Control Before Conception
When it comes to having a successful pregnancy with type 1 or type 2 diabetes, planning is everything. Achieving good blood glucose control before conception is the best way to ensure a good outcome for both you and your child. The ADA recommends that women who plan on becoming pregnant strive for an Alc level of less than 7 percent, and preand postprandial glucose readings as outlined in the following table. If you take drugs for hypertension or other diabetic complications, your doctor will discuss your options with you, as many are not recommended for pregnancy. Drug therapy that is contraindicated in pregnancy, including oral diabetes medications, will have to be stopped and replaced with insulin therapy (which is considered safe in pregnancy). Starting insulin before you try to conceive will give you the chance to become accustomed to the routine and make appropriate dosage adjustments for optimal control. Ideally, blood glucose will be stabilized at the target goal, or as close as possible to it, for several months before you try to conceive Adjustments to insulin and other aspects of your treatment will probably have to be made during pregnancy; too, which is why it's important to continue to involve your endocrinologist or diabetes care specialist, as well as your obgyn, in your treatment throughout your pregnancy.
Staying Healthy During Pregnancy
Once you become pregnant, your provider may recommend that you see a perinatologist, an obgyn that specializes in high-risk pregnancies. As with any member of your diabetes care team, you should make sure the physician you choose communicates clearly and proactively with you and your other providers, answers your questions to your satisfaction, and encourages you to play an active role in your treatment. Your insulin needs will probably go up in pregnancy; as your placenta starts to manufacture hormones that increase your insulin resistance. Frequent glucose checks during this time are critical, and your doctor may also administer Ale testing each month or every six weeks instead of the typical three-month interval.
Your Baby And Diabetes
Get your baby's doctor on board early. A neonatologist, a doctor who cares for newborns with special health needs, may be consulted to be in the delivery room at birth in case of any problems. Choosing a pediatrician early is also a good idea. If you are able to keep your blood glucose well controlled during pregnancy; your baby's risk of complications is reduced dramatically. Tight control in the first trimester in particular is important, because this is the critical time when the organ systems are developing in the fetus. Babies born to mothers with diabetes have a greater chance of being born large for birth weight. This is because the fetus converts extra glucose into body fat in the womb. The condition, called macrosomia, puts newborns at risk for unplanned C-section birth and shoulder dystocia (getting wedged in the birth canal during delivery). When the hard work of active labor starts to kick in to high gear, your insulin needs will drop. This is, after all, the ultimate form of exercise. And just like a strenuous workout, you run the risk of going low. Your glucose levels will be tested regularly, and you may have an IV line or heparin lock inserted to infuse glucose or insulin for type 1 as needed. Talk to your obgyn or perinatologist well before your due date to discuss the protocol used to prevent hypos in labor.