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PREGNANCY, YOUR BABY,

AND DIABETES

THIS TOPIC IS DIVIDED INTO TWO MAIN SECTIONS:

Pre-pregnancy and Diabetes

Pregnancy for the Woman with Diabetes

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Pre-pregnancy and Diabetes

•Choosing to have a baby is a big

decision and an exciting time. It

may also be a time when you are

more concerned about your health

if you have diabetes.

•Today, the chances are better than

ever that a woman with diabetes

will have a healthy baby. Keeping

blood sugar levels near the target

range before and during pregnancy

helps to ensure a positive outcome

of your pregnancy.

•What are the target blood sugar

values for the non-pregnant

woman with diabetes?

–Fasting: 70 -130 mg/dl

–Before meals: 70 -130 mg/dl

–HbA1c< 7%

•A careful balance of your meal

plan, activity, and insulin needs to

be achieved and maintained before

and during pregnancy.

•Having diabetes increases the risk

of problems for you and your baby.

During pregnancy, the sugar in

your blood goes to the baby so it

can grow and develop. If your

blood sugars are too high, they can

cause birth defects and other

problems.

•Because the baby’s organs are

formed during the first 12 weeks of

life, the risk for birth defects is

greatest if blood sugars are poorly

controlled during the first trimester.

•You can reduce your risks of birth

defects to that of someone that does

not have diabetes by having a

normal HbA1c and blood sugars

consistently in your target range

before you become pregnant.

•You will need to continue to use

contraceptives until your blood

sugars are in the target range and

your HbA1c is normal. This test

gives you a three month average of

your blood sugars.

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Controlling Your Blood

Sugar Before Pregnancy

•It is a good idea to begin working before pregnancy with the health care team

who will provide your prenatal care. This team includes an obstetrician,

pediatrician, nurse educator, and dietician. Pregnancy can bring out some of the

long term complications of diabetes. Get a check up now of your eyes, kidneys,

heart, and BP.

•If you take oral diabetes medications, you will stop taking them and begin

taking insulin. Oral medications and Glargine insulin may be harmful to the

developing fetus. ACE inhibitors (for kidney disease) should also be discontinued

when you become pregnant. Your doctor will decide on the best substitute

medication for you.

•Your insulin needs may increase, or you may take more than one type to meet

your blood sugar target goals. Two to four injections/day is common before and

during pregnancy.

•Meet with a dietician to develop a meal plan.

•If you have a regular exercise program, continue it. You will need to test more

often when you exercise. You may need an exercise snack before, during, or after

exercise.

•You will need to test and record your blood sugars at least 4 times a day to be sure

your target ranges are working.

•Once your blood sugars are lower, you may experience more low blood sugar

reactions, so you need to carry at all times a quick-acting source of sugar such as

glucose tablets, gel, or hard candies.

•Cigarette smoking and alcohol are harmful to your unborn child. If you smoke,

stop smoking. Alcohol and caffeine should be avoided during pregnancy.

Page 4 of 15

Other Considerations

There is very little chance your baby will be born with diabetes.

If you have type 1 diabetes, there is a 1 -2% chance that your

child will develop diabetes over his or her lifetime. Men with

diabetes have a 6% chance of having a child with diabetes. If you

have type 2 diabetes, there is a 30% chance your child will get

diabetes as an adult.

•There is no ideal age to become pregnant. Women between the

ages of 20 -35 years have fewer health risks.

•A pregnancy is very demanding when you have diabetes. This

can be a stressful time for you. It takes knowledge, time, effort,

planning, and money for the extra health care cost. You may

need to take time off from work or arrange for help caring for

other children or with housework.

Now is the time to talk and

plan with your partner and

other supporting people

about the demands of

pregnancy and diabetes.

Page 5 of 15

Pregnancy for the Woman

With Diabetes

•Women with diabetes are affected

by all of the normal changes that

occur during a pregnancy. Some of

these changes can cause problems

with blood sugar control.

•The amount of sugar lost into the

urine increases. Therefore glycosuria

or sugar in the urine can occur with

normal blood sugar levels.

•All women produce Ketones more

easily during pregnancy. Ketones

result when body fats are broken

down for energy instead of sugar. So

ketosis and diabetic ketoacidosis or

DKA can occur more rapidly in

women with diabetes when they are

pregnant. Ketones cross the placenta

and affect the fetus. This can be

avoided if blood sugars are in good

control.

•The placenta, the organ that feeds

the baby, produces hormones that go

against the action of insulin. These

hormones increase as pregnancy goes

on. This leads to a change in insulin

needs during pregnancy. You will

need more insulin as the weeks go by.

