The Center for Perinatal Care & Resident Continuity Clinic
Diabetic Pre-Pregnancy Counseling

Why Is Diabetes Pre-Pregnancy Counseling Important?

Having a baby and deciding to become a parent is a big decision. Most women with diabetes can have healthy babies, but it's important to get the facts in order to reduce the risk of problems and anticipate the demands of a high-risk pregnancy.

Learning about the care that is involved for diabetes during pregnancy can help women make informed decisions about when to have a baby, how to plan for a healthy pregnancy, and what to expect during pregnancy.

What is Pre-pregnancy Counseling?

• Talking with your primary care doctor/endocrinologist about diabetes and your desire for pregnancy or contraception
• Working with a team of diabetes specialists who are knowledgeable about diabetes and pregnancy care
• Talking with your doctor about health risks for you and your baby
• Planning the best time to have a baby

How Does High Blood Glucose Before and During Pregnancy Affect My Baby?

When a mother's blood glucose is high, her baby is at risk for:

• Birth defects, especially of the heart and spine
• Miscarriage or stillbirth
• Abnormally small or large in size
• Too much amniotic fluid, which can cause discomfort and lead to preterm labor
• Jaundice
• Problems controlling glucose and electrolyte levels
• Problems breathing after birth

How Can Diabetes Affect Me During Pregnancy?

• Diabetes damages blood vessels in the eyes, kidneys, etc. If diabetes has damaged eyes or kidneys before pregnancy, these problems may get worse with pregnancy
• Diabetes also puts women at risk for high blood pressure during pregnancy
• Women with type 1 diabetes are at higher risk for developing diabetes ketoacidosis during pregnancy

What Can I Do Before Pregnancy to Decrease My Risks?

• See a specialist who is experienced with diabetes and pregnancy care
• Do not become pregnant until your blood glucose is well-controlled (check with your provider regarding specific glucose and A1c goals)
• Make sure you've had a complete physical, dental exam, dilated eye exam and kidney screening in the last year
• Monitor blood glucose before and either 1 or 2 hours after meals
• Switch to medications that are suitable for pregnancy; this may mean switching from diabetes pills to insulin
• Take prenatal vitamins when you decide to try to become pregnant
• Stop smoking, consuming alcohol, or using recreational drugs
• Share what you have learned with family and friends

What Other Kind of Information Will I Need to Know?

• When and where to obtain care during pregnancy
• What to expect when you have diabetes and are pregnant
• Changes involved with caring for your diabetes during pregnancy, managing morning sickness, etc.
• Nutritional needs, weight gain goals, exercise recommendations
• Changing medications for pregnancy
• Increasing frequency of doctor and other medical appointments, including ultrasounds and other diagnostic tests

What if I've Decided Not to Become Pregnant at This Time?

• Remember that it is always important to take care of your diabetes!
• Find out about contraception and what to do if an unplanned pregnancy occurs
• Have a complete physical each year, along with diabetes screenings of the eyes, kidney, and cholesterol levels
• See your doctor at least twice each year for diabetes care
• Have your A1c—measured every three to six months (recommended A1c goal when not pregnant is 6.5)
• See your dentist twice a year
• Exercise and eat healthy
• Stop smoking cigarettes and/or using recreational drugs; use alcohol with caution and discuss the guidelines for this with your healthcare provider
• Do your best to find coping mechanisms to handle stress and lead a happy, balanced life

How Can I Take the Next Step?

The Center for Perinatal Care at Meriter Hospital helps women greatly reduce the risk of problems during pregnancy. We recommend pre-pregnancy counseling for all women with diabetes that is preexisting including pre-diabetes, type 1 diabetes, type 2 diabetes and cystic fibrosis related diabetes. Improving glucose control to normal levels and other pre-conceptional (pre-pregnancy) care helps to decrease risk for miscarriage and birth defects associated with diabetes.

Our diabetes and pregnancy program team consists of maternal-fetal medicine doctors, nurses, a diabetes nurse specialist, dietitian, social worker and others who can assist you in having a healthy pregnancy and baby. For more information, visit the Our Staff section. Our diabetes self-management education program is dedicated to helping you obtain your goals.

If you are interested in having diabetes pre-pregnancy counseling, contact your doctor for a referral to Meriter Hospital's Center for Perinatal Care. Our phone number can be found in the Contact Us section.

3/8/2007