Preparing for pregnancy when you have diabetes
Ideally, the planning stage for pregnancy, called preconception planning, starts months ahead of even trying to become pregnant. Some of you joke about walking into a room and taking a deep breath and suddenly you are pregnant. You very well know this isnât the case, and for most of us some planning should go into pregnancy. For many, it involves planning time off from work, saving some money ahead of time, securing some help around the house etc. A large part of his planning should surround your health.
This week in clinic I saw three women, all who have had diabetes prior to becoming pregnant. And I had to stop myself from both crying and shouting, because each one of them had horribly high blood sugars before becoming pregnant and still actively tried to conceive, or were careless and ignored advice to defer pregnancy right now. Some of you may be saying, âWell Doc, it is none of your business when someone decides to become pregnant.â I disagree, because my job is to look out for your health, and for your babyâs health. If I saw a woman about to walk into heavy traffic, I would try to stop her because of the danger. Same situation here: getting pregnant when your blood sugars are high is like walking right into the path of an oncoming bus. Still think I shouldnât say anything? Obviously I cannot force my opinion on anyone, but for all healthcare providers, this is our biggest task: to prevent harm from coming to you.
Let me remind you of the big deal here: high blood sugars in pregnancy, especially during the very first few weeks, is associated with birth defects and malformations in children, large size babies, difficulties with low blood sugars after delivery, overall complicated deliveries and pregnancies, and increase in chances of diabetes later in life. For the mothers, in addition to the pregnancy and delivery complications, your chances are higher for having worsened kidney function and eye disease, if your diabetes is not controlled during this time.
So, all of you ladies out there with diabetes who are thinking about becoming pregnant, or not even really planning it, but not being especially careful about birth control: STOP AND THINK. You need to optimally have your blood sugars controlled for several months (ideally 3-6 months) BEFORE trying to get pregnant. Your A1C should be as close to 7% or lower. Your blood pressure should be controlled. You should be taking prenatal vitamins and eating a healthy diet, as well as getting some exercise to get your heart and body healthy before going into this pregnancy.
If you do find yourself unexpectedly pregnant, get to your doctor as soon as possible to get some help in getting your sugars tightly controlled. The first few weeks are the most urgent, so donât sit at home just hanging out.
This is more important than decorating the baby room or buying cute clothes: make this first home, your body, as healthy and nurturing as possible for your baby.
Anita Ramsetty, MD [email protected]
Medical Director Endocrine Care Group