“I know the pond in which all the little children lie, waiting till the storks come to take them to their parents. The prettiest little babies lie there dreaming more sweetly than they will ever dream in the time to come.” – Hans Christian Andersen
Being a Danish company, we must of course pay tribute to our national treasure, H. C. Andersen, who popularised the idea of storks carrying babies to their parents.
While childbirth is beautiful, it is (unsurprisingly) not quite as simple as having a baby delivered by stork.
As with any pregnancy, a mother needs to take steps to ensure the health of both herself and her baby. Mothers with diabetes need to take further steps; their diabetes should be in check for their pregnancy.
There are three main kinds of diabetes to consider in this case: having type 1 diabetes and being pregnant; having type 2 diabetes and being pregnant; or having gestational diabetes (a kind of diabetes that exists during pregnancy).
Even though there is more to think about with being pregnant and diabetes treatment, you can still have a healthy pregnancy like any other mother. Have a look at what steps we suggest, so that we can help you have a pregnancy that’s almost as smooth as stork-delivery.
Having type 2 Diabetes and being Pregnant
When it comes to diabetes and pregnant mothers – despite the different nature and causes of the kinds of diabetes – the overall steps for the three types of diabetes will actually be fairly similar.
One of the only ways that type 2 diabetes differs in this case is how treatment changes at the beginning of pregnancy.
Some people with type 2 diabetes treat themselves purely with diet and exercise, while some treat themselves with diabetes pills or insulin injections.
Expectant type 2 mothers who take pills might be recommended a change to insulin injections.
This is because pills that are ingested might cross the placenta and affect the baby. Meanwhile, insulin injections have no effect on the baby.
Additionally, insulin injections can allow more precise control of high blood sugar. More control is important because the changing hormones can impact blood sugar levels a great deal.
Keep on reading for more general steps for being pregnant and diabetes treatment!
First of all: what is gestational diabetes? It’s a form of diabetes that only exists during pregnancy. It happens because the body becomes resistant to the effects of insulin – the same reason for type 2 diabetes.
The placenta makes hormones that can block the effect of insulin to a certain extent. This is what can lead to insulin resistance, and can be responsible for gestational diabetes.
There are a number of reasons why a mother might be more prone to gestational diabetes, such as genetics or being overweight.
If you’re pregnant, your doctor will screen for gestational diabetes if you have a number of risk factors (like having family members with diabetes or having a high body mass index).
As for treating gestational diabetes – it also won’t be that different to treating other kinds of diabetes with pregnancy. See the section on general steps for being pregnant and diabetes treatment for more information.
What is different is that dealing with diabetes will be new to those with gestational diabetes. First, a doctor will give such a mother a blood glucose testing kit, so that she can see if her blood sugar is too high.
A mother might be able to control high blood sugar with diet and exercise. If she finds that her blood sugar is still too high, she might be recommended insulin treatment.
Having type 1 Diabetes and being Pregnant
Since those with type 1 diabetes already take insulin injections, they generally won’t need to change to another kind of medication – unlike, potentially, those with type 2 diabetes.
However, the amount of insulin might need to change. A pregnant mother will generally need more insulin, and so, a doctor might recommend some changes to the insulin injections. See the general information for diabetes and pregnant mothers below!
Diabetes and Pregnant: what to do
1) Get medical advice. The absolute first step – even before getting pregnant, if you’re trying for a baby – is to speak to a doctor.
They will be able to judge what kind of changes to medication will be needed based on your situation. However, some of the most common guidance for being pregnant and diabetes treatment will be the following steps.
2) Get HbA1c on track. The HbA1c test, as you may well know, gives an average of the blood sugar levels over two or three months. This indicates how your diabetes is being managed.
If your HbA1c is too high, there is an increased risk of complications with the baby. The National Institute for Health and Care Excellence recommends the target HbA1c level of 6.5%.
So, if planning for a baby, wait until your HbA1c level is on target. And if unexpectedly pregnant, work towards lowering your HbA1c immediately.
3) Change medications according to needs. The changes in medication and diet you need will be determined by a doctor.