•When you have an infection such as

a cold, the need for insulin increases

and the risk for DKA increases. Test

your urine for Ketones if your blood

sugar is greater than 200mg/dl.

•Diabetes increases the risk for

certain problems in the mother and

baby:

–preeclampsia (a combination of

high blood pressure, protein in

the urine, and swelling in the

hands, face, and feet).

–urinary tract infections

–hydramnios or too much water

in the sac around the baby,

which may cause the uterus to

stretch and may lead to early

delivery. This occurs in 25% of

diabetic pregnancies. Bed rest is

recommended.

–large babies at birth (over 9

lbs)

–low blood sugar and breathing

problems in the baby after birth

–stillbirth

–while it is frightening to hear

about these possible problems, it

is important to know why blood

sugar control is so vital.

Keeping your blood sugar target

range near normal will help

prevent these problems.

Page 6 of 15

Caring for Diabetes During Pregnancy

•The target blood sugar level for pregnancy is:

–60-95 mg/dl fasting before breakfast

–60-105 mg/dl before other meals

–less than 120 mg/dl 90 minutes to 2

hours after meals

–above 60 mg/dl during the night

•Your prenatal care will probably be provided by a team of health

professionals. The team includes an obstetrician, endocrinologist,

nurse educator, dietician, and perhaps a social worker.

•You may need to visit your doctor as often as every other week

during the first and second trimesters, and then every week until

delivery.

•Test and record your blood sugar levels. Use this information to

see how the food you eat, your activity, and your insulin affect

your blood sugar levels. Bring your record with you to each of

your appointments.

•Follow your meal plan as prescribed by your dietician.

•Your insulin dosage will change often, especially during the last

half of pregnancy.

Page 7 of 15

Gestational Diabetes:

Diabetes Discovered

During Pregnancy

•This type of diabetes appears for

the first time during pregnancy. It

occurs in 7-10% of all pregnant

women.

•Women at risk:

–Women who are older than 35

years

–A previous pregnancy with a

baby weighing 9 lbs. or more at

birth

–family history of diabetes or

previous GDM

–overweight – ethnic

background of African

American or Hispanic

•Gestational diabetes, as this is

called, may occur because hormones

produced by the placenta in all

pregnant women may make insulin

work less well.

•These hormones increase as

pregnancy goes on. More insulin is

needed to maintain normal sugar

levels. If the pancreas is unable to

produce enough insulin, gestational

diabetes occurs.

•Gestational diabetes is usually

found in the 24-28 week of

pregnancy. A special screening

blood test is done at that time called

a glucose tolerance test.

•Gestational diabetes does increase

the risks of certain problems for

the mother and baby. The risks are

greatest in the last trimester and if

the blood sugar levels are not well

controlled. Some of the problems

are:

–large babies at birth (>9 lbs)

–low blood sugar and breathing

problems for the baby after

birth

–jaundice or yellowish skin in

the baby 2-3 days after birth

(temporary)

–stillbirth

–hydramnios (too much water

around the baby) which may

cause the uterus to stretch and

may lead to early delivery

–preeclampsia (a combination

of high blood pressure, protein

in the urine, and swelling of the

hands, face, and feet)

–urinary tract infections

–gestational hypertension

–vaginal yeast infections

•After pregnancy, the symptoms of

diabetes usually disappear. You need

to have your blood sugar tested

following delivery to be sure you no

longer have diabetes.

Page 8 of 15

Caring for Gestational Diabetes

•The purpose of the treatment is to keep the blood sugar near the target

range. The target blood sugar levels for pregnancy are:

–fasting: less than or equal to 95 mg/dl

–90 minutes to 2 hours after a meal: less than or equal to 120 mg/dl

–This may vary depending on your individual needs.

•The first treatment is a meal plan and exercise with

blood sugar monitoring daily.

•Insulin injections may later be needed for better

blood sugar control.

•Test and record your blood sugar levels. Use this

information to see how food, activity, and insulin

affect your blood sugar. Bring this record with you to each of your

appointments.

•You will be asked to visit your obstetrician more often than women

without gestational diabetes. It is very important that you keep your

appointments. You may be referred to a specialist in diabetes or high-

risk pregnancies.

•After pregnancy, the symptoms of diabetes usually disappear. Only 2%

continue to have diabetes immediately after delivery. You must continue

to seek medical care if this is so. You will have another GTT at your

post-partum visit to make sure that your blood sugars are back to

normal.

•If you no longer have diabetes and you plan to become pregnant again,

you should have a screening blood sugar test before your pregnancy and

once you are pregnant.

