Because women in America are not routinely tested for diabetes before they conceive and between each pregnancy, the incidence of preconception diabetes is unknown but it can be estimated by considering risk factors. The 2004 National Health and Nutrition Examination Survey reported that 12 percent of women age 18 to 44 have high blood sugar and 26.5 percent are obese. Having A1C blood testing for diabetes annually means a woman never has to guess.
Type 2 Diabetes
If you're considering having a baby, the time to find out you have diabetes is before you stop using contraception and try to conceive, according to the American Diabetes Association. This is also the time to correct the amount of glucose floating around in the blood, unable to get into the body's cells where it can be used for energy.
Insulin, a hormone produced by the pancreas, is required to move glucose out of the blood and into cells; but when the cells become overwhelmed by the amount of sugar in the diet, or they become resistant against the action of insulin, the glucose stays outside the cells. As a result, you feel chronically tired, and the pancreas works too hard trying to make more insulin.
The test used to determine the percentage of glucose unable to get into cells is called a glycosylated hemoglobin, or hemoglobin A1C, percentage. An A1C up to 5 percent is normal. A level between 5.1 and 7 percent is called a prediabetic state and is a precursor to diabetes because it indicates insulin resistance. At 7 percent, diabetes is diagnosed, according to the National Institutes of Health.
The National Institute for Health and Clinical Excellence, or NICE, Guidelines call for women to reach and achieve an A1C of less than 6.1 percent before becoming pregnant to optimize their own health and that of their future child. During pregnancy, daily blood glucose monitoring replaces A1C testing. After delivery, A1C testing should resume.
Correcting Weight to Correct A1C
More than 80 percent of women with diabetes are overweight or obese. The National Institutes of Health recommend correcting weight to a body mass index of less than 25 or at least losing 5 percent of body weight, as one way to help normalize A1C levels.
A woman who wants to become pregnant should achieve weight loss using a diet that provides a wide variety of nutrient-dense foods, including sources of omega 3 fatty acids, such as olive oil, walnuts, salmon and flaxseed, and foods high in calcium but low in calories, including kale, broccoli, arugula and other dark green leafy vegetables.
During the time of preconception weight loss, the A1C test should be done every two months to make certain progress is being made in managing diabetes as well as weight loss.
A1C Elevation Risks
It is possible to be living with diabetes for many years without being diagnosed.
When the A1C level is above 7 and type 2 diabetes is discovered, other body organs may be affected, including the cardiovascular system, the kidneys and the eyes. Before becoming pregnant, a woman should have each of these systems assessed to determine whether the risks of pregnancy are manageable.
The American Diabetes Association calls for all diabetic women to be informed of the risks involved in pregnancy. These risks include a 40-percent chance of permanent kidney damage to the mother and an increased chance her unborn child will be born with a congenital malformation. These risks can be minimized but are not eliminated when a diabetic woman's preconception A1C is brought to less than 6.1 percent.
- "American Journal of Public Health"; The Prevalence of Metabolic Syndrome Among US Women of Childbearing Age; R Ramos, Ph.D. et al; June 2006.
- Diabetes Care: Preconception Care of Women with Diabetes: January 2008
- National Institutes of Health: Know Your Blood Sugar Numbers
- Biomedical Central: Preconception Care of Women with Diabetes: January 2010