Approximately 1 in 1000 pregnant women in the United States have diabetes requiring insulin treatment prior to pregnancy. Another 3% to 12 % develop diabetes for the first time during pregnancy– commonly known as gestational diabetes. With both types, it is critical to the health of BOTH the expectant mother and fetus, to control the blood sugar level in an effort to reduce the risk of serious complications.

Women with poorly controlled diabetes are several times more likely than non-diabetic women to have a baby with a serious birth defect (involving specifically the heart, lower limbs, brain/spine). Additionally, they are at increased risk of miscarriage, stillbirth, or having their baby susceptible to birth injuries. Babies of diabetic women have an increased incidence of health problems arising in the newborn period, including jaundice (yellowing of the skin), low blood sugar, breathing problems and abnormal blood chemistries.

Today, most pregnant women with diabetes can look forward to having a healthy baby. Advancement in the management of these pregnancies complicated by diabetes has significantly reduced the risks associated with this disorder. The diabetic pregnant woman can do much to improve her chances of having a healthy baby.

Preconceptual Care
Diabetic women should consult their doctors prior to pregnancy to ensure that their blood sugars are well controlled. It is extremely important to do this before conception, as most serious birth defects associated with diabetes occur in the earliest weeks of pregnancy, often before the woman realizes she is pregnant. Studies have shown that in women with diabetes existing prior to pregnancy, (pre-gestational diabetes); blood sugar control reduces the risk, not only of birth defects, but also of miscarriages, stillbirths, and complications in the newborn period. Folic acid supplementation, in a dose of 1 mg/day, is very important to take in the preconceptual period to reduce the incidence of neural tube defects – (defects along the baby’s brain/spinal cord).

Screening for Gestational Diabetes
Diabetes discovered during pregnancy, (gestational diabetes), occurs in approximately 10% of all pregnancies, and is one of the more common pregnancy complications. Its development usually occurs during the second half of the pregnancy, when the hormones interfere with the body’s ability to utilize insulin. Some women are at increased risk of gestational diabetes; these include women who are obese, have a strong family history with diabetes, are over the age of 30, have had a large baby (more than nine pounds) or have had a stillbirth.

The American Diabetes Association recommends screening for gestational diabetes for all pregnant women. The screening test, the 1-hour glucola test, involves taking a blood sample after consuming a drink containing 50 grams of glucose (sugar); this test is usually performed between the 24th-28th week of pregnancy. Women with an abnormal test will be asked to take a similar, yet longer test known as the 3 hour glucose tolerance test, which involves drawing blood in the fasting state, and then 1, 2, and 3 hours after drinking 100 grams of glucose.

Once gestational diabetes is diagnosed, most women may control their blood sugar by diet, although a certain percentage may require insulin. All pregnant diabetic women should follow a special diet such as recommended by the ADA; it is important that a dietary consultation be initiated. The diet helps to utilize insulin in the body and decreases periods of high and low blood sugar. Pregnant diabetic women should also monitor their blood sugars four times daily; insulin dosage is adjusted in relation to how well glycemic status is maintained. After delivery, blood sugar levels usually return to normal. It should be kept in mind that women with gestational diabetes are at increased risk of the recurrence of gestational diabetes with future pregnancies or the development of overt diabetes later in life.

Pregnancy Complications
Women with diabetes, particularly poorly controlled pre-existing diabetes are at increased risk of developing pregnancy complications. All pre-gestational diabetic women should have their eyes examined as they are at increased risk of diabetic retinopathy (blood vessels grow abnormally into the retina causing detachment—resulting in blindness); additionally depending on the duration of their diabetes, evaluation of heart and kidney function is important. Evaluating the baby’s heart while in utero is performed between 20-22 weeks of gestation to ensure normal development. Pregnancy induced hypertension; preeclampsia, polyhydramnios (excess amniotic fluid) and abnormalities of fetal growth are among some of the more common complications encountered. Typically women begin fetal survillance (fetal heart rate monitoring/ultrasound) in the early third trimester to ensure fetal well-being/ normal growth. While most women with diabetes are at increased risk for cesarean delivery due to large fetal size, most can have a normal vaginal delivery.

While the risk for diabetes has been significantly reduced, it has not been eliminated. Diabetic women must see their doctor more often than non-diabetic women, follow their diet, and monitor their blood glucose diligently. The patient, her physician and dietician should all work together to ensure healthy pregnancy outcome.