Preexisting diabetes

What is preexisting diabetes?

Diabetes is a condition in which your body has too much sugar in the blood (called blood sugar or glucose). Preexisting diabetes (also called pregestational diabetes) means you have diabetes before you get pregnant. This is different from gestational diabetes, which is a kind of diabetes that some women get during pregnancy. Women with diabetes can and do have healthy pregnancies and healthy babies. But untreated diabetes can cause complications for both moms and babies.

In the United States, about 1 to 2 percent of pregnant women have preexisting diabetes. The number of women with diabetes during pregnancy has increased in recent years.

When you eat, your body breaks down sugar and starches from food into glucose to use for energy. Your pancreas (an organ behind your stomach) makes a hormone called insulin that helps your body keep the right amount of glucose in your blood.  When you have diabetes, your body doesn’t make enough insulin or can’t use insulin well, so you end up with too much sugar in your blood. This can cause serious health problems, like heart disease, kidney failure and blindness. High blood sugar can be harmful to your baby during the first few weeks of pregnancy when his brain, heart, kidneys and lungs begin to form. Treatment for diabetes can help prevent problems like these.

There are two types of preexisting diabetes. Managing them before and during pregnancy can help reduce your risk of complications:

• Type 1 diabetes. This is when your body doesn’t make insulin. This is because your immune system destroys the cells in your pancreas that make insulin. If you have type 1 diabetes, you need to take insulin every day. Type 1 diabetes is usually diagnosed in children and young adults, but you can get it at any age.
• Type 2 diabetes. This is the most common kind of diabetes. If you have type 2 diabetes, your body makes insulin but doesn’t make or use it well. It most often is diagnosed in adults, but you can develop it at any age.

Can preexisting diabetes cause problems during pregnancy?

Yes. If it’s not managed well, diabetes can increase your risk for complications during pregnancy, including:

• Birth defects, like heart defects and birth defects of the brain and spine called neural tube defects (also called NTDs). Birth defects are health conditions that are present at birth. Birth defects change the shape or function of one or more parts of the body. They can cause problems in overall health, how the body develops, or in how the body works. 
• Cesarean birth. Cesarean birth (also called c-section) is surgery in which your baby is born through a cut that your doctor makes in your belly and uterus (womb). You may need to have a c-section if you have complications during pregnancy, like your baby being very large (called macrosomia).
• High blood pressure and preeclampsia. High blood pressure is when the force of blood against the walls of the blood vessels is too high. It can stress your heart and cause problems during pregnancy. Preeclampsia is when a pregnant woman has high blood pressure and signs that some of her organs, like her kidneys and liver, may not be working properly. Signs of preeclampsia include having protein in the urine, changes in vision and severe headaches.
• Macrosomia or fetal growth restriction. These conditions have to do with your baby’s weight. Macrosomia is when a baby weighs more than 8 pounds, 13 ounces (4,000 grams) at birth. Weighing this much makes your baby more likely to get hurt during labor and birth. And you may need to have a c-section to keep you and your baby safe. Fetal growth restriction (also called small for gestational age) is when a baby doesn’t gain the weight he should before birth.
• Miscarriage and stillbirth. Miscarriage is when a baby dies in the womb before 20 weeks of pregnancy. Stillbirth is the death of a baby in the womb after 20 weeks of pregnancy.
• Perinatal depression. This is depression that happens during pregnancy or in the first year after having a baby (also called postpartum depression). Depression is a medical condition that causes feelings of sadness and a loss of interest in things you like to do. It can affect how you feel, think and act and can interfere with your daily life. It needs treatment to get better. 
• Preterm labor and premature birth. Preterm labor is labor that starts too early, before 37 weeks of pregnancy. Premature birth is birth that happens before 37 weeks of pregnancy. Premature babies are more likely than full-term babies to have health problems at birth and later in life. Women with diabetes are at increased risk for a condition called polyhydramnios. This is when there’s too much amniotic fluid in the sac around your baby. This can lead to preterm labor and premature birth. If there are problems with your pregnancy, your provider may induce your labor, sometimes earlier than your due date. Inducing labor means your provider gives you medicine or breaks your water (amniotic sac) to make your labor begin. 
• Shoulder dystocia or other birth injuries (also called birth trauma). Shoulder dystocia happens when a baby’s shoulders get stuck inside the mother’s pelvis during labor and birth. It often happens when a baby is very large. It can cause serious injury to both mom and baby. Complications for moms caused by shoulder dystocia include postpartum hemorrhage (heavy bleeding). For babies, the most common injuries are fractures to the collarbone and arm and damage to the brachial plexus nerves. These nerves go from the spinal cord in the neck down the arm. They provide feeling and movement in the shoulder, arm and hand.

