Pregestational diabetes is type 1 or type 2 diabetes that has been diagnosed before pregnancy. Women with pregestational diabetes require careful monitoring throughout pregnancy, delivery and the postpartum stage.How Pregestational Diabetes Affects Pregnancy
Management of pregestational diabetes should begin prior to pregnancy. Pregnancy should be carefully planned and the patient in optimal health prior to conception.
Blood sugars require careful monitoring during pregnancy, since insulin requirements can change suddenly. Hypoglycemia is more common during the first trimester, so insulin doses may be decreased during this time.
Managing blood sugar levels during pregnancy is extremely important. Maternal hyperglycemia that occurs during the first 8 weeks of pregnancy places a fetus at higher risk of birth defects because fetal organs are developing during this phase.
Even women with pregestational diabetes whose blood sugar is well controlled throughout pregnancy are at higher risk of complications, including:
- Single or multiple birth defects
- High blood pressure
- Hydramnios – an increased amount of amniotic fluid, which can lead to preterm labor and delivery
- Macrosomia – a very large baby due to too much glucose from the mother. This can lead to a difficult delivery and increase the risk of C-section
Pregestational Diabetes Care During Pregnancy
At your preconception visit, your obstetrician will likely:
- Perform a complete history and physical
- Evaluate whether or not your diabetes is controlled through a hemoglobin A1C blood test
- Discuss the associated risks and how they can be reduced
- Schedule a meeting with a diabetes educator and/or dietician
Throughout Pregnancy your OB/GYN will continue to monitor your blood glucose levels. Your diabetes will probably be managed with the same medications prescribed to you prior to pregnancy. Some women with pregestational diabetes who used an insulin pump will be able to continue, while others may instead require insulin injections. To help manage your diabetes during pregnancy your obstetrician will ask you to:
- Eat a well-balanced diet and avoid skipping meals
- Incorporate regular exercise into your daily routine
- Achieve appropriate weight gain
- Closely monitor your glucose level
In women with pregestational diabetes labor may be induced prior to the due date, particularly if there are complications. Glucose levels will be frequently monitored throughout labor and delivery. An insulin IV or insulin pump may be required.
If you have been diagnosed with pregestational diabetes, with careful management and good blood glucose control, you can have a successful pregnancy.