Pregnancy and Pre-Existing Diabetes

Pregnancy is a time of wonder and amazement -- and for women with pre-existing diabetes, it is also a time for extremely careful (and sometimes baffling) disease management. How do you plan for this? What risks are involved? What can you expect? The August issue of Diabetes Forecast, the consumer magazine of the American Diabetes Association, features articles about pregnancy with pre-existing diabetes to help. With good care and planning women with either type 1 or type 2 diabetes can have safe pregnancies -- and healthy babies.

If you have diabetes and want to become pregnant, the first step should be visiting your doctor -- or several doctors. Depending on your diabetes management, you may want to see an endocrinologist in addition to your ob-gyn for a pre-conception visit. When choosing your doctors, keep in mind that you may have appointments as often as twice a week, so try to find a physician that you are comfortable with and whose office you are comfortable getting to.

While pre-existing diabetes automatically puts your pregnancy in the high-risk category, healthy habits can lower the chance of problems for both mother and child. First and foremost, keep your blood glucose in check -- in general, your A1C should be below 7 percent before you conceive. Your health care team may also want to discuss your weight, use of prenatal vitamins and other supplements, the status of any diabetes-related complications, and your current medications (such as ACE inhibitors or statins, which are not considered safe for use in pregnancy). Polycystic ovary syndrome is associated with type 2 diabetes, so for some women with diabetes, asking about fertility treatments may also be in order.

Once you become pregnant, your body's changes can make blood glucose levels go from one extreme to the other. "I spent the entire first trimester with my face buried in the fridge," says Kerri Sparling, 31, who has type 1 diabetes and whose daughter was born in April. "I was low all the time. It wasn't until probably the second trimester that the insulin resistance kicked in. Everything I ate, the insulin didn't cover it." As your body changes through your pregnancy, so will its reactions to the elements you normally use to manage your blood glucose, so be prepared to communicate with your health care team often and make any necessary adjustments.

From pre-conception planning to integrating diabetes management into your birth plan and facing post-partum depression, having a baby can seem like an overwhelming task for women with diabetes, and yet, many women with diabetes find they have the best glucose control of their life during pregnancy. "This was so, so important to me that I was willing to do whatever to make sure she came out right," says Sparling. "It's so worth it."

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