Most babies born to women with preexisting diabetes are healthy after birth. But preexisting diabetes can increase your baby’s risk for health problems, including:

• Autism spectrum disorder. A group of developmental disabilities that can cause social, communication and behavior challenges. Developmental disabilities are problems with how the brain works that can cause a person to have trouble or delays in physical development, learning, communicating, taking care of himself or getting along with others.
• Enlarged organs if your baby is very large
• Jaundice. This is when a baby's eyes and skin look yellow because his liver isn’t fully developed or isn’t working.
• Obesity later in life. Obesity is being very overweight. It means you have an excess amount of body fat and a body mass index (also called BMI) of 30 or higher. To find out your BMI, go to cdc.gov/bmi.
• Hypoglycemia (also called low blood sugar) and polycythemia. Polycythemia is when the body makes too many red blood cells which causes the blood to be thick.
• Respiratory distress syndrome (also called RDS). This is a breathing problem caused when babies don’t have enough surfactant in their lungs. Surfactant is a protein that keeps the small air sacs in the lungs from collapsing.

Pregnancy can make health complications associated with diabetes worse. Some can be life-threatening. Getting regular treatment and managing your diabetes during pregnancy can help you prevent severe complications.

What kinds of health care providers do you need to treat preexisting diabetes during pregnancy?

To best manage your diabetes during pregnancy, you need a team of health care providers who work together to give you the best all-around care. Your team is led by:

• Your prenatal care provider
• Your endocrinologist. This is a doctor who treats people with diabetes and other diseases of the endocrine system. The endocrine system is all the glands in your body that produce hormones that control how your body works. .

Your team also may include other providers, including:

• A perinatologist. This is a doctor who treats women with high-risk pregnancies.
• A diabetes educator. This person has training to help you control your blood sugar.
• A registered dietitian (also called RD). This health professional has training to help you use diet and nutrition to help you stay healthy. 
• Your baby’s health care provider, especially as you get closer to your baby’s birth

Before you try to get pregnant, make sure each provider knows about your pregnancy plans and the other providers you see. All your providers work together with you to help you get ready for pregnancy and stay healthy during pregnancy. They make sure that any treatment you get is safe for your baby. Share their contact information so you and your providers can connect easily.

If you have diabetes, what can you do before you get pregnant to help you have a healthy pregnancy?

Plan ahead so you’re as healthy as you can be before you get pregnant. Here’s what you can do:

• Manage your diabetes. Get your diabetes under control 3 to 6 months before you start trying to get pregnant. Make sure all the providers on your health care team know you’re trying to get pregnant.
• Use birth control until your diabetes is under control and you’re ready to get pregnant. Birth control (also called contraception and family planning) is methods you can use to keep from getting pregnant. Also called contraception or family planning. Methods you can use to keep from getting pregnant. Birth control pills and intrauterine devices (also called IUDs) are examples of birth control.
• Take a multivitamin with 400 micrograms of folic acid in it every day. Folic acid is a vitamin that every cell in your body needs for healthy growth and development. If you take it before pregnancy and during early pregnancy as part of healthy eating, it can help protect your baby from neural tube defects. If you have diabetes, your provider may need more than 400 micrograms of folic acid each day. Talk to your provider about the right amount of folic acid for you.
• Tell your prenatal provider about any medicine you take. Your provider can make sure the medicine is safe for your baby when you do get pregnant. If not, you may need to change to another medicine. Don’t start or stop taking any medicine during pregnancy without talking to your provider team first.
• Eat healthy foods and do something active every day. Work with your RD or diabetes educator to create a healthy meal plan to help control your blood sugar. 

How is preexisting diabetes treated during pregnancy?

If you have diabetes, your prenatal care provider wants to see you often during pregnancy so she can monitor you and your baby closely to help prevent problems. At each prenatal care checkup, you get tests to make sure you and your baby are doing well. Tests can include:

• An ultrasound in the second trimester that includes a detailed look at your baby, to check his growth, weight and heart. Ultrasound uses sound waves and a computer screen to show a picture of your baby inside the womb.
• Tests like the nonstress test and the biophysical profile. The nonstress test checks your baby’s heart rate. The biophysical profile is a nonstress test with an ultrasound.  

Your provider tells you how often to check your blood sugar, what your levels should be and how to manage them during pregnancy. Blood sugar is affected by pregnancy, what you eat and drink and how much physical activity you get. What worked for you before pregnancy to control your blood sugar may not work as well during pregnancy. You may need to change what you eat or your physical activity. If you were taking insulin before pregnancy, you may need to take more during pregnancy, or you may need to take insulin shots.   

