How to Manage Diabetes During Pregnancy

How to Manage Diabetes During Pregnancy

Bringing a new life into the world can be exciting! However, it can also be stressful due to the toll that pregnancy has on an expecting mother’s health. One of these health concerns is gestational diabetes.

During the later phase of pregnancy, the fetus has a higher demand for food supply. As a result, the placenta produces a larger amount of hormones that prevents insulin from doing its job. Mothers who are at risk of developing gestational diabetes cannot adapt to the increased insulin need because the beta-cells cannot make enough insulin to keep up with the increasing demand. Researchers do not completely understand why some women's beta-cells do not make adequate insulin, while others are able to keep up. The insulin-blocking hormones and inadequate production of insulin contributes to the rise of maternal blood glucose. Gestational diabetes is diagnosed between weeks 24 and 28.

Will gestational diabetes affect the baby?

There are risks that will affect the fetus during the pregnancy, at the time of delivery, and once the child is born if blood sugar levels are not controlled. Mothers who experience gestational diabetes are more likely to have a very large baby (9 or more pounds), require a C-section to avoid injuries to the baby, and their baby becomes more likely to develop type 2 diabetes later in life. Therefore, it’s extremely important to maintain good blood sugar control throughout pregnancy. In fact, the parameters for controls are stricter than those of a typical type 2 diabetic (see glycemic targets below).

Will gestational diabetes come back?

A mother who experiences gestational diabetes is more likely to develop type 2 diabetes in the future. However, studies show that women who aggressively manage their diet and exercise can decrease this likelihood. The 2016 Diabetes Guidelines indicate that women who eat a balanced diet that’s low in animal fats and high in fiber are more likely to ward off type 2 diabetes after having gestational diabetes.

Is it different from other types of diabetes?

Gestational diabetes is similar to type 2 diabetes. However, a mother can experience a reprieve from it immediately after delivery, especially if her weight is within a normal range. Lifestyle habits, like exercising regularly before, during and after the pregnancy, eating a balanced diet high in fiber and low in saturated fats, and breastfeeding to improve glucose tolerance can help, as well.

Once a mother has been diagnosed with gestational diabetes, there is a greater likelihood it may appear again with another pregnancy or that she may develop type 2 diabetes in the future.

Glycemic Targets in Pregnancy

The goals for glycemic control for gestational diabetics are based on recommendations from the Fifth International Workshop Conference on Gestational Diabetes Mellitus. Below are the targets for maternal capillary glucose concentrations:

  • Pre-prandial ≤ 95 mg/dL and either
  • One hour post-meal ≤ 140 mg/dL or
  • Two hour post-meal ≤ 120 mg/dL

For pregnant women with pre-existing type 1 or type 2 diabetes, the following are recommended glycemic goals if they can be reached without excessive hypoglycemia:

  • Pre-meal, bedtime, and overnight glucose 60-99 mg/dL
  • Peak post-prandial glucose 100-129 mg/dL
  • A1C < 60%

If a woman can’t achieve the targets listed above without experiencing low blood sugar, the American Diabetes Association (ADA) suggests considering slightly higher targets:

  • Pre-prandial <105 mg/dL (before eating)
  • One hour postprandial < 130–140 mg/dL (1 hour after eating)
  • Two hour postprandial < 120 mg/dL (2 hours after eating)

If a woman can’t achieve these targets without hypoglycemia, the American Diabetes Association (ADA) suggests considering slightly higher targets:

  • Pre-prandial < 105 mg/dL, (before eating)
  • One hour postprandial < 130–140 mg/dL (1 hour after eating)
  • Two hour postprandial < 120 mg/dL (2 hours after eating)

Although oral diabetes medications and insulin are options to control blood glucose, many physicians and mothers with diabetes choose diet and exercise as their first line of defense. The ADA recommends insulin since it won’t cross the placenta however some researchers believe more research is needed for oral medications.

During the course of pregnancy, weight management is key. By the middle of the second trimester, an expecting mother should consume about 300 more calories a day to promote fetal growth and development. Any more than that leads to complications in the mother’s blood glucose values. If a mother requires insulin to their blood glucose, a certified diabetes educator (CDE) or a registered dietitian (RD) can calculate the amount of calories and carbohydrates she needs relative to the amount of insulin being used.

How can a healthy diet help?

Vegetables are the best foods for expecting mothers. They’re packed with fiber, minerals, and vitamins without adding too much carbohydrate to their diets. Fruits, in smaller amounts, are great options, as well!

If you’re pregnant, make sure to get your veggies and protein. Cut back on some of the fats that come with your protein intake after the delivery while still getting enough calories to produce breast milk. Overall, manage your blood sugar strictly and maintain good exercise and diet habits because your little one depends on you and your wellbeing.

And always consult your doctors before making changes to your diet and insulin intake.

Registered Dietitian, Licensed Dietitian, Certified Diabetes Educator


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