•Type 2 diabetes is likely to return later in life. If you are at your ideal

body weight, you have a 25% chance of developing type 2 diabetes. If

overweight, your chances increase to 60%.

Page 9 of 15

More About Controlling

Your Blood Sugar

DIET • Eating meals and snacks spread

out throughout the day and at

bedtime will help to keep your

blood sugar levels in the target

range.

• Do not go on a weight-reduction

diet. More calories are needed to

meet the energy needs of the baby

(300 more calories/day).

• Follow your meal plan as set out

for you by your dietician.

• You will learn about carbohydrate

counting.

EXERCISE • Exercise burns calories, decreases

blood sugar levels, and increases

feelings of well-being.

• Check with your doctor about the

exercise program that is right for

you. Walking and swimming are

good activities.

• Check your blood sugar levels

more often when you exercise. If

you are prone to low sugars, carry

fast acting sugar with you or eat an

exercise snack.

INSULIN • Most women take more than one

injection of insulin per day,

usually with two types of insulin.

This helps keep the blood sugar in

the target range.

• You will be taught how to inject

insulin and you may be taught to

adjust your insulin dose based on

your blood sugar readings and

carbohydrate meal content.

HYPERGLYCEMIA • Signs and symptoms of

hyperglycemia or high blood

sugar are: • high blood sugar

• Ketones in your urine

• more urine output than usual

• increased thirst

• dry skin and mouth

• decreased appetite, nausea, and

vomiting and blurry vision

• fatigue, drowsiness, or no

energy

• Vaginal yeast infections

• Call your doctor right away if

you have these symptoms. Do

not skip insulin.

Page 10 of 15

Team Care

•At each visit to your obstetrician, your weight, blood pressure,

general health, and growth of the baby will be checked.

•Your urine will be checked each time for glucose, Ketones,

protein, and bacteria.

•Your meal plan will be reviewed with you. Be sure to bring

your blood sugar logbook and meter. You may meet with a

dietitian to learn more about your meal plan or with a nurse to

learn more about diabetes during pregnancy.

•Between visits, write down any questions or concerns you have

so that you remember to ask them during your visits to your

health care team.

•Contact your doctor right away if you notice:

more than trace Ketones in your urine

blood glucose values consistently above target

decreased movement of your baby (less than 4 kicks/hr after 28 weeks)

any infection or illness (fever, nausea, or vomiting)

lower abdominal (stomach) cramps

vaginal bleeding or leakage of fluid

sharp back pain or abdominal pain

burning or pain when passing urine

Page 11 of 15

Team Care Continued...

dizziness, fainting, blurred vision, or spots before your eyes

rapid weight gain

swelling of your hands, face, or feet

low sugar that someone else has to help you treat, or so severe that you

pass out

severe nausea or vomiting with high sugar and Ketones in your urine

Special tests and procedures during pregnancy

‒ An ultrasound test to determine the size, growth, and position of

the baby and placenta, this uses sound waves to measure and it is

safe.

‒ A 24 hour urine test done every so often to test for protein and

creatinine. These tests measure kidney health.

‒ Ophthalmology visit to check the health of your eyes.

‒ Non stress test done periodically to record your baby’s movements

and changes in heart rate. How often depends on how well your

diabetes is controlled.

‒ Drawing of your blood to measure A1C or 3 month average of

your blood sugars.

‒ Quadruple screen is a blood test done at 16 -18 weeks of

pregnancy. This gives information about whether your baby is at

high risk for birth defects.

Page 12 of 15

Meal Planning for Diabetes in

Pregnancy

To control your blood sugar, you need to watch what, how much, and when you

eat. It is important to consume balanced meals and snacks, paying special attention

to amounts and types of carbohydrates. Here are some general guidelines.

1. Eat consistently during the day, distributing your carbohydrate choices evenly.

The best way is to eat 3 meals a day.

•Try not to go longer than 4 hours without eating during the day

•Healthy snacks are ok if you become hungry

2. Include a good source of protein at every meal and snack. High protein foods

are:

●Low-fat meats

●Chicken

●Fish

●Low fat cheese

●Natural peanut butter

●Nuts

●Low fat cottage cheese

●Eggs

3. Eat breakfast soon after waking

•Have no more than 2 carbohydrate servings

•It is best to avoid fruit, fruit juice, and cold cereal with milk

•Include some protein and healthy fat

4. AVOID SUGAR AND CONCENTRATED SWEETS. These include:

●Table sugar

●Honey

●Molasses

●Candy

●Jams and jellies

●Cookies

●Cakes

●Regular soda

●Chocolate

● Ice cream

●Fruit canned in heavy or lite

syrup

●Sugar-sweetened drinks (like

Kool-Aid, Hi-C, and sweet tea)