Here’s what you can do to help manage your diabetes during pregnancy:

• Go to all your prenatal care checkups, even if you’re feeling fine. And keep seeing all the providers on your health care team who help you manage your diabetes.
• Follow your provider’s directions about how often to check your blood sugar. Call your provider if your blood sugar is too high or too low. Keep a log that includes your blood sugar level every time you check it. Share the log with your provider at each prenatal checkup.
• If you take insulin, take it exactly as your provider tells you to. You need more insulin during pregnancy, especially between 28 and 32 weeks of pregnancy. Insulin is safe for your baby during pregnancy and labor.
• Tell your providers about any medicine you take, even medicine that’s not related to your diabetes. Some medicines can be harmful during pregnancy, so your provider may need to change them to ones that are safer for you and your baby. Don’t start or stop taking any medicine during pregnancy without talking to your provider first.
• Talk to your provider about taking low-dose aspirin. Low-dose aspirin (also called baby aspirin or 81 mg aspirin) can help prevent preeclampsia. You can start taking low-dose aspirin after 12 weeks of pregnancy (before 16 weeks is best). Don’t start or stop taking low-dose aspirin or any other medicine during pregnancy without talking to your provider first.
• If you don’t have a dietician, get one. Your provider can recommend one for you. An RD can help you learn what, how much and how often to eat to best control your diabetes. She can help you make meal plans and help you know the right amount of weight to gain during pregnancy. Check to see if your health insurance covers treatment from an RD. Eating healthy foods and being active every day can help you manage your diabetes.
• Ask your provider if you need to have a c-section. Diabetes increases your chances for needing a c-section. If your provider thinks you need to have your baby by c-section, ask about timing. If your diabetes is well controlled, ask about waiting until at least 39 weeks to have your baby. This gives your baby time to grow and develop in the womb before birth. If you have complications during pregnancy, you may need to have your baby earlier.

During labor and birth, your provider watches your glucose level closely. You can take insulin during labor.

What is insulin resistance?

Some pregnant women with diabetes become insulin resistant. This means your body makes insulin but doesn’t use it well. During pregnancy, the placenta grows in your uterus (womb) and supplies food and oxygen to your baby through the umbilical cord. The placenta also makes hormones that help your baby develop. But these hormones can make you insulin resistant. You may need more and more insulin the longer you’re pregnant—up to 3 times as much as you needed before pregnancy. You’re most resistant to insulin in your third trimester.

If you have preexisting diabetes, is it OK to breastfeed?

Yes. If you have diabetes, it’s safe to breastfeed your baby. Breast milk is the best food for a baby in the first year of life. It helps him grow healthy and strong. Talk to your providers before your baby is born about breastfeeding:  

• Talk to your dietician. She can help create a new meal plan to make sure you get all the calories you need for you and your baby. You need about 500 more calories each day for breastfeeding. She may recommend that you eat a healthy snack before or after breastfeeding.
• Talk to your providers about the amount of insulin you need. You may need less insulin than usual for a few days after giving birth, and breastfeeding can lower the amount even further. It’s safe to take insulin while breastfeeding.
• Talk to your providers about how often to monitor your blood sugar. If you’re breastfeeding, your providers may want you to check your blood sugar more often than usual.

What are hypoglycemia and hyperglycemia?

Hypoglycemia is low blood sugar and hyperglycemia is high blood sugar. Both of these conditions are common if you have preexisting diabetes. If you have signs or symptoms of either condition, tell your provider. Signs of a condition are things someone else can see or know about you, like you have a rash or you’re coughing. Symptoms are things you feel yourself that others can’t see, like having a sore throat or feeling dizzy.

If you have preexisting diabetes, you’re more likely to have low blood sugar (hypoglycemia) during pregnancy. This can happen if you don’t eat enough or often enough, if you get too much physical activity or if you take too much insulin. It’s usually mild and easily treated by eating or drinking something. But if it’s not treated, it can cause you to pass out. Signs and symptoms of hypoglycemia include: 

• Being hungry
• Having a headache
• Feeling weak, dizzy, shaky, confused, anxious (worried) or cranky
• Looking pale
• Sweating
• Having a fast heart beat

You also may have high blood sugar (hyperglycemia), even if you’re being treated for diabetes. You may have hyperglycemia if:

• You don’t take your medicine at the right times.
• You eat more than usual or at irregular times.
• You’re less active than normal.
• You’re sick.

If you have hyperglycemia, you may need to change the amount of insulin you take, your meal plan or the amount of physical activity you get. Signs and symptoms of hyperglycemia include:

• Being thirsty
• Having a headache
• Needing to urinate often
• Felling weak or tired
• Having trouble paying attention
• Having blurred vision
• Having a yeast infection

Your provider can check you for these conditions during pregnancy to make sure you and your baby stay healthy.

Last reviewed: April, 2019