Pre-existing Diabetes and Pregnancy

Women with pre-existing diabetes (diabetes prior to pregnancy) can have healthy pregnancies and babies. They are no longer discouraged from having children; however, there are important things you need to know to help you have a healthy pregnancy.

First of all, follow general recommendations for healthy pregnancy, healthy diet and exercise, avoid smoking, alcohol and drugs, get appropriate dental care, etc.

Risk for miscarriage and birth defects is highly dependent on your glucose control when you get pregnant. The higher the glucose levels, the higher the risk for miscarriage and birth defects. Meriter Perinatal recommends your a1c be 6.5 or less before you conceive, but it is also important to have glucose control with a minimal amount of extreme high and low glucose levels.

Medication changes may be recommended prior to pregnancy. Some medications given for diabetes and diabetes related conditions cannot be used during pregnancy. Prenatal vitamins and extra folic may be recommended.

Complications of diabetes (if they exist) for the woman (heart, kidney, eye complications, etc.) can worsen during pregnancy. It is important to have all diabetes screenings for complications completed just prior to pregnancy.

Care of a woman with diabetes during pregnancy is more complex due to the many risks. More appointments and tests are required than for an average woman during pregnancy. Most women with diabetes during pregnancy will have at least some care from specialty OB providers. Much of the risk to mother and baby can be reduced to a minimum with proper care prior and during pregnancy. Insulin needs will usually double or triple during the course of pregnancy during a time when normal glucose levels are needed to maintain a healthy pregnancy. Planning ahead for this time of increased focus on diabetes can help lessen the stress and difficulty.

For these reasons, it is suggested that all women use a reliable method to prevent pregnancy until glucose levels are in the recommended range and see qualified health providers to discuss pregnancy prior to becoming pregnant. Women with diabetes should know who they will receive care from if they become pregnant and who to contact if an unplanned pregnancy occurs. Care should be provided immediately to provide assistance with glucose control and address other issues at the earliest opportunity. Continued help from diabetes experts will be needed to help maintain tight control of diabetes throughout the pregnancy. Many other complications can occur if tight control is not maintained including having a large baby, extra amniotic fluid, preterm labor, increased risk of baby needing intensive care at delivery for various reasons, and more. Again, all risks can be greatly reduced if normal glucose levels are maintained throughout the pregnancy.

The Meriter Center for Perinatal Care offers pre-pregnancy through postpartum care for women with diabetes. Pre-pregnancy care includes consultation with UW Maternal Fetal Medicine physicians and a Certified Diabetes Educator who is an Advance Practice Nurse, Board Certified in Advanced Diabetes Management. The program provides frequent appointments and the latest strategies to assist women in meeting pre-pregnancy glucose targets necessarily for a healthy start to pregnancy.  

For more information on pre-pregnancy diabetes counseling please visit the following links.

Diabetes Pre-Pregnancy Counseling

CDC-Diabetes and Pregnancy

The Meriter Center for Perinatal Clinic phone number is 608-417-6667 and provider referrals can be faxed to 608-417-6364.

Sincerely,

April Eddy, RN, CNS, CDE (APNP)
Diabetes Clinical Nurse Specialist for Perinatal Services

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