Diabetes and pregnancy: planning, care and checks before and after

Many women with diabetes have healthy pregnancies, and good planning and care make a real difference. This article explains what MedlinePlus, the NIDDK and the NHS say about diabetes before and during pregnancy. It is general information, and your own care team will tailor advice to you. For diabetes that begins in pregnancy, see our separate article on gestational diabetes.

Why plan ahead?

MedlinePlus says the ideal time to bring blood glucose under control is before pregnancy, because high levels can harm a developing baby in the earliest weeks, often before a woman knows she is pregnant. It advises seeing your provider before trying to conceive to talk about diet, physical activity and which diabetes medicines are safe in pregnancy. The NIDDK says women planning pregnancy, especially those with risk factors, should be tested for type 2 diabetes. Do not stop or change prescribed medicine without talking to your doctor.

Possible effects on pregnancy

MedlinePlus lists these possible effects:

• For the mother: a higher risk of pre-eclampsia, which is a sudden rise in blood pressure, and of caesarean delivery because the baby is more likely to be large. Glucose levels may shift, so diet, activity or medicine may need to change, and existing complications may worsen.
• For the baby: a higher risk of birth defects if glucose is high early, preterm birth, breathing problems and low blood glucose after birth. Later, the child faces higher risks of obesity and type 2 diabetes. Miscarriage and stillbirth risks also increase.

These are possibilities, not certainties. Good care aims to lower these risks.

Care during pregnancy

MedlinePlus says management includes:

• A healthy diet and regular physical activity, with diabetes medicines added if needed
• Regular prenatal check-ups
• Prenatal vitamins
• Avoiding alcohol, tobacco and illegal drugs

The NIDDK says some medicines are not safe in pregnancy. For example, it says certain blood pressure medicines used to protect the kidneys are not safe during pregnancy, so tell your doctor if you are planning a pregnancy or are pregnant.

Eye checks

The NIDDK says pregnancy can worsen existing diabetic retinopathy. It advises a dilated eye exam before pregnancy or within the first 3 months, with possible repeat exams later, until the baby is 1 year old. It adds that gestational diabetes usually does not cause eye problems.

Testing in pregnancy

The NIDDK says that if you are already pregnant and may have undiagnosed diabetes, testing can be done at the first prenatal visit or within the first 15 weeks. Pregnant women without a diabetes diagnosis are tested for gestational diabetes at 24 to 28 weeks. A1C may be unreliable in the second or third trimester, so other tests may be used.

After the baby is born

If diabetes was present before pregnancy, MedlinePlus says your provider will monitor your glucose and adjust your management plan as needed. If you had gestational diabetes, testing for type 2 diabetes should be done 4 to 12 weeks after birth, and then every 1 to 3 years, even if results are normal. The NHS suggests a blood test 6 to 13 weeks after birth, then yearly if normal.

Questions to ask your team

• Which of my medicines are safe to continue while I try to conceive?
• What glucose targets should I aim for?
• When should I have my eyes and kidneys checked?
• Who do I call if my sugars are unusually high or low?

When to see a doctor

Book a pre-pregnancy visit as soon as you think about conceiving. During pregnancy, contact your team about readings that are often out of range, vomiting, or symptoms that worry you.

Seek emergency help for fainting, seizures, trouble breathing, or fruity-smelling breath. In an emergency, call your local emergency number (112 in India, 911 in the United States).

This article is for education only and does not replace advice from your own doctor or midwife.