Patients who are considering getting pregnant but have diabetes should be aware of some health concerns and extra steps they should take for a healthy pregnancy. On an episode of Healthful Woman, Dr. Jennifer Lam-Rachlin explained some need-to-know information for type 1, type 2, and gestational diabetes in pregnancy. You can listen to that episode on HealthfulWoman.com or your favorite podcast platform, or continue reading to learn more.
Pregestational Diabetes vs. Gestational Diabetes
It’s important for patients to understand the difference between gestational diabetes and pregestational diabetes. Dr. Lam-Rachlin explains that “the easiest way to differentiate or define both of them would be pregestational diabetes is diabetes that was diagnosed before you got pregnant and, classically, we think of gestational diabetes as diabetes being diagnosed at really any point in the pregnancy.” So, women who have existing type 1 or type 2 diabetes before and after their pregnancy are considered to have pregestational diabetes. Other women may develop gestational diabetes during their pregnancy, which typically resolves after the birth. Gestational diabetes typically carries a lower risk of serious issues like birth defects or miscarriage compared to pregestational diabetes.
Risks of Diabetes in Pregnancy
The initial concerns in pregnancy for patients with pregestational diabetes are increased risk of miscarriages and birth defects. According to Dr. Lam-Rachlin, “the organs are formed very early in pregnancy. So, [if] someone has diabetes and it’s not well controlled and her A1C is high and her sugars are high, and she gets pregnant, even if we quickly sort of recognize that and try to correct it, it may take several weeks and by then the organs may be formed, or in this case, malformed, there may be a malformation or a birth defect.” This means that it is incredibly important for patients to make sure their blood sugar is under control before getting pregnant. Women will well controlled sugars (e.g. normal A1c) prior to conception will generally have a pregnancy outcomes similar to those who do not have diabetes.
Patients with pregestational diabetes are also at increased risk of adverse pregnancy outcomes including but not limited to preeclampsia of pregnancy, macrosomia (aka “large baby”), and/or Cesarean delivery.
Diabetes Care Before and During Pregnancy
Most patients who have type 1 diabetes have had the condition since childhood, and therefore are used to and aware of what they need to do to manage their diabetes by monitoring their blood sugar and taking insulin or medication. Patients who have been more recently diagnosed with type 2 diabetes may require more education initially on daily glucose monitoring and insulin teaching (if required).
Patients with pre-gestational diabetes should inform their endocrinologist and/or their OB/GYN on their desire for pregnancy in the near future and work closely with their doctors optimize their treatment regimen by checking their blood sugar daily and taking medication, such as insulin, before getting pregnant. Increase medication dosage, such as insulin, are often times necessary throughout the pregnancy. The increase in glucose values in pregnancy if not monitored can increase the risks of adverse pregnancy outcomes. Patients with type 1 diabetes are more sensitive to these increases in glucose which can result in a rare but life-threatening condition called diabetic ketoacidosis (DKA). DKA can also rarely occur amongst patient with type 2 diabetes. Therefore, close monitor of daily glucose by specialists such as endocrinologist and/or maternal fetal medicine specialist during the pregnancy is recommended.
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Carnegie Imaging for Women blogs are intended for educational purposes only and do not replace certified professional care. Medical conditions vary and change frequently. Please ask your doctor any questions you may have regarding your condition to receive a proper diagnosis or risk analysis. Thank you!