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Preexisting diabetes means you had diabetes before becoming pregnant, unlike gestational diabetes, which develops during pregnancy. Diabetes occurs when your blood sugar levels are too high because your body either doesn’t produce enough insulin or can’t use it effectively. This can lead to serious health issues like heart disease, kidney problems, or vision loss.
During early pregnancy, high blood sugar can harm your baby’s developing organs, such as the heart, brain, kidneys, and lungs. Working with your doctor allows you to develop a treatment plan that fits your needs.
Types of Preexisting Diabetes
There are two types of preexisting diabetes:- Type 1 diabetes: Your body doesn’t produce insulin because your immune system attacks the insulin-producing cells in your pancreas. You need daily insulin injections to manage this condition.
- Type 2 diabetes: The most common form, where your body produces insulin but doesn’t use it well. It can be managed with medications, insulin when needed, or lifestyle changes.
Potential Complications of Preexisting Diabetes in Pregnancy
If not properly managed, preexisting diabetes can increase the risk of complications for both you and your baby. Keeping your diabetes under control is crucial to minimise these risks. Potential complications include:For You:
- Higher risk of birth defects, including heart defects or neural tube defects affecting the brain and spine.
- Higher chances of needing a caesarean section.
- Risk of pregnancy loss, including miscarriage (before twenty weeks) or stillbirth (after twenty weeks).
- Risk of worsening retinopathy or nephropathy during pregnancy.
For Your Baby:
- Higher risk of birth defects, such as heart defects or neural tube defects affecting the brain and spine.
- Possible growth issues such as the baby being too large, a condition known as macrosomia, or too small, which is called foetal growth restriction.
- Increased chance of preterm birth before 37 weeks.
- Risk of birth injuries like shoulder dystocia, which may occur if the baby is too large and becomes stuck during delivery.
Babies born to people with preexisting diabetes are often healthy, but there’s an increased risk of them having low blood sugar, also called hypoglycaemia, breathing difficulties, jaundice, obesity and type 2 diabetes later in life.
Managing Diabetes-Related Complications
You should be screened for diabetes-related complications like retinopathy and nephropathy. A retinal exam is recommended, ideally before conception or in the first trimester. This exam checks for diabetic retinopathy, which can temporarily worsen with rapid improvements in blood sugar control.For nephropathy, a urine albumin-to-creatinine ratio test can assess kidney function. If you have kidney disease, you’ll need close monitoring by a nephrologist and a perinatologist.
Stop the use of medications that are unsafe during pregnancy and switch to pregnancy-safe options under medical supervision.
Blood Glucose Monitoring During Pregnancy
During pregnancy, it's important to monitor your glucose levels to maintain stable blood sugar.You should check your blood sugar at least 6 to 10 times daily. Continuous glucose monitoring can be valuable as it improves glycaemic control and also reduces the risk of large-for-gestational-age babies.
Glycaemic Targets During Pregnancy for Preexisting Diabetes
Preparing for pregnancy is critical if you have preexisting diabetes, as organ development begins early in pregnancy. Optimal glycaemic control, ideally with an HbA1c below 6.5 per cent, is recommended before planning a pregnancy.Glycaemic targets during pregnancy are:
| Fasting plasma glucose | less than 90 mg/dL |
| 1 hour postprandial glucose | less than 140 mg/dL |
| 2 hour postprandial glucose | less than 120 mg/dL |
You’ll need to work closely with your doctors and a perinatologist to optimise your blood sugar control.
Nutrition and Weight Management in Pregnancy with Preexisting Diabetes
Achieving a healthy weight before pregnancy is essential because obesity is common in type 2 diabetes and increasingly seen in type 1 diabetes. Excess weight can increase the risk of congenital heart defects and other complications.You should aim to lose at least 5 to 10 per cent of your body weight if you’re overweight. A registered dietitian can help by creating a personalised nutrition plan.
Screening for obstructive sleep apnea (OSA) is also important, especially if you’re obese. Untreated OSA can worsen glycaemic control and lead to gestational hypertension.
To support your baby's development, make sure to take at least:
- 400 micrograms of folic acid daily for a month before conception.
- 500 milligrams of elemental calcium.
- 250 international units of vitamin D3.
Recognising Hypoglycaemia and Hyperglycaemia
Pregnancy can change how your body responds to insulin. This often leads to increased insulin requirements, particularly in the third trimester. Being aware of low blood sugar (hypoglycaemia) and high blood sugar (hyperglycaemia) is crucial for your safety.Signs to look out for include:
Hypoglycaemia
- Feeling dizzy, weak, or shaky
- Sweating or having a fast heartbeat
- Feeling hungry or irritable
Hyperglycaemia
- Feeling thirsty
- Needing to urinate frequently
- Feeling weak or tired
- Experiencing blurred vision
- Developing a yeast infection
What are the Insulin Requirements During Pregnancy?
Insulin is the primary treatment for managing diabetes during pregnancy, as it’s safe and effective for both type 1 and type 2 diabetes. According to a research article titled ‘Management of preexisting diabetes in pregnancy’ your insulin needs will change throughout pregnancy:- Weeks 0-9: Insulin requirements may increase.
- Weeks 9-14: Requirements often decrease.
- Weeks 14-16: Insulin needs are low.
- Weeks 16-37: Insulin needs may double.
- Weeks 37-40: Requirements may decrease.
- Postpartum: Insulin needs can drop to half of pre-pregnancy levels.
Breastfeeding with Preexisting Diabetes
Breastfeeding is safe and beneficial if you have preexisting diabetes. It can help regulate your blood sugar after delivery and provide essential nutrients for your baby. Individuals who breastfeed may be at risk of hypoglycaemia, as carbohydrates are transferred into breast milk. As a result, insulin doses may need to be reduced during this period. You might also be advised to have a snack while breastfeeding to prevent hypoglycaemia.For non-obese individuals who are breastfeeding, an increase of 500 kcal/day above pre-pregnancy caloric intake is generally recommended.
How to Manage Diabetes During Pregnancy?
To manage diabetes during pregnancy, follow these steps:
- Attend all prenatal checkups to monitor your and your baby’s health.
- Check your blood sugar levels as frequently as your doctor recommends.
- If you use insulin, follow your doctor’s instructions exactly.
- Inform your doctor about any medications you take, even those not related to diabetes.
- Ask your provider if you should start low-dose aspirin after 12 weeks to help prevent preeclampsia.
FAQs on Preexisting Diabetes in Pregnancy: What You Need to Know
- What is preexisting diabetes during pregnancy?
Preexisting diabetes refers to diabetes that you had before becoming pregnant. This can be Type 1 or Type 2 diabetes. - What are the risks of preexisting diabetes in pregnancy?
Risks include complications like high blood pressure, birth defects, miscarriage, stillbirth, and preterm birth. Babies may also be at risk for hypoglycemia and other health issues. - Can I breastfeed with preexisting diabetes?
Yes, breastfeeding is safe, but it may require adjustments to your insulin dosage.
