Posted: October 19th, 2023

Diabetes Management During Pregnancy

Diabetes Management During Pregnancy

Pregnancy is a special time for women, but it can also bring some challenges for those who have diabetes. Diabetes is a condition that affects how the body uses glucose, a type of sugar that is the main source of energy for the cells. Women with diabetes need to manage their blood glucose levels carefully during pregnancy to avoid complications for themselves and their babies.

There are two types of diabetes that can affect pregnant women: pre-existing diabetes and gestational diabetes. Pre-existing diabetes is when a woman has diabetes before becoming pregnant, either type 1 or type 2. Gestational diabetes is when a woman develops high blood glucose levels for the first time during pregnancy, usually in the second or third trimester.

Both types of diabetes can increase the risk of adverse outcomes for the mother and the baby, such as pre-eclampsia, preterm birth, macrosomia (large baby), birth defects, hypoglycemia (low blood sugar), and neonatal jaundice. Therefore, it is important for women with diabetes to have regular prenatal care and follow a personalized plan to manage their condition.

The main goals of diabetes management during pregnancy are to keep the blood glucose levels within a target range, to monitor the fetal growth and well-being, and to prevent or treat any complications that may arise. The following are some of the key strategies to achieve these goals:

– Diet and exercise: A healthy diet and moderate physical activity can help control blood glucose levels and prevent excessive weight gain during pregnancy. A registered dietitian can help design a meal plan that meets the nutritional needs of the mother and the baby, while taking into account the blood glucose levels, medications, and personal preferences. The meal plan should include a variety of foods from different food groups, with an emphasis on complex carbohydrates, lean protein, healthy fats, and fiber. The amount and timing of carbohydrates should be consistent throughout the day to avoid spikes and dips in blood glucose levels. Physical activity can also lower blood glucose levels by increasing the insulin sensitivity of the cells. Pregnant women with diabetes should aim for at least 30 minutes of moderate-intensity exercise on most days of the week, unless there are medical reasons to avoid it. Some examples of suitable exercises are walking, swimming, cycling, and low-impact aerobics. It is important to check the blood glucose levels before and after exercise, and to adjust the food intake or medication dose accordingly.
– Medication: Some women with diabetes may need medication to keep their blood glucose levels within the target range during pregnancy. The type and dose of medication may vary depending on the type of diabetes, the blood glucose levels, and the stage of pregnancy. Women with type 1 diabetes usually need insulin injections throughout pregnancy, as oral medications are not effective for this condition. Women with type 2 diabetes may be able to continue using oral medications in the first trimester, but may need to switch to insulin injections in the later stages of pregnancy, as oral medications may not be safe or effective for the fetus. Women with gestational diabetes may be able to control their blood glucose levels with diet and exercise alone, but some may also need insulin injections if diet and exercise are not enough. Insulin is the preferred medication for gestational diabetes, as it does not cross the placenta and affect the fetus. The dose and frequency of insulin injections may change over time, as the insulin resistance increases in pregnancy. Therefore, it is essential to monitor the blood glucose levels regularly and adjust the medication accordingly.
– Monitoring: Monitoring is a vital part of diabetes management during pregnancy, as it can help assess the effectiveness of the treatment plan and detect any problems early. Women with diabetes should check their blood glucose levels at least four times a day: before breakfast, before lunch, before dinner, and before bedtime. Some women may also need to check their blood glucose levels after meals or during the night. The target range for blood glucose levels during pregnancy is usually between 60 and 95 mg/dL before meals, and between 100 and 120 mg/dL one hour after meals. However, these targets may vary depending on individual factors, such as age, weight, medical history, and complications. Women with diabetes should also have regular prenatal visits with their health care provider, who can monitor their blood pressure, weight gain, urine protein, and hemoglobin A1c (a measure of average blood glucose levels over three months). In addition, they should have frequent ultrasounds to measure the fetal growth and development, as well as non-stress tests or biophysical profiles to assess the fetal heart rate and movements.
– Delivery: The timing and mode of delivery for women with diabetes depend on several factors, such as the type of diabetes, the blood glucose control, the fetal size and maturity, and the presence of any complications. In general, women with pre-existing diabetes are advised to deliver between 37 and 39 weeks of gestation, unless there are medical reasons to deliver earlier or later. Women with gestational diabetes are usually allowed to go into labor spontaneously, as long as their blood glucose levels are well controlled and there are no other complications. However, they may need to be induced if they go beyond 40 weeks of gestation, as the risk of stillbirth increases after this point. The mode of delivery (vaginal or cesarean) depends on the fetal position, size, and well-being, as well as the maternal preference and history. During labor and delivery, women with diabetes should have continuous monitoring of their blood glucose levels, fetal heart rate, and contractions. They may also need intravenous fluids and insulin to maintain their blood glucose levels within the target range. After delivery, the blood glucose levels usually return to normal within a few days for women with gestational diabetes, but they may remain high for women with pre-existing diabetes. Therefore, they should continue to monitor their blood glucose levels and adjust their medication accordingly. They should also have a follow-up test for diabetes six to 12 weeks after delivery, as some women may develop type 2 diabetes later in life.

Diabetes management during pregnancy can be challenging, but it can also be rewarding. By following a personalized plan that includes diet, exercise, medication, and monitoring, women with diabetes can have a healthy and successful pregnancy and deliver a healthy baby.

References:

– American Diabetes Association. (2021). Management of diabetes in pregnancy: Standards of medical care in diabetes—2021. Diabetes Care, 44(Supplement 1), S200-S210. https://doi.org/10.2337/dc21-S015
– National Institute of Diabetes and Digestive and Kidney Diseases. (2017). What I need to know about gestational diabetes. https://www.niddk.nih.gov/health-information/diabetes/overview/what-is-diabetes/gestational/what-i-need-to-know
– Royal College of Obstetricians and Gynaecologists. (2015). Diabetes in pregnancy: Management from preconception to the postnatal period (NICE guideline NG3). https://www.nice.org.uk/guidance/ng3
– World Health Organization. (2016). Diagnostic criteria and classification of hyperglycaemia first detected in pregnancy. https://apps.who.int/iris/bitstream/handle/10665/85975/WHO_NMH_MND_13.2_eng.pdf