Planning a healthy pregnancy with diabetes

For women with diabetes, pre-pregnancy planning can help ensure the best outcome for mother and baby.

“Women with diabetes can have healthy pregnancies, but those pregnancies should be planned and their diabetes should be in good control before they get pregnant,” says Dr. Lorraine Lipscombe, an endocrinologist at Women’s College Hospital and a scientist at Women’s College Research Institute.

If their diabetes isn’t well controlled, these women are at higher risk for pregnancy complications and birth defects.

“Those complications can be reduced with good pre-pregnancy counselling and pregnancy planning,” Dr. Lipscombe says.

Before getting pregnant

• Blood sugar – The first step in pregnancy planning for women with diabetes is to see their doctor and make sure that their blood sugar control is good. They need to have a blood test and possibly monitor their blood sugar. “We recommend that the A1c be less than seven per cent,” Dr. Lipscombe says. “That’s been shown to reduce the risk of birth defects.”
• Medications – Next, they need to talk to their doctor about their medications. Some medications may be harmful to the developing baby, and may need to be changed. Women with diabetes are sometimes treated with medications such as blood pressure drugs and cholesterol drugs, some of which are not safe for use during pregnancy.
• Complications – They should also be assessed for any diabetes complications, such as eye disease or kidney disease, and make sure those are under control. “Pregnancy is a stressor on the body,” Dr. Lipscombe explains. “If you already have those complications, they worsen in pregnancy.”
• Supplements – Like all women planning a pregnancy, women with diabetes should start taking folic acid before they try to conceive.

During pregnancy

• Specialty diabetes care – Dr. Lipscombe recommends that all pregnant women with Type 1 or Type 2 diabetes see either an endocrinologist or an internist to manage their diabetes throughout their pregnancy. Even in women with controlled diabetes, pregnancy often leads to a need for insulin. They will need to learn how to use insulin and how to check their blood sugars. They also need to be monitored regularly.
• Specialty pregnancy care – Ideally, women with diabetes should see an obstetrician who has expertise in treating pregnant women with other medical conditions, such as a maternal-fetal medicine specialist. “If they’re monitored closely and have a good care team to help them, they should have a healthy pregnancy,” Dr. Lipscombe says. “There is a higher rate of prematurity and need for C-sections in women with diabetes, but a lot of women can still go on and have a natural delivery.”

Plan ahead

Dr. Lipscombe adds that these precautions are not intended to discourage or scare women with diabetes, but to educate and prepare them for a healthy pregnancy.

Even if they know they should plan their pregnancy, some women with diabetes don’t want to tell their doctor they are trying to conceive because they are afraid of being told they shouldn’t. Dr. Lipscombe advises women to seek help with medical planning before trying to get pregnant.

“We want to make sure that women know that if we help them, they can get into a good place where pregnancy will be healthy and safe,” she says.

The number one message that women with diabetes need to hear about family planning is that they can have healthy pregnancies.

“We can help them so that complications can be avoided,” Dr. Lipscombe says. “And planning really needs to start before trying to get pregnant.”

Talk about pregnancy planning

Dr. Lipscombe recommends that women with diabetes have regular conversations with their doctor about their plans for pregnancy and their birth control needs.

Those who don’t want to get pregnant need to talk to their doctor about adequate birth control. Those who do want to get pregnant need to talk to their doctor about using birth control until their diabetes is optimized and they get the go-ahead from their doctor to get pregnant.