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A coordinated treatment program for women with preexisting or pregnancy-related diabetes is giving moms peace of mind and babies a safer start in life.
“Much of your baby’s fetal development occurs in the first eight weeks of pregnancy,” says maternal fetal medicine (MFM) specialist Meredith Rochon, MD, with LVPG Maternal Fetal Medicine. “Women with type 1 or 2 diabetes should always get pre-pregnancy counseling before they get pregnant to optimize their health and baby’s health.”
Some diabetes medications pose risks to the developing fetus during pregnancy, but there are alternatives. The Comprehensive Diabetes in Pregnancy Program (CDIPP) is designed to give women with preexisting diabetes the specialty care they need to manage their high-risk pregnancy.
“Diet, weight, and ethnicity all play a part in a women’s risk for diabetes, as does advancing maternal age,” says Marc Vengrove, DO, with LVPG Endocrinology. “It’s important to seek professional help to get blood sugar under control before pregnancy. Higher blood sugar going into pregnancy increases the chance of birth defects.”
Some women don’t realize they have diabetes until they are diagnosed during pregnancy. Yet diabetes during pregnancy poses risks for both mom and her baby. Moms with longstanding diabetes are at risk for their own baseline complications affecting the cardiovascular system, kidneys, and eyes. While babies can be at risk for congenital defects and birth defects.
Gestational diabetes, which occurs during pregnancy is also on the rise. About six percent, or 1 of every 16 pregnant women, will develop it. High-risk women are screened in the first trimester, while others will be screened between 24-28 weeks.
Here’s what you need to know about diabetes in pregnancy:
Preexisting diabetes (types 1 and 2)
- MFM specialists, an endocrinologist and other members of the care team will coordinate your care jointly in one central location.
- You should have pre-pregnancy counseling to understand the risks and treatment requirements for women with preexisting diabetes.
- Some diabetes medications aren’t safe during pregnancy. You may need to transition to insulin or have your medication adjusted to maintain tight control.
- Medication may include short-acting insulin prior to each meal and long-acting insulin once or twice a day. You may need increased insulin as your pregnancy progresses.
- New insulin pumps and continuous blood glucose monitors make it easier to monitor blood sugars.
- Tight control of blood sugar before and during pregnancy can help prevent health complications in mom, and miscarriage, birth defects, congenital malformations and other issues in baby.
Gestational diabetes
- MFM specialists, specially educated nurse practitioners and dietitians will work with you to control diabetes that occurs as a result of pregnancy.
- Losing weight and exercising before you become pregnant may help you avoid gestational diabetes.
- You will receive diabetes education, a glucose meter and nutritional counseling from a registered dietitian who specializes in pregnancy nutrition.
- A nurse practitioner will review your food logs and blood sugar numbers to see how well your blood sugar is controlled.
- About 50 percent of women will be able to manage gestational diabetes through diet management and blood sugar monitoring four times a day. The other half may need medication.
- Risks include stillbirth, abnormal fetal growth, birth defects, shoulder and other injuries during vaginal labor. Moms are at risk for Caesarean section, preeclampsia, obstetrical hemorrhage, and type 2 diabetes.
“We know a lot about managing diabetes in pregnancy,” Rochon says. “Treatment has been revolutionized over the past 15 years. We now have a lot of great tools to help women be successful. It’s a lot of work for patients, but we’re here to provide the emotional and physical support to help moms through.”