Getting Things Under Control
Once upon a time, doctors told women with diabetes they were better off not having kids. But today, there have been such advances in our understanding of insulin and diet management that a healthy pregnancy and successful delivery is an excellent bet for the woman who has diabetes and wants to have a baby. Of course, it's all in the planning.
If you have diabetes and want to become pregnant, you'll need to seek preconception counseling and start on a regimen that will keep both you and your baby safe, once pregnancy occurs. The main issue with diabetes is getting things under control with your blood sugar well in advance of conception and maintaining good sugar control throughout your pregnancy.
According to Robert Meloni, M.D., a fellow of the American College of Endocrinology, a woman who wishes to conceive should ideally have achieved "excellent blood sugar control" within half a year prior to conception. "It takes time to get everything together—diet, exercise, insulin—in the proper proportion for continuous, excellent control," says Meloni.
Diabetes-related birth defects tend to occur during the time before a woman is aware she has conceived. These birth defects are a response to the high levels of maternal blood sugar during the first two weeks of gestation. No amount of careful sugar control can counteract these early-to-occur birth defects. This is the main reason for making sure your blood sugar is under control well before conception.
Meloni states that diabetes doesn't interfere with fertility unless blood sugar is in "very poor control" or out of control altogether. Instead, birth defects due to diabetes come from poor preconception blood sugar control, such as in the case of macrosomia or large baby over the weight of 9.5 pounds. Other diabetes-related birth defects include immature lungs, malformations of the central nervous or cardiovascular systems, and cleft palate.
The reason that babies born to mothers with diabetes are sometimes very large is due to the fact that mom's blood sugar feeds the developing fetus a nonstop supply of glucose by way of the placenta. The result of this overfeeding is an increase in growth, which manifests as stores of fat. In turn, the baby tends to develop his own too-high insulin levels. This state of affairs may in turn, lead to severe postpartum hypoglycemia in which the baby's insulin levels continue to remain high even after the birth while the mother's glucose no longer has any counteractive effect.
But there are risks to the mother, too. Diabetes that is poorly controlled puts a pregnant woman at risk for early miscarriage. The rate of early miscarriage is twice as high in women with out-of-control diabetes.
Diabetes that is not under good control can also lead to a worsening of the diabetes condition during pregnancy which can lead to complications like retinopathy and neuropathy.
Meloni recommends that women with diabetes who want to conceive first get as close as they can to their ideal body weight, follow a careful diet for sugar control, and avoid both hyperglycemia and hypoglycemia.