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Preconception Care For Women With Diabetes

Nov 13 2014

The key to a healthy pregnancy for a woman with diabetes is keeping blood glucose (sugar) in the target range – before and during her pregnancy. Because of this, preconception counseling and planning is incredibly important for expecting mothers with diabetes.

At Novant Health Providence OB/GYN, we are promoting American Diabetes Month to raise awareness and focus the nation's attention on the issues surrounding diabetes and the many people who are impacted by this disease.

Did you know that babies born to women with diabetes, especially women with poor diabetes control, are at greater risk for birth defects? High blood glucose levels during the first trimester – when the baby's organs are forming – increase the risk of birth defects and miscarriage. Since the baby's organs are completely formed by seven weeks after your last period, when you may have just realized you are pregnant, it's important to get blood glucose levels under control before getting pregnant.

Because these early weeks are so important to your baby, you need to plan your pregnancy. If your blood glucose levels are not in your target range, work to bring your diabetes under control before getting pregnant. It is a good idea to be in good blood glucose control three to six months before you plan to get pregnant. Obviously, you'll want to keep excellent blood glucose control during pregnancy, and after as well.

Target Blood Glucose Goals before Pregnancy

– Pre-meal: 60-119 mg/dl
– One hour after meals: 100-149 mg/dl

Some of the possible risks to the mother and baby if blood glucose levels are too high during pregnancy are:

Risks for the Baby

– Premature delivery
– Miscarriage
– Birth defects (not usually a risk for women with gestational diabetes)
– Macrosomia (having a large baby)
– Low blood glucose at birth (hypoglycemia)
– Prolonged jaundice (yellowing of the skin)
– Respiratory distress syndrome (difficulty breathing)

Risks for the Mother

– Worsening of diabetic eye problems
– Worsening of diabetic kidney problems
– Infections of the urinary tract, bladder and vaginal area
– Preeclampsia (high blood pressure usually with protein in the urine)
– Difficult delivery or cesarean section

Prenatal Care for Women with Diabetes

For the best prenatal care, assemble a team that includes the following:

– A doctor, trained to care for people with diabetes, who has cared for pregnant women with diabetes
– An obstetrician who handles high-risk pregnancies and has cared for other pregnant women with diabetes
– A pediatrician or neonatologist who can treat special problems that can happen in babies of women with diabetes
– A registered dietitian who can change your meal plan as your needs change during and after pregnancy
– A diabetes educator who can help you manage your diabetes during pregnancy

Preconception Counseling

During a preconception counseling appointment, we will discuss what effect a pregnancy will have on your overall health and the potential effects of any medical or obstetrical problems on a future pregnancy.

This is especially important if you have a chronic medical disease, such as diabetes or hypertension, which we should treat optimally prior to conception. It is also important for us to review your family history to see if any genetic diseases run in your family that we should discuss prior to pregnancy. We also recommend that all women start a prenatal vitamin with folate (or folic acid) before they become pregnant.

Our goal is to plan the care of a future pregnancy in a way that optimizes the chance of a successful pregnancy outcome. To schedule a preconception counseling session, please visit us on MyChart or call one of our two convenient locations. Our office hours are: Monday through Thursday: 9 a.m. to 5 p.m., and Friday: 9 a.m. to 2 p.m.

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