If you have diabetes that was diagnosed before or in early pregnancy, you will need to maintain tight control of your blood glucose levels throughout pregnancy to reduce complications. High blood sugar early in pregnancy can cause multiple problems for your baby before, during and after birth. If you have diabetes or are at risk for diabetes, see a health care provider before pregnancy or as soon as you find out that you are pregnant.
Diabetes
Diabetes mellitus is a disease in which your body does not use blood sugar correctly. Insulin is a hormone that helps the cells in your body metabolize blood sugar. If your body does not make insulin or if you do not make enough insulin, high levels of blood sugar circulate in your bloodstream and cause tissue damage. Women with type I diabetes do not make insulin; those with type II diabetes do not make enough insulin or cannot use the insulin their bodies make. Although some women are diabetic before pregnancy, early testing during pregnancy may reveal the diagnosis for the first time.
Some women enter pregnancy without diabetes and have normal blood sugar levels until the demands of pregnancy disrupt their ability to use sugar correctly. A diagnosis of diabetes at any time during pregnancy is considered gestational diabetes, but you may be at high risk of remaining diabetic after delivery if your physician finds indicators that you were diabetic before you became pregnant.
Birth Defects
If your blood sugar is high early in pregnancy because of poor glucose control or undiagnosed diabetes, your baby could be at an increased risk for certain birth defects. If you have type I diabetes, you are 3 times more likely to have a baby with a birth defect, including heart defects, bladder or genital malformations or neural tube defects such as spina bifida. Tight glucose control in the first trimester may help to reduce your baby's risk of birth defects, and adequate folic acid protects against neural tube defects.
Other Problems
High blood sugar in early pregnancy is associated with an increased risk of miscarriage. Poor glucose control can also influence your baby's health throughout your pregnancy. High blood sugar can cause the baby to grow too large before the due date, which can result in a difficult labor and delivery for both you and your baby. Your baby may also be at increased risk of low blood sugar after delivery, as well as an increased risk of stillbirth. Women with diabetes are at an increased risk for preeclampsia, a disease in pregnancy that causes high blood pressure and increases your risk of having seizures or a bleeding problem during pregnancy or immediately after you deliver. Work closely with your health care team to optimize your health and your baby's well-being.
Risk Factors
Although some women know they have diabetes before pregnancy, many others remain undiagnosed until early pregnancy. The March of Dimes estimates that 1 out of 3 women with preexisting diabetes are unaware of their condition. Your doctor or midwife may routinely test you for diabetes, but if you have risk factors for diabetes, you should ask about preconception testing or testing during the first trimester. If you are over 35, obese or have a history of delivering a large baby, you should ask your doctor to test you early in your pregnancy. Early diagnosis will help you control your diabetes and protect your baby.
References
- Medline Plus: Diabetes
- "British Medical Journal": Risk of Complications of Pregnancy in Women with Type 1 Diabetes: Nationwide Prospective Study in the Netherlands; I. Evers et al.; April 2004
- March of Dimes: Preexisting Diabetes; April 2009
- "Diabetes Care": Diagnosis of Gestational Diabetes in Early Pregnancy; DM Super, et al.; April 1991
