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Planning a healthy pregnancy with diabetes

For women with diabetes, preparing for pregnancy in advance leads to the best outcomes for mother and baby

By Patricia Nicholson

For women with diabetes, pre-pregnancy planning can help ensure the best outcome for mother and baby.

“Women with diabetes can have healthy pregnancies, but those pregnancies should be planned and their diabetes should be in good control before they get pregnant,” says Dr. Lorraine Lipscombe, an endocrinologist at Women’s College Hospital and a scientist at Women’s College Research Institute.

Pregnancy planning is particularly important for women with diabetes because if their diabetes isn’t well controlled, they are at higher risk for pregnancy complications and birth defects.

“Those complications can be reduced with good pre-pregnancy counselling and pregnancy planning,” Dr. Lipscombe says.

She adds that this information is not intended to discourage or scare women with diabetes, but to help educate and prepare them for a healthy pregnancy. Dr. Lipscombe notes that even if they know they should plan their pregnancy, some women with diabetes don’t want to tell their doctor they are trying to conceive because they are afraid of being told they shouldn’t or that they’re not ready. She advises women to seek help with medical planning before trying to get pregnant.

“We want to make sure that women know that if we help them, they can get into a good place where pregnancy will be healthy and safe,” she says.  

Before getting pregnant

Blood sugar – The first step in pregnancy planning for women with diabetes is to see their doctor and make sure that their blood sugar control is good. They need to have a blood test and possibly monitor their blood sugar to check the levels. “The doctor can tell them if the blood test shows that they’re at a good level to get pregnant. We recommend that the A1c be less than seven per cent,” Dr. Lipscombe says. “That’s been shown to reduce the risk of birth defects.”

Medications – Next, they need to make sure they’re not on any medications that are harmful to the developing baby. Women with diabetes are sometimes treated with medications such as blood pressure drugs and cholesterol drugs, some of which are not safe for use during pregnancy. If they are planning a pregnancy, women with diabetes should talk to their doctor about any medication they are taking that may need to be changed.

Complications – They should also be assessed for any diabetes complications, such as eye disease or kidney disease, and make sure those are under control. “Pregnancy is a stressor on the body,” Dr. Lipscombe explains. “If you already have those complications, they worsen in pregnancy.”

Supplements – Like all women planning a pregnancy, women with diabetes should start taking folic acid before they try to conceive.

During pregnancy

Specialty diabetes care – Dr. Lipscombe recommends that all pregnant women with Type 1 or Type 2 diabetes see either an endocrinologist or an internist to manage their diabetes throughout their pregnancy. “The vast majority need to be on insulin if they weren’t on it already,” she explains, noting that even in women with controlled diabetes, pregnancy often leads to a need for insulin. “That requires some education and a care team that will help them learn how to use insulin and how to check their blood sugars. And they need to be monitored regularly.”

Specialty pregnancy care – Ideally, women with diabetes should see an obstetrician who has expertise in treating pregnant women with other medical conditions, such as a maternal-fetal medicine specialist. “If they’re monitored closely and have a good care team to help them, they should have a healthy pregnancy,” Dr. Lipscombe says. “There is a higher rate of prematurity and need for C-sections in women with diabetes, but a lot of women can still go on and have a natural delivery.”

Unfortunately, not all women are following these guidelines. In a study published earlier this year in the Journal of Maternal, Fetal and Neonatal Medicine, Dr. Lipscombe and her colleagues found that only about half of women with diabetes had planned their pregnancies.

“We would hope that there would be closer to 100 per cent telling us that the pregnancy was planned, but we saw around 50 per cent,” she says.

The study, which included 163 Ontario women with Type 1 or Type 2 diabetes, looked at two factors: planning a pregnancy or trying to conceive, and controlling diabetes prior to pregnancy. The study looked at these factors separately because sometimes women with diabetes who are trying to get pregnant aren’t aware that they need to address their diabetes.

“We found 20 per cent of women who were actively trying to get pregnant did not do anything to improve their diabetes,” Dr. Lipscombe says of the study results. “So that’s a concern.”

Talk about pregnancy planning

One factor that be contributing to the situation is the growing number of women who are developing Type 2 diabetes. Many of these women may not have access to specialty care, and issues around pregnancy planning for women with diabetes may not be as well known among general practice doctors. Also, women are now getting pregnant at older ages. Dr. Lipscombe notes that physicians may not be asking women in their late 30s or early 40s if they are thinking of getting pregnant, or if there is a possibility that they might get pregnant.

As a result, important conversations between doctors and women with diabetes may not be happening. “Then women perhaps don’t have the appropriate education or knowledge to understand that they should ideally plan their pregnancy,” Dr. Lipscombe says.

She recommends that women with diabetes have regular conversations with their doctor about their plans for pregnancy and their birth control needs.

“For any woman of reproductive age who has diabetes, whenever they’re in seeing the doctor is an opportunity to discuss pregnancy planning,” she says. Those who don’t want to get pregnant need to talk their doctor adequate birth control. Those who do want to get pregnant need to talk to their doctor about using birth control until their diabetes is optimized and they get the go-ahead from their doctor to get pregnant.

But the number one message that women with diabetes need to hear about family planning is that they can have healthy pregnancies.

“We can help them so that complications can be avoided,” Dr. Lipscombe says. “And planning really needs to start before trying to get pregnant.”


This information is provided by Women’s College Hospital and is not intended to replace the medical advice of your doctor or healthcare provider. Please consult your healthcare provider for advice about a specific medical condition. This document was last reviewed on: Feb. 15, 2014

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