Pregnancy complications

• Pregnancy complications may need special medical care.
• Common problems include anemia, diabetes and bleeding.
• Ask your provider about the signs of serious complications.

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Nearly 9 out of 100 women in the United States have diabetes. About 3 out of those 9 don’t know it. It’s very important for all women to see their health provider regularly to watch for this disease and learn how to manage it.

If you have diabetes and are pregnant or trying to get pregnant, your health care provider will want to take extra special care of you. Pregnant women who have diabetes before pregnancy (preexisting diabetes) are considered to have a high-risk pregnancy.

A high-risk pregnancy doesn’t necessarily mean that you’ll have problems. Instead, it means that your health provider will pay special attention to your health and may work with other specialized health providers to help you have a healthy pregnancy.

Before pregnancy
It’s important for people living with diabetes to manage glucose (sugar) in their blood. This is especially true for women who want to get pregnant.

• During the first 8 weeks of pregnancy, a baby’s brain, heart, kidneys and lungs begin to form.
• High blood sugar levels are especially harmful to unborn babies during this early part of pregnancy. Too much glucose in the blood can cause birth defects.
• Unfortunately, most women don’t realize they’re pregnant until about 5 or 6 weeks after conception.

If you’re planning to get pregnant, use this checklist to help you get ready for pregnancy:

• Get your diabetes under control 3 to 6 months before trying to get pregnant.
• Take a multivitamin with 400 micrograms of folic acid every day. Your health provider may increase your daily dose of folic acid to help reduce the risk of birth defects.
• If you’re already pregnant, see your health provider right away to get prenatal care. This will help you have the healthiest outcome.
• Talk to your health provider about any medications you’re currently taking and if they’re safe during pregnancy. Your provider may adjust some medications to help you have a healthy pregnancy.
• With your health provider’s OK, add regular physical activity to your daily routine.
• Talk to a dietitian or diabetes educator to help you create a healthy meal plan.
• Meet with any specialists that your health provider recommends. These experts can help you better manage your diabetes and any other complications that may arise during pregnancy. Some examples include: perinatologist (focuses on high-risk pregnancies) and endocrinologist (concentrates on problems of the endocrine system including diabetes). The endocrine system includes the glands that make hormones.

During pregnancy
Women who have diabetes are almost as likely as women without the disease to have a healthy baby. But they must control their blood sugar levels before and throughout pregnancy.

If diabetes is not well controlled, a mom and baby could face serious health complications:

• The woman is more likely to have a miscarriage and stillbirth.
• The baby is 2 to 4 times more likely to have a serious birth defect than other babies. Heart defects and neural tube defects are more common among babies born to women with diabetes.
• The baby is likely to be very large (10 pounds or more). This makes vaginal delivery more difficult and puts the baby at risk for injuries during birth.

Medications for diabetes
During pregnancy, the safest diabetes medication is insulin. Insulin is a hormone that helps the body control its blood sugar level. People with diabetes have trouble making or responding to insulin and may need to use medications to help them control their blood sugar.

Your health provider will work with you to create a personal plan for your insulin routine.

• If you’re taking diabetes pills, your provider will switch you to insulin. Health providers don’t recommend diabetes pills because researchers aren’t sure if the pills are safe to take during pregnancy.
• During pregnancy, some women become less able to respond to insulin. This is called insulin resistance. You may need to change the kind and amount of insulin you take.
• As the end of your pregnancy gets closer, your body may need more insulin than it did in early pregnancy. This could mean double or even triple the amount you normally used.

Some medications are not safe for your unborn baby. Talk to your health provider about all other medications you currently take. Your provider can tell you which medications are safe, which ones are unsafe, and which ones need to be changed.

Low blood glucose (hypoglycemia)
When you’re pregnant, women with preexisting diabetes are at increased risk of having low blood glucose. This condition is called hypoglycemia. When blood glucose levels are too low, your body can’t get the energy it needs. Usually, hypoglycemia is mild and can easily be treated by eating or drinking something with sugar. But if left untreated, hypoglycemia can make you pass out.

Low blood glucose can be caused by:

• Meals or snacks that are too small, delayed or skipped
• Doses of insulin that are too high
• Increased activity or exercise

High blood glucose (hyperglycemia)
When your body doesn’t have enough insulin or isn’t able to use insulin correctly, you could be at risk of having high blood glucose, also called hyperglycemia. This condition can be caused by:

• A mismatch between food and medication
• Eating the wrong kinds of foods
• Eating more food than usual
• Being less active than usual
• Illness
• Stress 

If your blood glucose is high, be sure to talk to your health provider. Your provider may suggest a change in your insulin, meal plan or physical activity routine. Symptoms of high blood glucose include:

• Frequent urination 
• Thirst
• Weight loss

Healthy Eating
If you haven’t already seen a dietician, now is a good time to start. A dietician is a specialist in nutrition and healthy eating. Check with your health insurance provider to see if it will cover the cost of meeting with a dietician. Your dietician can:

• Help you learn what, how much and how often you should eat
• Help you understand servings and portion sizes of your meals
• Create a meal plan tailored to your needs, likes and dislikes
• Work with you to have healthy goals for your weight gain during pregnancy

Exercise
With your health provider’s OK, daily physical activity can help you reach your target blood glucose levels. It can also help improve any other health conditions you may have, such as high blood pressure or high cholesterol.

• Healthy pregnant women should get at least 2 1/2 hours of aerobic exercise every week.
• This means that most pregnant women should try to get 30 minutes of aerobic exercise on most, if not all, days.  
• Examples of aerobic exercise are walking, swimming and dancing.

After your baby arrives
Now that you’ve welcomed your new baby into the world, there are certain steps that you can take to help you manage diabetes after giving birth.

• Breastfeeding is recommended for most women. It helps give your baby the nutrition she needs to stay healthy and has added benefits for moms, too.
• Since breastfeeding women usually need more calories each day than non-breastfeeding women, your dietician will work with you to create a healthy diet that’s right for you.
• After you’ve given birth, you may need less insulin than usual for several days. Breastfeeding can also lower the amount of insulin you need. Taking insulin while breastfeeding is safe.
• Diabetes pills are not recommended for breastfeeding moms.
• Giving birth could increase your risk of having low blood glucose, especially if you’re breastfeeding. Try eating a healthy snack before or after you breastfeed. You health provider may suggest that you check your blood glucose more often than usual.

For more information

• U.S. Centers for Disease Control and Prevention (CDC)
• Womenshealth.gov

April 2009