contrast, people with “Type 1 diabetes” (previously called Whether a mother’s diabetes increases the chance Does diabetes lead to any pregnancy complications? …
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Diabetes and Pregnancy
This sheet talks about the risks that diabetes can have during pregnancy With each pregnancy, all women have a 3 to 5 chance of having a baby with a birth defect This information should not take the place of medical care and advice from your health care provider
What is diabetes? Diabetes is a condition in which the body either does not produce enough insulin or cannot use insulin properly Insulin is a naturally occurring hormone in the blood that is necessary for providing our cells with energy to function Insulin helps sugar glucose move from the bloodstream into the cells When glucose cannot enter our cells, it builds up in the blood hyperglycemia This can lead to damage of organs including the eyes and kidneys, or damage of blood vessels and nerves Most people with diabetes have Type 2 diabetes, which means that the body does not produce enough insulin or the insulin is not able to transfer glucose into cells Type 2 diabetes used to be known as adult-onset diabetes In contrast,
people with Type 1 diabetes previously called juvenile-onset diabetes have a condition where the body does not produce any insulin at all People with Type 1 diabetes need insulin injections and close monitoring to control their blood sugar levels I have diabetes and am planning on getting pregnant Is there anything I need to know? It is recommended that women with diabetes speak with their doctors before becoming pregnant This will help ensure that their blood glucose levels are under control Whether a mothers diabetes increases the chance of birth defects is based on how well her glucose is controlled just before and during a pregnancy This is true no matter what the cause of the diabetes Studies have shown that women who have well-controlled diabetes before becoming pregnant and who maintain low glucose levels throughout pregnancy are not at increased risk for having a baby born with birth defects A blood test measuring the levels of Hemoglobin A1C glycosated hemoglobin estimates glucose control for the previous 2-3 months Ideally, this level should be within the normal range before pregnancy Some doctors will recommend additional home blood glucose testing to check the sugar
levels more regularly Women with diabetes should also work with their doctors and nutritionists to develop a personalized diet and exercise plan before pregnancy Does maternal diabetes cause birth defects? It is important to remember that most babies born to women with diabetes are not born with birth defects However, high glucose levels during pregnancy increase the chance that a baby will be born with birth defects High
glucose levels have the most significant effect early in pregnancy, possibly before a woman knows she is pregnant For pregnant women with poor diabetic control, the risk for a baby to be born with birth defects is about 6-10; this is about twice the chance for birth defects if the mothers diabetes is well controlled For those with extremely poor control in the first trimester, there may be up to a 20 risk for birth defects Some of the associated birth defects include spinal cord defects spina bifida, heart defects, skeletal defects, and defects in the urinary, reproductive, and digestive systems Finally, babies born to women with diabetes also have an increased chance of having breathing difficulties, low blood sugar hypoglycemia and jaundice yellowish skin at
birth Does diabetes lead to any pregnancy complications? Women with diabetes are generally followed more closely in pregnancy because of the potential for certain complications When glucose levels are not in good control, there is also an increased risk for miscarriage and stillbirth There is also a higher chance of pre-eclampsia high blood pressure, swelling, and protein in the urine, pre-term delivery and excess amniotic fluid around the baby polyhydramnios Finally, mothers with diabetes are more likely to have large babies, some weighing over 10 pounds When this occurs, the doctor may advise the woman to deliver the baby by cesarean section rather than by vaginal delivery in order to reduce the risk of injuries to the mother and baby Chances for these complications are lower when women have good glycemic control What kinds of tests are recommended during pregnancy for women with diabetes? There are several tests that can be done during a pregnancy to evaluate how the baby is growing and developing An ultrasound, which uses sound waves to create a picture of the baby, can be used to look at different structures of the baby and to make sure the baby is growing at a normal rate A
fetal echocardiogram can be used to evaluate whether the babys heart is developing properly Non-stress tests can be used to monitor the babys heart rate A test of maternal blood called the AFP test or triple screen measures certain proteins the baby makes that cross into the mothers blood The levels of these proteins can give information on a babys chances to have certain birth defects such as spina bifida
I have to take insulin injections for my diabetes Does insulin have any effects on the baby? Animal, human or synthetic insulin may be used for glucose control during pregnancy Several studies have shown that using insulin during pregnancy is not associated with an increased risk for birth defects It is thought that the potential benefits of using insulin to regulate glucose outweigh the risks of insulin use, since better glucose control can reduce the risks of birth defects associated with poorly controlled diabetes If I am taking oral medications to control my diabetes, will I have to switch to insulin injections during pregnancy? Since insulin is thought to control glucose levels better than most oral medications, your physician may want you to switch to insulin injections
