Blood glucose (sugar) control is a daily challenge for people with diabetes. Hormonal changes during pregnancy make diabetes even more challenging.
The majority of women who properly control their diabetes before and during pregnancy have successful pregnancies, and give birth to beautiful, healthy babies.
Risks and potential complications
Women with diabetes have a higher risk of miscarriage and of having a baby with birth defects (heart and kidney defects, for example). This risk significantly increases if blood glucose (sugar) control is not optimal, especially at conception and during the first 3 months of pregnancy, when the baby’s organs are forming.
If your blood glucose (sugar) levels are poorly controlled, you should avoid becoming pregnant until your healthcare team has helped you improve your blood sugar control.
Risks for the mother:
- Rapidly worsening retinopathy (damage to the retina caused by diabetes)
- Rapidly worsening nephropathy (kidney damage caused by diabetes) and kidney failure
- A more difficult vaginal delivery (because of the baby’s weight) requiring special maneuvers by the obstetrician or the use of forceps or suction
- Caesarean delivery
- Gestational hypertension and pre-eclampsia (a pregnancy complication characterized by high blood pressure and significant swelling)
- Excess amniotic fluid, which can cause premature labour
Risks for the baby:
- Defects (especially if the diabetes is poorly controlled in the first 3 months of pregnancy) of the heart, kidneys, urogenital tract, brain, spinal cord and backbone
- Higher-than-average birth weight (more than 4 kg or 9 lbs.) or, conversely, sometimes stunted growth and low birth weight
- Premature birth
- Difficulty breathing at birth because of delayed lung maturity, among other factors
- Hypoglycemia at birth, all the more severe if the mother’s diabetes was poorly controlled in the days/weeks prior to the birth
- Calcium deficiency in the blood at birth
- Malfunction in the production of red blood cells (polycythemia or hyperviscosity)
- Perinatal death
All of these complications occur almost exclusively when the mother’s diabetes has been poorly controlled.
With the intensification of treatment for women with diabetes, the mortality of newborns has decreased significantly, but remains slightly higher in women with poorly controlled diabetes, especially if they have episodes of ketosis, ketoacidosis or hypertension during pregnancy.
How to reduce the risks
Strict blood sugar control from preconception to delivery and close monitoring by a multidisciplinary team in a specialized centre can greatly reduce most of these risks.
It is advisable for diabetic women who want a child to keep their glycated hemoglobin (A1C), below 7.0 % (even below 6.5 % if possible) to reduce the risk of complications and deformities. This may seem a tall order, but it is achievable. If you can’t reach that number, remember that any decrease in A1C whatsoever improves your chances of having a healthy baby.
Note: women with A1C above 10.0% should seriously consider delaying pregnancy until they reach their blood glucose (sugar) targets.
To help you succeed, your doctor may suggest increasing or modifying your current treatment. For some women with type 2 diabetes, it is sometimes advisable to start insulin treatment prior to pregnancy to ensure better blood glucose (sugar) control.
Be aware that stricter control of blood glucose using antidiabetic medication or insulin may increase the risk of hypoglycemia. In short, women with diabetes who are planning a pregnancy and who need antidiabetic medication or insulin should monitor their blood glucose (sugar) levels more frequently to avoid hyperglycemia and hypoglycemia.
Women with type 1 diabetes are also advised to test for ketones in their urine or blood when their blood glucose (sugar) level stays high for several hours. Ask your healthcare provider to show you how to do this test.
Attaining a healthy weight
Overweight women are more at risk for fertility problems and pregnancy complications. Before becoming pregnant, all overweight women should try to reach a healthy weight (a BMI between 18.5 and 25), particularly women with type 2 diabetes.
Losing 10% of your body weight at a slow and gradual pace, even if you don’t reach your healthy weight, will still have a positive impact on your fertility and limit birth complications. Overweight women are advised to seek advice from a dietitian or kinesiologist to help them lose weight and increase their physical activity.
Care of the eyes and kidneys
People with diabetes are at risk of developing eye and kidney complications, and these risks increase during pregnancy. That is why diabetic women wishing to become pregnant should have an eye exam and their kidney function tested prior to conception. It is recommended that you see your ophthalmologist or optometrist if you have not had an eye exam in the last six months.
If you suffer from eye or kidney complications, they should be treated and controlled before conception so that they do not become worse.
Before becoming pregnant, it is also important that your blood pressure (hypertension) is properly controlled. Hypertension causes a rise in the pressure of the small blood vessels in the eyes and kidneys, which makes them fragile. It can also have a negative impact on the development of the placenta during pregnancy and cause complications.
Folic acid (folate) is an important vitamin in the prevention of brain and spinal-cord defects (spina bifida) in babies. Most women get their daily requirement of folic acid by eating a varied diet.
Folic acid is found in leafy green vegetables, fruits, nuts, bread and cereals. In addition to eating a balanced diet, it is recommended that all diabetic women who want a child start taking a supplement of 1 mg per day of folic acid at least three months before conception and continue taking this supplement for at least the first 3 months of pregnancy.
Consult your pharmacist for advice about taking a folic acid supplement.
Research and writing: Diabetes Québec team of health care professionals
Excerpted from: Diabetes Québec (2013), Diabète et grossesse.
Other reference: Feig D, Berger H, Donovan L et al. Diabetes Canada 2018 Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada: Diabetes and Pregnancy. Can J Diabetes 2018; 42 (Suppl 1): S255-S282.
Last update: July 2018
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