Staying healthy during pregnancy requires nine months of constant effort.
Staying healthy during pregnancy when you have a chronic medical condition like diabetes? Twice that effort.
“Having diabetes in pregnancy is a lot of work. There is frequent monitoring, visits and check-ins. It’s not an easy thing to have but most people do really well and they’re often very motivated, so that helps,” says Dr. Emily Fay, a maternal fetal medicine specialist who sees patients at the Maternal and Infant Care Clinic at University of Washington Medical Center.
Whether you have type 1 or type 2 diabetes, were recently diagnosed, or have lived with it since childhood, here’s what you need to know if you want to have a safe and healthy pregnancy.
What to know before getting pregnant
No two people with diabetes are exactly alike. A woman who has type 1 and takes insulin every day may have a very different pregnancy experience from a woman who has type 2 and is able to control her diabetes by diet alone.
Even for women who have the same type, pregnancy varies depending on how well-managed the disease is, what complications they may have from it, whether they have other health conditions, and other factors.
Ideally, women with diabetes who want to have a baby should see their doctor before they get pregnant.
Why? If diabetes isn’t under control and the woman has high blood sugar, that can impact both the mother and the fetus.
Development of vital organs like the brain and heart happens within the first two months of pregnancy. If the woman has high blood sugar during that time, birth defects are more likely to occur.
Women with diabetes are also at higher risk for having a miscarriage. Most miscarriages happen within the first trimester.
“To lower their risk, our goal is for them to have a relatively normal hemoglobin A1C test at the start of pregnancy. If they don’t, we usually recommend working on diabetes control for several months and getting it better-managed before they start trying for pregnancy,” Fay says.
The hemoglobin A1C test shows what someone’s blood sugar levels have been for the past three months, so it’s an indicator of how well the person is managing their diabetes over time.
If you have diabetes and recently found out you’re pregnant — but don’t completely have your blood sugar under control — don’t panic. See a doctor as soon as you can so they can help you come up with a plan for getting healthier.
And, in case you were wondering, diabetes isn’t something you can easily pass onto your children. There is a genetic component to diabetes (both type 1 and type 2), in that you might pass along genes that make your kids more prone to the disease. But that doesn’t mean they’re guaranteed to get it — in fact, they’re more likely not to.
Managing diabetes during pregnancy
Googling “pregnancy and diabetes” can be scary when you see the list of potential complications: Low blood sugar, preterm birth, C-section, stillbirth and extra-large babies. (Which can create extra-large vaginal tears. Ouch.)
Women with diabetes are also at higher risk for developing high blood pressure during pregnancy, including a condition called preeclampsia that can cause seizures or stroke.
While it’s good to be aware of those risks, it’s also important to try not to be overwhelmed by them.
“Doctors monitor for all of those things during pregnancy,” Fay says.
Which means if there is anything of concern, your doctor will find out sooner rather than later and do their best to help.
There are many ways doctors monitor health of the mother and fetus. This includes all the standard tests — like getting your blood tested, screening for genetic diseases and regular ultrasounds — plus a few extra.
For women with type 1 or with type 2 that isn’t well-controlled, doctors may do a specialized ultrasound, called a fetal echocardiogram, of the fetus’ heart during the second trimester, Fay says.
Other common tests throughout pregnancy are nonstress tests, which monitor fetal heart rate, regular ultrasounds and monitoring your blood pressure. Nonstress tests are typically recommended twice a week once you reach 32 weeks, according to Fay.
All of the extra tests may seem tedious, but they’re super important.
“Controlling diabetes well throughout pregnancy helps lessen complications,” Fay says.
Doctors may also prescribe baby aspirin throughout pregnancy, since that has been shown to decrease someone’s risk for preeclampsia, Fay says.
Controlling blood sugars during pregnancy
Another thing doctors will want to keep a close eye on are your blood sugar levels. Insulin resistance typically increases during pregnancy because of hormonal changes.
“Throughout pregnancy, insulin needs will continue to increase until the end of pregnancy. Postpartum, insulin requirements will quickly drop and go back to pre-pregnancy needs,” Fay says.
It’s important to keep blood sugars balanced — not too high and not too low — for both you and your baby’s health.
One of the easiest ways to do this is have patients send in weekly blood sugar reports. Currently, Fay’s patients do this via a centralized email. You could also use recordings from a continuous glucose monitor, which is a small device inserted into the arm or abdomen that regularly keeps track of blood sugars and makes the data easily accessible.
Doctors will also monitor and help control blood sugar throughout labor; some women are given an insulin drip to help with this, Fay says.
Diabetes, pregnancy and mental health
With diabetes, the focus is often on how the disease affects people physically: the blood sugar testing, specialized diet and insulin injections. But Fay believes it’s equally important to consider how having diabetes affects someone’s mental health.
“Pregnancy is fraught with emotion and is potentially anxiety-provoking for anyone. When you add medical problems on top of that, it may increase the risk for mental health problems,” she says.
Anxiety and other issues can crop up before pregnancy, throughout pregnancy and postpartum. Some things after pregnancy, like breastfeeding and sleep disruptions, can especially add stress when you’re already managing your own health condition.
This is why many doctor’s offices and clinics will screen you for anxiety, depression and other mental health issues during and after pregnancy. At UW Medical Center, where Fay works, patients have access to perinatal psychologists and psychiatrists who can help with counseling and medication management, plus social workers who help connect patients with any needed resources.
“I try to normalize it with people, to congratulate them on the hard work they’re doing,” Fay says.
Additionally, Fay helps organize Project ECHO, a video conferencing-based program that allows maternal fetal medicine specialists such as herself, psychologists and psychiatrists, social workers, and other obstetricians and gynecologists to discuss patient cases together.
The idea is that, if a patient is struggling and her provider wants a second opinion, the provider can get help from other experts in the community.
“We’re trying to improve comfort with perinatal mental health so providers in the community feel more comfortable providing that care and referring to us when needed,” Fay says.
If you have diabetes and want to have a child, there’s a lot you can do to maximize your chances of having a healthy pregnancy — but some things will always be out of your control.
“The better controlled people are, the less the risk of complications. That being said, we have people who are perfectly controlled and still get preeclampsia,” Fay says.
This might not sound reassuring, but she wants women to recognize it — and not to put too much pressure on themselves.
“People can sometimes feel like, ‘Oh is this my fault, I didn’t control my diabetes well enough,’ but sometimes it just happens despite the best of situations. And even if complications arise, most people do well,” she says.
Not everything will be in your control, but many things are. What you can do is talk with your doctor early and be serious about staying healthy during pregnancy.