Diabetes During Pregnancy

Consult with the maternal-fetal medicine team.

Diabetes during pregnancy carries risks for you and your baby, but careful management with the help of your obstetrician, maternal-fetal medicine specialist and, when necessary, your endocrinologist, can help ensure a healthy pregnancy and newborn.

Managing diabetes during pregnancy — whether you had the condition before you conceived or developed it while pregnant — can help you and your baby be healthy during and after delivery.

If you already have Type 1 or Type 2 diabetes, discuss it with your medical provider before getting pregnant. People with diabetes can have healthy pregnancies. If left untreated, however, the condition can have complications for you and your baby.

Norton Women’s Care provides a multidisciplinary approach to treating diabetes during pregnancy. We can help you if you are planning to get pregnant, are pregnant now with preexisting diabetes, developed gestational diabetes or have had gestational diabetes previously.

We provide a comprehensive evaluation and treatment plan for each patient. Pregnant patients are seen by a maternal-fetal medicine specialist for a consultation and, if needed, an ultrasound. They also meet with a certified diabetes educator and nutritionist who can help with nutrition, meal planning and more.

Gestational diabetes is different from the more common Type 1 or Type 2 diabetes. The key differences are that with Type 1 diabetes, your body doesn’t produce insulin, the hormone that helps blood sugar get into your cells to provide energy; with Type 2 diabetes, your body produces insulin, but doesn’t use it well to provide energy.

Gestational Diabetes

With gestational diabetes, your body produces high amounts of insulin, but it doesn’t effectively lower your blood sugar levels. The changes your body undergoes during pregnancy, including natural weight gain, can affect how well your body uses insulin. Gestational diabetes has been increasing in recent years, and as many as 10% of pregnancies in the United States are affected, according to the Centers for Disease Control and Prevention.

The extra blood sugar increases fetal blood sugar, triggering your baby’s little pancreas to create more insulin. Extra blood sugar is stored as fat, increasing your risk of having a large baby (9 pounds or more), which can make delivery more difficult.

Gestational diabetes can develop after your 20th week of pregnancy. Obesity, advanced maternal age (35 years or older), hypertension, a family history of diabetes and having a previous gestational diabetes diagnosis are all risk factors. Ethnicity can be a factor, with women of African, Asian, Hispanic, Native American and Pacific Islander descent more often affected.

There are no symptoms of gestational diabetes. Healthy eating, exercising and taking medication, if necessary, can help control gestational diabetes and prevent complications when you deliver.

Your blood sugar generally returns to normal after your delivery, but about half those with gestational diabetes will go on to develop Type 2 diabetes. You’ll need more frequent glucose tests to stay on top of it.

Gestational Diabetes Class

Your obstetrician may refer you to a gestational diabetes class that covers topics such as nutrition, blood sugar management, meal planning and additional ways to help you manage your blood sugar levels. This class requires a referral from your obstetrician. Call(502) 629-2604 for more information.

Pre-gestational Diabetes

If you are already living with diabetes when you get pregnant or plan to get pregnant, you will likely need specialized care with a maternal-fetal medicine specialist. Left untreated, diabetes at the time of conception risks complications for you and your baby.

Pre-gestational diabetes occurs in about 1% to 2% of pregnancies in the United States, but cases have increased as Type 2 diabetes diagnoses have increased broadly.

Insulin is often part of pre-gestational diabetes treatment, as it doesn’t cross the placenta to the fetus. It has been shown to be safe and very effective at lowering glucose levels.

Managing pre-gestational diabetes starts before conception by working on a healthy weight and controlling your blood sugar. You also may be tested for obstructive sleep apnea, which has been linked to gestational hypertension (high blood pressure), preeclampsia and preterm birth. You may need to work with a dietician to reduce your weight before conception. Prenatal vitamins, including folic acid, are especially important for patients with pre-gestational diabetes.

While you are pregnant, you’ll need to monitor your glucose more closely — at least seven times per day. Your insulin sensitivity will be especially high early in your pregnancy, and you’ll risk hypoglycemia.

Fetal echocardiogram may be part of your pregnancy care. This special ultrasound will show images of your developing baby’s heart.

After delivery of the placenta, your need for insulin may drop dramatically, possibly to lower than pre-pregnancy levels. Breastfeeding has advantages of weight loss for you and bonding with your baby. Because you’ll express carbohydrates through breast milk, hypoglycemia is a risk and may require lower insulin doses.

Pre-gestational Diabetes Risks for Mother

  • High blood pressure and preeclampsia
  • Cesarean section delivery
  • Perinatal depression
  • Hemorrhage after delivery if the baby’s shoulders get stuck in the pelvis (shoulder dystocia)

Pre-gestational Diabetes Risks for Baby

  • Congenital anomalies of the heart, brain and spine
  • Macrosomia (birth weight greater than 8 pounds, 13 ounces), which increases the risk of injury during labor
  • Fetal growth restriction, also called small for gestational age
  • Miscarriage and stillbirth
  • Preterm labor and premature birth
  • Trauma from shoulder dystocia or other injuries, such as a broken collarbone and arm

How We’ll Care for Your Complex Pregnancy, Delivery and Newborn

  • Our caring team of over 10 highly experienced maternal-fetal medicine physicians ensures easier access to expertise for your complex pregnancy.
  • Our compassionate patient navigators who are registered nurses provide one-on-one support and guide you through your pregnancy care, including coordinating appointments.
  • Maternal-fetal medicine offices in downtown Louisville, St. Matthews, Bowling Green, Elizabethtown and Paducah all provide the same level of specialized care.
  • Deliver down the hall from the Norton Children’s Hospital’s Level IV neonatal intensive care unit (NICU) — the highest rated in Louisville and Southern Indiana — or the Level III NICU at Norton Women’s & Children’s Hospital.
  • We bring together a team of experienced specialists from Norton Children’s to prepare for your baby’s specialized care after birth. They will review your baby’s development and create a comprehensive plan to ensure the best possible care.
  • Depending on your condition, you may deliver at your home hospital; if necessary, the Norton Children’s Hospital  “Just for Kids” Transport Team will bring your baby to a Norton Children’s NICU in Louisville.
  • You can keep your OB/GYN for your delivery while getting the expertise of the maternal-fetal medicine team caring for your health and the health of your baby or multiples.
  • Medicaid and most commercial insurance plans are accepted.
  • Communicate with your medical provider, manage appointments and get alerts if an earlier appointment becomes available through your free Norton MyChart account.

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