Proper planning before pregnancy is crucial to reduce the risk of complications and improve outcomes for the mother and baby.
Planning a pregnancy is an exciting but anxious period for women. Besides worrying about your fertility and how long it will take to get pregnant, you may also be concerned about your health if you have diabetes.
Diabetes increases the risk of pregnancy complications and adverse outcomes for mothers and their babies, so proper planning before conceiving is crucial.
This article discusses the key steps to take before getting pregnant when you have diabetes.
How Diabetes Affects Pregnancies
Preexisting diabetes complicates 0.9% of pregnancies in the United States and 1 in 250 pregnancies in the United Kingdom.1 It also increases the risk of congenital disabilities, premature delivery, abnormally large babies, stillbirths, caesarean sections, and preeclampsia.
Diabetes in pregnancy may also affect the long-term health of children. It can increase their risk of several conditions in adulthood, including diabetes, obesity, cardiovascular disease, medication use and even mortality.1 Diabetes exposure may also lower their thinking skills, worsen their school performance, and increase their risk of autism and attention-deficit/hyperactivity disorder.1
Key Steps to Take Before Planning a Pregnancy
Uncontrolled high blood sugar is the primary reason for adverse pregnancy outcomes, so it is wise to avoid getting pregnant if your blood sugar is above the target your doctor has recommended. Use contraception before actively trying to get pregnant until you hit your blood sugar target.
Most contraceptives, including the uterine coil, the progestogen-only implant (IMP), combined hormonal contraception (CHC) and progestogen-only pill (POP), are suitable. However, CHC may be unsuitable if you have eye, kidney, nerve disease, or other blood vessel complications.2
In addition to using contraception, here are the six steps to take before actively trying to conceive.
1 | Lower Your Blood Sugar Levels
According to observational studies, the risk of pregnancy complications is directly proportional to HbA1c levels during the first ten weeks of pregnancy.3 HbA1c levels greater than 58 mmol/mol (7.5%) are associated with a higher risk of adverse outcomes than levels below 58mmol/mol (7.5%).4 International guidelines recommend avoiding pregnancy if your HbA1c is 86 mmol/mol (10%) or higher.5
Achieving an HbA1c target below 48mmol/mol (6.5%) or as close to it as possible before pregnancy is associated with the lowest risk of adverse outcomes, such as congenital abnormalities, preeclampsia and preterm births.6 However, not all women can achieve this target safely without frequent episodes of hypoglycaemia – when blood sugar levels fall dangerously low or less than 4mmol/mol.
Speak with your doctor or healthcare team to establish the best target for you.
2 | Eat a healthy, low-glycaemic diet
A healthy low-glycemic diet, such as a Mediterranean diet, is crucial during pregnancy. It supplies essential nutrients you and your baby need and helps you manage your blood sugar and weight. If your body mass index (BMI) is above 27 kg/m2, it is worth losing weight to improve your insulin sensitivity and pregnancy outcomes.5,6
A registered nutritionist or dietitian can help you plan a well-balanced and nutritious diet to support you before and during pregnancy. You will also need to reduce caffeine intake and consider quitting alcohol and smoking.
3 | Review medications
Most glucose-lowering medications, all statins and blood pressure-lowering medications are unsuitable during pregnancy because they can harm your baby.5,6
Your healthcare team will likely leave you on metformin if you can tolerate it before pregnancy. Still, they will transition you to insulin once you become pregnant because it does not cross the placenta and is associated with the best pregnancy outcomes.
4 | Take a Folic Acid Supplement
Women with diabetes have a higher risk of having babies with neural tube abnormalities such as spina bifida and anencephaly.7 It is wise to enrich your diet with folate-rich foods such as leafy green vegetables, peas, lentils and oranges.
You may need a high dose (5mg) of folic acid supplement, and if you do, it is vital to start taking it at least three months before you conceive and up to the 12th week of pregnancy.5,8
Women in the US may not need such a high dose since everyday foods are supplemented with folic acid. Your healthcare team will give you specific advice.
5 | Check Your Eyes
Pregnancy tends to increase the risk of developing and worsening eye disease (retinopathy) in women with diabetes, particularly with poorly controlled blood sugar.8
Schedule an eye assessment with an ophthalmologist before pregnancy. Depending on your results, you may need further evaluations during the first trimester and at regular intervals throughout pregnancy
6 | Check Your Kidneys
The risk of complications to mothers and babies is higher with diabetic kidney disease.8 Besides, women with advanced diabetic kidney disease have a higher risk of reduced kidney function or kidney failure, so checking your kidney function before pregnancy is crucial.
Your doctor will check your estimated glomerular filtration rate (eGFR), urine albumin: creatinine ratio (uACR) and serum creatinine levels. Your primary care team will refer you to a specialist if your levels are below or above certain thresholds.
7 | Screen for Diseases
Screening for sexually transmitted diseases such as gonorrhoea, chlamydia, syphilis and HIV and genetic diseases such as sickle cell anaemia, cystic fibrosis, and Tay-Sachs diseases. A cervical screen (pap smear) is also crucial.6
8 | Take Your Vaccinations
Certain vaccinations may be necessary, such as rubella, varicella, hepatitis B and influenza.6
You can have a healthy pregnancy with diabetes
Diabetes in pregnancy is complex, but you can absolutely have a healthy baby and pregnancy if you take proper precautions, plan, and get support from your healthcare team.
The most critical step is controlling your blood sugar with a healthy, balanced diet and moderate exercise.
REFERENCES
- Alexopoulos, S., Blair, R., & Peters, A. L. (2019). Management of preexisting diabetes in pregnancy: A Review. JAMA, 321(18), 1811. https://doi.org/10.1001/jama.2019.4981.
- Faculty of Sexual and Reproductive Healthcare (FSRH) (2016) UK Medical Eligibility for Contraceptive Use. Accessed 27 October 2022. Available: https://www.fsrh.org/documents/ukmec-2016/
- Guerin A., Nisenbaum, R., Ray, J.G. (2007) Use of maternal GHb concentration to estimate the risk of congenital anomalies in the offspring of women with prepregnancy diabetes. Diabetes Care, 30: 1920-1925.
- Temple, R. (2011) Preconception care for women with diabetes: is it effective and who should provide it? Best Practice & Research Clinical Obstetrics and Gynaecology, 25: 3-14.
- National Institute of Health and Care Excellence (NICE). (2020) Diabetes in pregnancy: management from preconception to postnatal period. Accessed 27 October 2022. Available: https://www.nice.org.uk/guidance/ng3/chapter/Recommendations.
- American Diabetes Association (ADA). (2022) Management of diabetes in pregnancy: standards of medical care in diabetes–2022. Diabetes Care, 45(Supplement_1): S232-S243.
- Salbaum, J. M., & Kappen, C. (2010). Neural Tube Defect Genes and Maternal Diabetes during Pregnancy. Birth defects research. Part A, Clinical and molecular teratology, 88(8), 601. https://doi.org/10.1002/bdra.20680.
- Shearer, D., White, A., Thompson, D., Pawlowska, M. (2018) Preconception management of diabetes. BC Medical Journal, 60(5): 253-257.
