DEAR DOCTOR K:
I have Type 2 diabetes, and I would like to get pregnant. What can I do to increase my chances of having a healthy baby?
Like you, some women already have either Type 1 or Type 2 diabetes before they become pregnant. There also is a kind of temporary diabetes that develops during pregnancy called gestational diabetes. It goes away after the baby is born.
You’re right to be concerned. Type 1, Type 2 and gestational diabetes all cause high blood sugar and can cause pregnancy complications. But for this column, I’ll focus on pregnancy and Type 2 diabetes.
Consistently higher-than-normal blood sugar during pregnancy puts your baby’s health at risk. It increases the chances of having a miscarriage or going into premature labor. It may also cause your growing baby’s organs to form abnormally. Women with diabetes are also more likely to have large babies. This can make delivery difficult, and cesarean sections more likely.
So, keeping blood sugar under control early in pregnancy is crucial to your baby’s health. In fact, it is also important to achieve good blood sugar control before you become pregnant. That means keeping your HbA1c levels less than 7 percent. (HbA1c levels indicate your average blood sugar over the past three months.)
Many women with Type 2 diabetes are overweight or obese. Try to lose weight by eating fewer calories and exercising regularly if you are trying to become pregnant. This should help reduce your blood sugar levels before and even during the pregnancy.
If lifestyle changes aren’t enough to drop or keep your blood sugar levels in a healthy range, you may need to begin medication. If you’re already taking a medicine, you may need to increase the dose or switch the kind.
Unfortunately, studies have not yet shown whether it is safe to take oral diabetes medications during pregnancy. Your doctor may recommend two pills that appear to be safe: metformin or acarbose. Alternatively, doctors often recommend starting or switching to insulin. This is an injectable hormone that lowers blood sugar.
Your diet during pregnancy is different from your diet before pregnancy because you’re eating for two. That means taking in enough calories for the two of you, and also eating the types of food that are healthiest for both you and the baby.
For that reason, you will likely work with a dietitian during your pregnancy. He or she will adjust your diet to ensure that your baby receives proper nutrition, but that you do not consume too many calories. Finally, you will have more frequent HbA1c tests during pregnancy. And you will have more frequent ultrasound tests to monitor your baby’s growth and development.
With good prenatal care and by keeping your blood sugar under control, you can look forward to a safe pregnancy and a healthy baby.