Target Blood Glucose Levels Before Pregnancy
When youre planning to become pregnant, your daily blood glucose targets may be different than your previous targets. Ask your health care team which targets are right for you.
You can keep track of your blood glucose levels using My Daily Blood Glucose Record. You can also use an electronic blood glucose tracking system on your computer or mobile device. Record the results every time you check your blood glucose. Your blood glucose records can help you and your health care team decide whether your diabetes care plan is working. You also can make notes about your insulin and ketones. Take your tracker with you when you visit your health care team.
Elective Early Delivery With Diabetes During Pregnancy
Women who develop gestational diabetes, as well as women with preexisting mild diabetes that is well controlled, can usually carry to their due date safely though their babies are a bit more likely to be born prematurely.
But when moms normal blood sugar levels have not been well maintained throughout pregnancy, if the placenta deteriorates early or if other problems develop late in pregnancy, baby may be delivered a week or two before term.
The various tests mentioned above help a physician decide when to induce labor or perform a C-section late enough so the fetal lungs are sufficiently mature to function outside the womb, but not so late that the babys safety is compromised.
If your baby is delivered early, dont worry if shes placed in a neonatal intensive care unit immediately after delivery. This is routine procedure for babies born before 37 weeks.
Your baby will be observed for respiratory problems and for hypoglycemia . You should be able to get your baby back soon so you can start nursing, if thats your plan.
Diabetes Pcos And Fertility
If you have diabetes, you may also have other conditions that can make it harder to become pregnant. For instance, PCOS, or polycystic ovary syndrome, is associated with both type 1 and type 2 diabetes. PCOS can interfere with fertility by causing ovulatory problems, including a lack of ovulation. The combination of PCOS and diabetes can create significant barriers to pregnancy, but working with a reproductive endocrinologist before you try to conceive can help you develop a plan to overcome them.
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I Have Some Complications Of Diabetes: How Does This Affect My Pregnancy
It is important to have your kidneys, eyes and nerves checked for complications of diabetes before you get pregnant. This is referred to as a baseline screening.
You will need to have a urine test to check the amount of protein passing through your kidneys and a blood test to check your kidney function.
Its also important to have the back of your eyes checked by an optometrist or ophthalmologist.
Your nerves can be checked for damage by your doctor, podiatrist or diabetes educator.
Your Blood Sugar Levels
Youll also need to check your blood sugar levels more regularly at home. This is so you can try to keep them in a safe range during the day.
If you have type 1 diabetes, youll already have a blood sugar testing kit, but make sure it checks for ketones too.
If you have type 2 diabetes and dont have a blood sugar testing kit, ask your diabetes team for one.
Heres an example of some targets to aim for:
- when you wake up and havent eaten yet 5 to 7mmol/l
- before meals at other times of the day 4 to 7mmol/l
- 90 minutes after meals 5 to 9mmol/l.
Your diabetes team can help you set these targets they may be different depending on your situation. They can also help you reach these targets, so you can reduce the risks for you and your baby.
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Preexisting Diabetes And Planning Pregnancy
Andrea Chisolm, MD, is a board-certified OB/GYN who has taught at both Tufts University School of Medicine and Harvard Medical School. She has over 20 years of clinical experience and is currently is in practice at Cody Regional Health in Cody, Wyoming.
If you are diabetic and want to get pregnant, you may be worried about having a more complicated pregnancy. Although you will likely face more challenges in pregnancy than if you did not have diabetes, being diabetic does not mean that your pregnancy is destined for major complications or miscarriage. That said, you do need to be proactive in your diabetes care prior to pregnancy to optimize your health and your baby’s and prevent possible complications.
Complications For The Baby
Pregnancy in women with diabetes isn’t just a risk for the mother. Complications for the baby can include:
Fetal macrosomia is a high-risk condition during pregnancy where the infant’s gestational weight range is not the same as average, often landing in the 90th percentile or more).
Approximately 7.8% of babies born in the US were more than 4,500 grams at birth, with 22.3% of pregnant mothers with diabetes having a high birth weight baby compared to just 13.6% of pregnant mothers without diabetes. Symptoms of an abnormally large baby include excessive amniotic fluid or abnormal measurements identified in fundal height and fetal size in an ultrasound.
If glucose during pregnancy isn’t controlled, the baby can grow big and lead to an increase in amniotic fluid. This, in turn, can trick the body into thinking it is further along than it really is, resulting in preterm birth in many cases.
