then. High blood sugar increases the risk of congenital defects, including to the heart and brain.

But managing your diabetes isn’t only important during those first few months. Uncontrolled and high blood glucose (sugar) levels any time during pregnancy can increase the chances the baby will:

  • Be born early, which can cause problems with breathing, brain, bowels and vision.
  • Have hypoglycemia, or low blood sugar levels, and electrolyte problems immediately following birth
  • Require a cesarian section (c-section) for delivery
  • Weigh too much, causing issues during delivery and putting the baby at risk of nerve damage due to increased pressure.

Even if you manage your disease perfectly, getting pregnant while living with diabetes comes with added risks. Pregnancy increases some long-term health risks associated with diabetes, such as eye issues and kidney disease. Pregnant people with pregestational diabetes also have a higher risk of:

  • Preeclampsia, or high blood pressure during pregnancy, which can cause early birth and severe health issues for the parent during labor and delivery
  • Miscarriage, pregnancy loss before 20 weeks 
  • Stillbirth, pregnancy loss after 20 weeks 

Tips for managing pregestational diabetes in pregnancy

Knowing what to expect is helpful if you live with diabetes and are planning to become pregnant. Only your physician can provide you with a personalized plan for managing your diabetes during pregnancy. But if you have Type 1 or Type 2 diabetes, taking these steps may give you peace of mind and a plan for pregnancy:

Plan for pregnancy if possible

Planning is vital if you have diabetes and are hoping to become pregnant. Well-managed diabetes before pregnancy supports your baby’s fetal development. Before you get pregnant:

  • Get regular check-ups, and let your primary care physician (PCP) know you plan to get pregnant
  • Have a dilated eye exam performed by an ophthalmologist or optometrist (and have another during the first trimester)
  • Manage blood glucose levels so they are close to or in your target range
  • Quit smoking
  • Stop or change unsafe prescription medications, such as cholesterol and hypertension drugs, under your doctor’s direction
  • Take any prenatal vitamins prescribed by your physician
  • See an obstetrician or maternal-fetal medicine physician prior to attempting to conceive

Be prepared for medication changes

If you currently take non-insulin medication for diabetes, your provider may switch you to insulin to control your blood sugar. Insulin doesn’t cross the placenta to enter the womb — it’s the safest and most effective option for your developing baby. 

Expect to tweak your insulin dose throughout the pregnancy. You may need as much as double your insulin dose during the third trimester.

Expect target blood glucose levels to change

Keeping your blood glucose (sugar) levels in the target range is vital — but that range may differ during pregnancy. According to the National Institute of Diabetes and Digestive and Kidney Diseases, the recommended targets for most pregnant persons with diabetes are:

  • Before meals, at bedtime and overnight: 95 milligrams per deciliter (mg/dL) or less
  • One hour after the first bite of a meal: 130 to 140 mg/dL or less
  • Two hours after the first bite of a meal: 120 mg/dL or less

Hitting your daily blood sugar targets may require you to make dietary changes. Your obstetrician may recommend a nutritionist. Staying physically active can also help you reach your target levels. Talk to your doctors about safe exercise during pregnancy.

Track blood sugar levels closely

The best way to manage diabetes during pregnancy is to monitor your blood glucose often and keep track of the levels. Pregnancy can cause blood glucose levels to shift quickly, so plan to test it:

  • When you wake in the morning
  • Before you eat (if you bolus insulin for meals)
  • One hour after the first bite of a meal
  • Two hours after the first bite of a meal

Bring your tracker to all health appointments or share your continuous glucose monitor data with your health care team. Your physician can recommend changes or actions to take if your blood glucose levels are unstable.

Treat low blood sugar quickly

Keeping blood glucose levels stable is vital to fetal development. It also helps to ensure your baby will have stable blood sugar following birth. Always have a source of quick sugar on hand, such as gummy or hard candy, orange juice or glucose tablets.

Expect an early delivery

Your estimated due date is the 40-week mark, but pregnancy is considered to be term at 37 weeks. But if the baby is distressed, you have additional complications or your blood glucose levels are uncontrolled, your health care provider may recommend delivery earlier to reduce additional risks to you and the baby.  Experts recommend delivery by 40 weeks for someone with diabetes. During labor, they will monitor your blood glucose levels and give you insulin when necessary. 

Type 1 diabetes in pregnancy

Patients with Type 1 diabetes may have questions about continuous glucose monitoring, continuous subcutaneous insulin infusion (CSII, or insulin pump), or closed-loop systems. These questions can be addressed with your endocrinology or maternal-fetal medicine providers.

Pregestational vs. gestational diabetes

In up to 10% of pregnancies in the United States, diabetes develops during pregnancy — called gestational diabetes. It increases the risk of preeclampsia during pregnancy. It also puts the baby at risk of early birth, high birth rate and low blood sugar — similar to pregestational diabetes. 

Blood sugar levels return to normal after childbirth for most pregnant people. But gestational diabetes does increase the risk of developing Type 2 diabetes later in life for both mother and child. 

Take the Next Step

If you have Type 1 or Type 2 diabetes and are planning to become pregnant, reach out to your primary care physician.