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Pregnancy and Diabetes Management: New Guidelines

Katlyn Joy |16, November 2013


The Endocrine Society has issued new guidelines for the management of patients who are trying to conceive and all pregnant patients.

The guidelines recommend women who have been diagnosed with diabetes be tested for gestational diabetes during the 24th to 28th weeks of pregnancy by having an oral glucose tolerance test. However, they also recommend testing all women who have not been previously diagnosed with diabetes at their first prenatal appointment.

Ian Blumer, MD, of the Charles H. Best Diabetes Centre in Whitby, Ontario, Canada, and chair of the task force responsible for the guidelines stated, "Many women have type 2 diabetes but may not know it. Because untreated diabetes can harm both the pregnant woman and the fetus, it is important that testing for diabetes be done early on in pregnancy so that, if diabetes is found, appropriate steps can be immediately undertaken to keep both the woman and her fetus healthy." Other recommendations by the task force include:

  • Gestational diabetes first-line treatment should be dietary measures and daily exercise of a minimum of 30 minutes.
  • Women wanting to conceive who are overweight or obese should get their weight to a healthy level prior to attempting pregnancy.
  • Should a pregnant woman not respond to dietary changes and exercise treatment, blood glucose medication should be administered to lower her glucose.
  • Women with a history of gestational diabetes in previous pregnancies should be tested regularly for diabetes prior to becoming pregnant.
  • At 6-12 weeks, and again following childbirth women who have developed gestational diabetes should have an oral glucose tolerance to determine whether she should be diagnosed with diabetes or prediabetes.
  • Before conceiving, women with type 1 or 2 diabetes should have an in-depth eye exam to check for diabetic retinopathy. If damage is found, treatment should be undertaken.

Risks of having diabetes during pregnancy

According to the National Diabetes Information Clearinghouse, which is a service of the National Institute of Diabetes and Digestive and Kidney Diseases and the National Institutes of Health, diabetes poses significant dangers to expectant mothers and their babies including:

  • An increased risk of diabetes complications in mothers such as heart or kidney disease or eye problems.
  • An increased risk of miscarriage or stillbirth.
  • Her baby will have a higher chance of birth defects such as heart defects or neural tube defects.
  • Her baby may be born overweight, which decreases the odds of having a vaginal birth.
  • Her baby is at increased risk of prematurity.
  • Her Baby may experience health problems at birth or soon after as respiratory issues, or low blood glucose.
  • Mothers who are diabetic are more likely to get preeclampsia.
  • Expectant mothers who have diabetes are at risk for developing depression.

What to expect during pregnancy if you have diabetes

If you have diabetes and expecting a baby, your pregnancy will be designated a high risk pregnancy, which may affect your choice of obstetricians and he location of where you will give birth. You will be watched more closely than the average pregnant woman at prenatal visits and will likely see your OBGYN more often.

According to the March of Dimes, women who take pills for diabetes will most likely need to switch to using insulin during pregnancy as the pills are not considered wise for expectant mothers to take. Your body will react differently to the disease during pregnancy and this may result in you needing perhaps two or three times as much insulin as usual. Also, insulin resistance in pregnancy is common and can mean you might need to try different types of insulin.

During pregnancy you will probably be seeing more than one physician, such as an Endocrinologist, and OBGYN and a Perinatologist. You could also be under the care of an ophthalmologist due to eye conditions resulting from diabetes. Additionally, if your kidneys or heart are compromised by the disease, you may see a Cardiologist and a Nephrologist. Make sure everyone on your medical team is in communication with each other and that all your health care providers have a complete list of all your medications, regardless of who prescribed them.

When to Call the Doctor

  • If you have chills or fever.
  • If you have a severe headache.
  • If you have any heavy bleeding or if you have bleeding that lasts 24 hours or more.
  • If you experience eye problems or something like blurriness.
  • If your legs or face swell.
  • If you have a noticed your are gaining weight too quickly.

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