But, generally, a pregnant mother needs more insulin – especially towards the middle or the end of pregnancy, as the NIDDK points out. This is because the placenta releases hormones that interfere with how insulin works.
Also, a doctor will almost definitely prescribe folic acid: pregnant mothers, in general, are always recommended folic acid for the health of the baby. With diabetes and pregnant women, even higher doses of folic acid are recommended.
Other medication might also be prescribed, such as metformin, which helps the body respond to insulin.
4) Keep up the good diet and exercise. Staying healthy is important for any expectant mother, especially when it comes to avoiding alcohol and tobacco.
But staying healthy also makes diabetes management easier, which in turn will lower the risk of any complications. So, lose weight if needed, keep exercising about once a day, and have a balanced diet.
For tips on exercising with diabetes, read Does Exercise Lower Blood Sugar? For tips on healthy eating, read Food and Diabetes, written by our Nutrition and Health Consultant! Of course, listen to what your doctor recommends for diet and exercise with pregnancy, too.
5) Check blood sugar and ketones more often. Your body is going through a multitude of changes to support the little one. This includes changes in hormones, which in turn results in changes in blood sugar levels – sometimes without any way of predicting it.
If your blood sugar is unexpectedly high, you might have unexpectedly high ketone levels too.
To know what’s going on, it’s important to check your blood sugar and ketone levels regularly, and treat your diabetes to help both yourself and baby.
6) Keep to your check-ups. When pregnant, a mother should expect to see a medical team about every two weeks (antenatal appointments).
These check-ups are especially important for mothers with diabetes, as they will include, for instance, the HbA1c test, or an eye test (the risk for eye problems increase with pregnancy, especially for people with diabetes).
Your antenatal medical care team will have experience in managing diabetes and pregnancy, and will be able to guide you through your pregnancy.
Birth and the baby
The big moment has come – you’re soon due to give birth! Does this birth need to be different for mothers with diabetes? Slightly, but not completely.
There’s a bit more to consider with diabetes and giving birth; a hospital birth is definitely recommended.
It isn’t unusual for mothers with diabetes to have babies that are somewhat larger. This is due to the mother’s high blood sugar reaching the baby in the womb. This extra sugar is then stored by the baby, leading to more fat tissue.
Consequently, a doctor might suggest having a caesarian section, so that the potentially large baby is not injured on its way out. A doctor might also recommend inducing labour slightly earlier, so that the baby hasn’t grown so large before birth.
Childbirth itself can be – to say the least – stressful. Since stress and diabetes can lead to high blood sugar, it’s important that the mother’s blood sugar is monitored.
An insulin pump might also be recommended by a doctor to better regulate blood sugar at this time. If blood sugar continues to be erratic, the mother might be given both insulin and dextrose via a drip.
And then – congratulations! You have the prettiest little baby (to use H.C. Andersen’s words)!
That prettiest little baby will need its pretty little blood sugar checked because its blood sugar might be too low. The baby in the womb was probably using a great deal of its own insulin to deal with the extra glucose it was getting.
Now, Baby has been welcomed to the world and doesn’t need the extra insulin that it has been producing: baby’s blood sugar drops. This doesn’t mean that the baby has diabetes; it’s just adjusting to not being in the womb any more.
To bring the baby’s blood sugar back to normal, Baby might like some breastfeeding. If you do choose to breastfeed, be aware that your blood sugar can drop slightly.
Breast milk contains lactose – a kind of sugar. In effect, you are giving your sugar to the baby. Accordingly, your insulin levels might need to be adjusted slightly for the period of breastfeeding.
Diabetes UK recommends staying in hospital for at least 24 hours, so that the blood sugar of both you and the baby can be monitored.
Diabetes and Pregnant: a Delivery like any other
Diabetes and pregnancy isn’t always a fairytale; there’s much to take into account, and it can be hard. At the same time, any pregnancy – with or without diabetes – has a great deal going on. The changes that occur during pregnancy are both fascinating and beautiful.
So, keep the steps of this blog in mind, follow the advice of your doctor, and enjoy the process. If you stay healthy and keep up the good work managing your diabetes, you should be able to expect a stork delivery soon like any other mother might!