Ther 
e have been studies comparing birth defect rates of babies from women who control their diabetes with insulin injections with those who take oral medications to lower glucose in their blood In general, taking oral medications does not increase the risk that a baby will be born with birth defects It is important to recognize that there may be more specific information available for different medications Consult with your physician regarding which medication may be appropriate for you For more information about the oral medication metformin during pregnancy, please see the OTIS fact sheet available at http://otispregnancyorg/pdf/metforminpdf I am 26 weeks pregnant and was told I have gestational diabetes Is this the same as Type 1 or Type 2 diabetes and will this affect my baby? Of all the women who have diabetes during pregnancy, 90 have gestational diabetes Gestational diabetes is diabetes that is diagnosed during pregnancy, generally between 24-28 weeks Most pregnant women are screened for gestational diabetes by drinking 50 grams of a glucose solution and measuring their blood glucose level one hour later If this test is abnormal, additional testing may be done to verify
whether a woman really has gestational diabetes Most women with gestational diabetes do not have symptoms, but some may experience extreme thirst, hunger or fatigue For most women with gestational diabetes, blood glucose levels return to normal after pregnancy, although 40 of women with a history of gestational diabetes develop diabetes at some point in the future Most women with gestational diabetes can control blood glucose levels with dietary changes, while 10-15 may require insulin injections Because gestational diabetes typically occurs late in the second trimester when the babys body is already formed, it does not usually increase the risk of birth defects, but is associated with a chance for delivering a large baby You should discuss with your doctor whether vaginal delivery or cesarean section is most appropriate given the babys size If gestational diabetes is not well controlled, there is an increased chance for the baby to have hypoglycemia and breathing problems at birth In rare cases where gestational diabetes is present in the first trimester, there may be a small increased risk for birth defects similar to that seen with other forms of diabetes It is not clear whether
gestational diabetes truly increases these risks, or whether the women in these studies
simply had Type 1 diabetes that had not previously been identified If I have diabetes will I be able to breastfeed my baby? Diabetes can slow down the production of milk Insulin is necessary for milk production, so this may partly explain why women with diabetes are slow to produce milk You can stimulate milk production in a number of ways, including skin to skin contact with your baby within one hour after birth and frequent nursing sessions in the first two days A lactation consultant can help you learn feeding cues from your baby and maximize your milk production I take medication for my diabetes How will breastfeeding affect the health of my baby? The insulin you may take to control your diabetes should not cross over into breast milk Even if small amounts cross over, the babys digestive system will break it down Other medications such as glibenclamide and glipizide have not been detected in breast milk Only small amounts of metformin have been found in breast milk and no changes in infant growth and development have been seen A slightly larger percentage of tolbutamide has been detected in
breast milk There are no data for the following medications: acarbose, glibornuride, gliclazide, glimepiride, gliquidone, glisoxepide, miglitol, pioglitazone, repaglinide and rosiglitazone There are many health benefits of breastfeeding, including a lowered risk of your child developing diabetes later in life How will breastfeeding affect my health? Mothers with Type 1 diabetes will often experience lowered blood sugar after nursing Your insulin requirements may be reduced Eat a snack with carbohydrates and protein prior to nursing to help avoid low blood sugars Keep snacks, glucose tablets or fast-acting sugars available where you nurse in case of a rapid decline in blood sugar Keep in mind with any type of diabetes, your blood sugar may rise and/or fall as you nurse
April 2008 Copyright by OTIS Reproduced by permission References:
Bhattacharyya A, et al 2001 Insulin lispro and regular insulin in pregnancy QJM 945:255-260 Brydon P, et al 2000 Pregnancy outcome in women with type 2 diabetes mellitus needs to be addressed International Journal of Clinical Practice 547:418-419 Coetzee EJ and Levitt NS 2000 Maternal diabetes and neonatal outcome Seminars in Neonatology 53:221-229
Hadden DR and McCance DR 1999 Advances in management of type 1 diabetes and pregnancy Current Opinion in Obstetrics and Gynecology 116:557-562 Hagay Z and Reece EA 1992 Diabetes mellitus in pregnancy and periconceptional genetic counseling American Journal of Perinatology 92:87-93 Jovanovic L 1999 Role of diet and insulin treatment of diabetes in pregnancy Clinical Obstetrics and Gynecology 431:46-55 Landon MB 2000 Obstetric management of pregnancies complicated by diabetes mellitus Clinical Obstetrics and Gynecology 431:65-74 Langer O, et al 2000 A comparison of glyburide and insulin in women with gestational diabetes mellitus New England Journal of Medicine 34316:1134-1138 National Institute of Child Health and Human Development 2001 Understanding Gestational Diabetes: A Practical Guide to a Healthy Pregnancy Available at: wwwnichdnihgov/publications/pubs/gesttochtm Reece EA and Homko CJ 2000 Why do diabetic women deliver malformed infants? Clinical Obstetrics and Gynecology 431:32-45 Rosenn BM and Miodovnik M 2000 Medical complications of diabetes mellitus in pregnancy Clinical Obstetrics and Gynecology
431:17-31
Source:nhlbi.nih.gov
