Diabetes and Pregnancy: Preparing for Conception

With type 1 and type 2 diabetes, it is recommended that preparing for pregnancy begin months prior to conception.

Only seven weeks after a woman’s last period, about the time she realizes she is pregnant, the baby’s organs have already developed. Since high blood sugar and harmful ketones can pass through the placenta, it is important for the mother’s glucose levels to already be well-controlled.

A Preconception Doctor Visit

If you are ready to start or add to your family, discuss the desire for pregnancy with your physician. When blood sugar is managed carefully before and during the pregnancy, the odds of delivering a healthy baby are nearly the same as for non-diabetics.

A preconception exam usually involves tests for high blood pressure, heart or kidney problems, nerve damage, and vision complications. Doctors will typically check A1C levels to monitor glucose control over the past few months. Having A1C readings of less than 7 percent is recommended; less than 6 percent is ideal.

Your physician will also help you set daily glucose goals. The American Diabetes Association suggests before-meal readings of 60-199 mg/dl, and readings of 100-149 mg/dl an hour after eating.

Meds Appropriate for Pregnancy?

Some diabetes medications and supplements are not recommended for use during pregnancy. This includes certain oral diabetes, high blood pressure, and kidney medications. Switching to pregnancy-friendly alternatives well before getting pregnant is best for Mom and baby.

Fortunately, insulin does not cross the placental barrier, so it can be used during pregnancy. If you are on an oral prescription, your doctor may switch you to insulin. Since new and long-term insulin users need to have glucose levels stable before conceiving some women might need to increase their daily dose, number of injections, or possibly start using an insulin pump.

Preparing Your Body

While getting your blood sugar level ready for pregnancy, it is a good idea to get your body in shape as well. Discuss your exercise regimen, or lack of it, with your doctor. Regular physical activity is safe for pregnant women and helps control glucose.

If you are already exercising, your physician might recommend adjustments to your routine. If you are not getting exercise, the doctor can suggest a safe way to get started. Good activities for pregnant women include swimming, stationary biking, walking, and low-impact aerobics.

Setting up a Team

While you are getting your blood sugar steadied and your body in shape, you can also assemble a health care team to see you through conception, pregnancy, and child birth. You may want some or all the following individuals ready and waiting to assist you and the baby:

• A doctor trained to care for people with diabetes, including pregnant women (if you are not already seeing one).
• An obstetrician who has expertise with diabetes and high-risk pregnancies.
• A registered dietitian to help you control your blood sugar before and after conception, and post pregnancy.
• A neonatologist or pediatrician knowledgeable about baby issues related to a mother’s diabetes.

If You Need to Wait

If your doctor recommends waiting until your glucose is more stable before conceiving, it is wise for you and your partner to settle on a birth control method. The options are the same as for women without diabetes: the pill, implants, IUD (intrauterine device), diaphragm, condoms, and spermicides. Your health history, personal, and partner preferences are the deciding factors.

Sources: American Diabetes Association, The Mayo Clinic
Photo credit: Steve Slater