5. Artificial sweeteners may be used to sweeten foods and drinks

•Studies have shown that moderate amounts are safe for you and your baby

6. Choose high fiber foods, such as:

•100% whole wheat bread or “White Wheat”

•Fresh and frozen vegetables

•Beans and legumes

•Fresh fruit

Page 13 of 15

7. White-colored foods may cause your blood sugar to rise significantly. These

foods, and healthy alternatives, include:

8. Lower your total fat intake

•Eat lean sources of protein •Chicken

•Roast beef

•Turkey

•Ham

•Fish

•2% or low-fat cheese

•Look for leaner cuts of red meat, such as round and loin

•Look for less marbling

•Remove all visible fat and skin from meats

•Bake, broil, steam, boil, or grill foods (rather than frying)

•Use skim or 1% low fat milk and dairy products

9. Watch sodium intake

•Limit lunch meat, bacon, sausage, and hot dogs

•Rinse canned beans and vegetables

•Resist the urge to use the salt shaker

•Limit frozen and pre-prepared meals/snacks and canned soups

•Guidelines: < 100 mg for snacks and side dishes and < 400 mg for meals

10. Include small amounts of healthy fats, such as:

•Olive and canola oil (rather than vegetable oil)

•Nuts, peanuts, almonds, and walnuts

•Avocados

11. Food safety is important!

•Avoid undercooked meat

•Avoid shark, swordfish, king mackerel, and tilefish •Limit all other fish to 12 oz. or less per week

•Eat no more than 6 oz. (1 can) of light tuna per week (avoid albacore)

•Cook eggs until done

•Only consume pasteurized milk and dairy products

•Watch out for cross-contamination (i.e. handling raw meat and eggs)

12. Regular exercise can help control blood sugar levels. Try these things:

•Walking

•Swimming

•Housework

•Playing with kids

“White Food”: Try This:

White rice Brown rice

White bread Whole wheat bread

Regular pasta Wheat pasta

Potatoes Sweet potato

Page 14 of 15

Breakfast: 2 Carbohydrate servings

Snack: 1 Carbohydrate serving

Lunch: 3 Carbohydrates servings

Snack: 1 Carbohydrate serving

Dinner: 3 Carbohydrates servings

Snack: 1 Carbohydrate serving

Carbohydrate Food Choices

1 serving = 15 g carbohydrate

Starch

Supplies energy and fiber

An example of a serving is 1 slice of

bread

Fruit

Supplies vitamins, minerals, and fiber

An example of a serving is 1 small fresh apple

Milk

Supplies calcium, phosphorous, protein, and vitamins

An example of a serving is 1 cup of milk (8 oz.)

Page 15 of 15

Sample Menus for Diabetes in

Pregnancy

Breakfast

Breakfast Sandwich 1 poached or scrambled egg

1 whole grain English muffin (2)

1 slice cheese 1 slice Canadian bacon

Oatmeal 1 cup cooked oatmeal (2)

1 tsp Splenda ®

1 tsp cinnamon

¼ cup of nuts

Lunch

Ham Sandwich and Yogurt 2/3 cup light yogurt (6 oz. container) (1)

2 slices low sodium ham 2 slices whole wheat bread (2)

Lettuce and tomato Mustard and/or mayonnaise

Soup and ½ Sandwich 1 cup low sodium vegetable soup (1)

1 slice whole wheat bread (1)

1 slice reduced-fat American cheese

2 oz. deli turkey

1 slice tomato

1 small apple (1)

Dinner

Chicken Fajitas 3 oz. chicken breast 1 6-inch flour tortillas (1)

2/3 cup rice (2)

1 oz. 2% shredded cheese Shredded lettuce 2 Tbl reduced-fat sour cream

Healthier Hamburger 3 oz. hamburger patty

1 hamburger bun (2)

Green salad with non-starchy veggies

1 corn on the cob (1)

1/3 cup salsa

Snacks 3 cups air-popped popcorn (1)

2/3 cup (6 oz.) light yogurt 2 Tbl nuts (1)

6 crackers with 2 oz. tuna (1)

3 graham crackers with natural peanut butter

(1)

1 cup carrot sticks with 2 tbsp low-fat ranch

dressing

½ banana and 1 Tbl of natural peanut butter

(1)

½ cup peaches with ½ cup non-fat cottage

cheese (1)

1 small apple (1) and 1 oz. of low-fat cheese

½ medium baked potato with ¼ cup shredded

2% cheese (1)