A 2014 study linked type 2 diabetes to premature births finding that previously having a preterm birth was strongly associated with a 29% higher risk of being diagnosed with type 2 diabetes. The report also noted that pregnant mothers with gestational diabetes before 32 weeks had a 55% higher risk of type 2 diabetes.
Fetal and neonatal loss
Congenital disorders or birth injury
Birth injuries, on the other hand, refer to the injuries that occur during birth. This can include bruising, clavicle or collarbone fracturing, broken bones, etc.
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How Does Diabetes Affect Pregnancy
Women with diabetes before pregnancy will need to be watched closely. Pregnancy will affect blood sugar levels, and medication will most likely need to be adjusted. High blood glucose within the first trimester can cause birth defects. Children born to diabetic mothers often have a much higher birth weight due to the excess sugar passed through the placenta and are often delivered via cesarean. The risk of a blood sugar crash right after birth is high, and many of the babies are monitored for several hours after birth. The child of a diabetic mother is also more likely to develop type 1 or type 2 diabetes later in life. Women may also develop diabetes during pregnancy, known as gestational diabetes. Preeclampsia is a risk to all diabetic mothers.
Metformin Safety In Pregnancy Still An Open Question
The American Diabetes Association recommends metformin only for pregnant women with type 2 diabetes who dont achieve good blood sugar control with insulin, because metformin can cross the placenta to reach developing babies, according to guidelines published in the January 2021 issue of Diabetes Care.
The exact health impact of metformin exposure in the womb isnt well understood, according to an analysis published October 2017 by the Cochrane Database of Systematic Reviews. This analysis found that the risk of babies being large for their gestational age was similar with metformin and insulin, and the risk of cesarean section deliveries was lower with metformin. But the researchers described this evidence as low quality and noted that more research is needed to determine long-term health for babies exposed to metformin during pregnancy.
If its not well managed, diabetes during pregnancy can increase the risk of birth defects, stillbirth, and preterm birth, according to the CDC. For this reason, the CDC recommends that women with type 2 diabetes try to maintain healthy blood sugar levels prior to conception. Once they become pregnant, the CDC advises women to follow a healthy eating plan, get plenty of exercise, and use insulin as needed to manage their blood sugar.
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Tips To Control Blood Sugar Levels
Have small frequent meals instead of heavy meals.
Include sources of protein and non-starchy veggies in all meals.
Choose grilled, baked roasted or steamed food rather than fried food items. Choose 1 portion of fresh fruit/salad for desserts or plain yoghurt instead of sugar laden sweets.
Choose water instead of regular soda, fruit mock tails, sweet tea and other sugar-sweetened drinks. Have 3-4 litres of water a day.
Avoid creamy toppings, like mayonnaise. High-fat topping on salads, dressings, cheeses.
Its all about portion size. No fasting No feasting. Pair your carbs with protein and veggies to maintain blood sugar level.
Switch to healthy snacks instead of unhealthy junks food.
Maintain your meal timings
Include fatty non mercury fishes anchovy, sardines, salmon, and herrings to get the benefit of Omega acids.
Walking 30-45 minutes a day and permitted exercise will help further control blood sugar. Do get in touch with physiotherapist for further details.
“It’s important to have a balanced diet and do physical activity to keep blood sugar under control. Talk to your nutritionist for a personalised diet plan. Medication and insulin may be required in some cases but diet and exercise have to be the first priority to have a healthy diet,” says Susmita S.
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Managing Diabetes During Pregnancyexpand All
- How can I control my diabetes during pregnancy?
You can control your glucose level with a combination of eating right, exercising, and taking medications as directed by your health care professional. You may need to see your ob-gyn more often. Your ob-gyn should schedule frequent prenatal visits to check your glucose level and do other tests.
- What blood sugar levels are recommended during pregnancy?
Many women with diabetes who have never been pregnant are surprised at how low the recommended blood sugar level is for pregnancy. Your ob-gyn will likely recommend that you check your blood glucose level several times a day to make sure it is in the normal range and meets the following goals:
Fasting level = below 95 mg/dL
1 hour after eating = below 140
2 hours after eating = below 120
Keep a log that lists your glucose levels with the time of day and share your log with your ob-gyn at each prenatal visit.
A blood test called a hemoglobin A1C test may be used to track your progress. This test result gives an estimate of how well your blood glucose level has been controlled during the past 4 to 6 weeks. Your hemoglobin A1C should not be higher than 6 percent.
