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Diabetes And Pregnancy: Should You Get Screened Earlier?

Almost 2 million women of reproductive age have diabetes, and this number continues to rise, according to the Centers for Disease Control and Prevention.

As this number continues to rise, it is increasingly important for women with diabetes to achieve normal blood glucose levels before they become pregnant, because if women have poorly controlled diabetes going into a pregnancy they are at much higher risk for serious fetal complications.

Changing hormones in the body during pregnancy cause blood glucose levels to rise, and high blood glucose levels within the first four to six weeks can result in a 30 to 40 percent chance of having a baby with a birth defect compared with a 2 percent risk in women whose diabetes is in excellent control.

What Are The Associated Risks?

Women with type 1 or type 2 diabetes are also at higher risk for:

  • Large birth weight babies, resulting in more Cesarean deliveries and increased complications during delivery
  • Premature births or fetal death
  • Pre-eclampsia: a dangerous surge in blood pressure associated with protein in the urine
  • Diabetic retinopathy: damage to the retina caused by high glucose levels
  • Nephropathy: diabetic kidney disease
  • Severe hypoglycemia: episodes of low blood glucose that can result in confusion or unconsciousness

Ensuring A Healthy Pregnancy

The good news is that women with uncomplicated diabetes who keep their blood glucose levels in a normal range before and during pregnancy have about the same chance of having a successful pregnancy as women without diabetes.

The Joslin-Beth Israel Deaconess Pregnancy Program recommends the following blood glucose goals and medical assessments before pregnancy:

  • Fasting and pre-meal blood glucose: 80-110 mg/dl
  • Blood glucose one hour after a meal: 100-155 mg/dl
  • A1C, a blood test that measures average blood glucose over two to three months: less than 7 percent and as close to 6 percent as possible without hypoglycemia
  • Review of diabetes and obstetrical history
  • Eye evaluations to screen for and discuss risks of diabetic retinopathy
  • Renal, thyroid, gynecological and sometimes cardiac evaluations

Once pregnant, women with type 1 or type 2 diabetes should monitor their blood glucose levels at least six times a day (before meals and one hour after every meal) and also before driving. Fasting and pre-meal glucose levels should be between 60 and 95 mg/dl, and one-hour post-meal readings should be between 100 and 129 mg/dl.

Gestational Diabetes

The other form of diabetes that affects women is gestational diabetes, which develops during pregnancy. Mirroring the epidemic of type 2 diabetes, rates of gestational diabetes are also on the rise in the U.S., particularly in the African-American, Latino, Asian-American, American Indian and Alaskan native communities.

Gestational diabetes usually develops between the 24th and 28th weeks of pregnancy and affects about 4 percent of all pregnancies. This condition typically ends after birth; however, these women have a 50 percent risk of developing type 2 diabetes over the next 10 to 20 years.

Factors that increase a woman’s risk of developing gestational diabetes:

  • Obesity
  • Previous history of gestational diabetes
  • Sugar in the urine
  • A parent or sibling with diabetes
  • Polycystic ovary syndrome or other glucose metabolism problem
  • Previous pregnancy in which the baby weighed more than 9 pounds at birth

If you fall into any of these categories, you should be screened early, within the first trimester, for gestational diabetes. Women who find out that they have gestational diabetes should see a nutritionist and diabetes nurse educator, as diet is the first line of therapy.

With careful diabetes management, women can and do have successful pregnancies and healthy babies.

This article has been republished with the permission of the Joslin Diabetes Center.

Updated by dLife Editors 8/18.

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