6 Critical Tips for Pregnant Women with Diabetes

Diabetes and pregnancy
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After hearing words of congratulations for their impending motherhood, pregnant women with diabetes also need to listen carefully to information about the risks for their child. According to new research, the life of the fetus and the infant are both at significantly greater risk of death if the woman already has diabetes when she gets pregnant.

The number of women with diabetes who are giving birth is rising for several reasons. One is the increase in overweight and obesity among young women who are then more prone to develop type 2 diabetes at an early age—childbearing years.

Another reason is that more and more women are deciding to postpone getting pregnant until they are in their thirties or after, and they are more likely to have diabetes. Better insulin and management techniques also make it safer for women with type 1 diabetes to have children.

New study of pregnant women with diabetes
In this study, the British-based researchers evaluated data concerning normally developed singleton offspring from 1,206 women with type 1 diabetes and 342 with type 2 diabetes. The data were then compared with those from a general population survey.

Here’s what they found:

  • The unborn fetus was 4.56 times more likely to die among women who had diabetes before getting pregnant than it was among women without diabetes. That is, fetal death was 3 percent among women with diabetes compared with 0.7 percent among women without diabetes
  • Infants born to women with pre-existing diabetes were 1.86 times more likely to die than those born to women without the disease. The corresponding percentages were 0.7 percent and 0.4 percent, respectively.
  • The risk of fetal death and infant death was similar among women who had type 1 or type 2 diabetes
  • Factors associated with a greater risk of fetal or infant death were glycated hemoglobin A1c (HbA1c) levels greater than 6.6 percent, presence of diabetic retinopathy prior to pregnancy, and failure to take folic acid during pregnancy

Type 2 Diabetes Risk after Pregnancy, What Women Should Know

The American Diabetes Association recommends that women with diabetes who are pregnant should maintain a HbA1c level of 7 percent or lower, while England’s National Institute for Health and Care Excellence (NICE) recommends a level of 6.1 percent. The average HbA1c level of the women in the study was 7.8 percent.

The authors of the study, who hailed from Newcastle University, South Tees NHS Trust, and Public Health England, explained that the prevalence of fetal and infant death could be about 40 percent lower if all the women had maintained either of the desired HbA1c targets.

What women with diabetes should do
If you are a woman who has type 1 or type 2 diabetes and you plan to get pregnant, here are 6 critical tips to consider to help reduce the risk of stillbirth or infant death.

Get control of your blood glucose levels. Talk to your doctor about your plans to get pregnant and keep a careful eye on your blood glucose levels. If they are elevated at all, take steps immediately to bring them under control. That may mean dietary changes, exercise modifications, stress management, a change in medications if you are using them, consideration of natural remedies, weight loss, or any combination of these options.

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Why is good blood glucose control so important? Because an infant’s organs form during the first seven weeks of pregnancy. If blood glucose levels are not under control, there is an increased risk of birth defects and miscarriage. Women with diabetes are urged to bring their diabetes under control for at least three months before getting pregnant and then maintaining good control throughout the pregnancy.

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Take folic acid. Women with diabetes who plan to get pregnant should take 5 milligrams of folic acid daily beginning at least three months before conception, according to the study’s authors. This dose is much greater than the usual recommendation and is available by prescription. Folic acid supplementation helps protect against certain birth defects.

Check for complications. You and your doctor need to have a good handle on the state of any diabetes complications you may have as well as other health issues that can impact your pregnancy. That includes an assessment of high blood pressure, kidney function, nerve function, vision problems, and heart disease. If you have type 1 diabetes, a thyroid function check also should be on the list.

Review medication and supplement use. If you are using antidiabetes medications or any other drugs, as well as any natural or herbal supplements, you need to reveal them all to your doctor and evaluate them.

Some medications prescribed to treat diabetes and diabetic complications may be harmful during pregnancy, including statins for high cholesterol, ACE inhibitors for hypertension, and angiotensin II receptor blockers (ARBs), which are used to treat high blood pressure, heart disease, and for slowing the progression of kidney failure in people who have diabetes. In addition, numerous herbal remedies should not be taken during pregnancy, so be sure to check all of the supplements you take.

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Limit your weight gain. If you are overweight or obese at the beginning of your pregnancy, your doctor will work with you to limit the amount of weight you gain to about 15 to 25 pounds. If your weight is at a healthy level when you get pregnant, you can expect to gain up to 35 pounds. You may need to work with a diabetes educator or dietician to help you keep your weight at a healthy level during your pregnancy.

Keep moving. Daily exercise is an essential part of any diabetes management program, and that does not change with pregnancy. In addition to helping you keep your blood glucose values in line, daily exercise can relieve stress, assist with weight control and blood pressure, and keep you in good physical shape for a healthy delivery. Walking is the most popular and convenient exercise for many pregnant women, but you should talk to your doctor about other activities such as swimming, yoga, jogging, rowing, and light resistance training.

The bottom line is this: if you have diabetes and are pregnant, you need to take proactive steps to keep your disease under control. When you do, you can help ensure the safety and health of your baby and reduce your chances of encountering potentially deadly outcomes.

Study Reference
Tennant PWG et al. Pre-existing diabetes, maternal glycated haemoglobin, and the risks of fetal and infant death: a population-based study. Diabetologia 2013; doi:10.1007/s00125-013-3108-5

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