If you think you have symptoms of hypoglycemia, check your blood glucose level right away. If it is below 60 mg/dL, eat or drink something, such as a glass of milk, a few crackers, or special glucose tablets. Make sure your family members know what to give you as well.
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Complex Carb Pulses And Legumes Vegetables Fruits And Good Fats
Pregnancy a life-changing phase for a woman can cause a series of hormonal changes in her body which may also put the expecting mother at risk of several diseases. Gestational diabetes is one such condition where insulin sensitivity is developed and if the blood sugar levels are not controlled, one may be at risk of complications during pregnancy or childbirth. Gestational diabetes many a time do not have clear symptoms and it is often detected during blood test. Increased thirst and urination may be some of the symptoms. If you have been diagnosed with gestational diabetes, the right diet can help control it.
“Becoming a mother is a wonderful phase in a womans life. With the change in body there will also be a chemical change from the start to pregnancy up till delivery. One such change is rise in blood sugar levels which is known as gestational diabetes that can develop due to insulin sensitivity caused due to the hormonal changes. It is essential to maintain the food habits to keep the blood sugar in check,” says Susmita S, Executive Nutritionist, Cloudnine Group of Hospitals, Bengaluru, Bellandur.
Here are some foods that can help manage gestational diabetes:
After The Baby Is Bornexpand All
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Copyright 2022 by the American College of Obstetricians and Gynecologists. All rights reserved. Read copyright and permissions information.This information is designed as an educational aid for the public. It offers current information and opinions related to women’s health. It is not intended as a statement of the standard of care. It does not explain all of the proper treatments or methods of care. It is not a substitute for the advice of a physician. Read ACOGs complete disclaimer.
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Preparing For Pregnancy With Type 1 Or 2 Diabetes
The first thing to do is talk to your GP or diabetes team. They may refer you to a specialist pre-conception care team.
You should get information about how diabetes affects pregnancy and how pregnancy affects diabetes. You will also be given details of local support you can have during pregnancy, including emergency contact numbers.
Having diabetes should not affect your fertility . Talk to your doctor if you have any concerns about your fertility.
There are several steps you can take before getting pregnant that will give you the best possible chance of having a healthy pregnancy.
Feeding And Caring For Your Baby After Delivery
If youre planning to breastfeed, baby should nurse as soon as possible after birth, ideally within 30 minutes, and then every two to three hours to prevent hypoglycemia, or low blood sugar.
Be sure to ask the hospital staff not to test your babys blood glucose levels until just before the second feed so that a diagnosis of hypoglycemia isnt made prematurely.
Check, too, that your baby isnt given formula or glucose water and is brought to you regularly and early for continued feedings.
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Do Ketones Lower Blood Sugar
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Preeclampsia & High Blood Pressure
Preeclampsia is when a pregnant woman has high blood pressure and signs that some of her organs, like her kidneys and liver, may not be working properly, explains the .
Preeclampsia is very dangerous and can be life-threatening, so you should keep a close eye out for symptoms throughout your pregnancy, especially in the later months.
Signs of preeclampsia include:
- Presence of protein in your urine
- Changes in vision and severe headaches
- High blood pressure
For some, preeclampsia can be managed with medication and bed rest, but for more severe cases, it can require staying in the hospital for 24-hour observation until its safe to induce labor or deliver via C-section.
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How Can I Prepare For Pregnancy If I Have Diabetes
If you have diabetes, keeping your blood glucose as close to normal as possible before and during your pregnancy is important to stay healthy and have a healthy baby. Getting checkups before and during pregnancy, following your diabetes meal plan, being physically active as your health care team advises, and taking diabetes medicines if you need to will help you manage your diabetes. Stopping smoking and taking vitamins as your doctor advises also can help you and your baby stay healthy.
What Health Problems Could I Develop During Pregnancy Because Of My Diabetes
You also have a greater chance of developing preeclampsia, sometimes called toxemia, which is when you develop high blood pressure and too much protein in your urine during the second half of pregnancy. Preeclampsia can cause serious or life-threatening problems for you and your baby. The only cure for preeclampsia is to give birth. If you have preeclampsia and have reached 37 weeks of pregnancy, your doctor may want to deliver your baby early. Before 37 weeks, you and your doctor may consider other options to help your baby develop as much as possible before he or she is born.