Diabetes is a condition that causes high levels of glucose in the blood. Glucose is a sugar that is the body's main source of fuel. Health problems can arise when the glucose levels are too high or not well controlled.

Causes
Diabetes occurs when there is a problem with the way the body makes or uses insulin. Insulin is a hormone that converts the glucose in food into energy.

During pregnancy, the hormones produced by the placenta can change the way insulin works. As a result, gestational diabetes may occur.

Gestational diabetes can occur even when no risk factors or symptoms are present.

Effects During Pregnancy
The risk of problems during pregnancy is greatest when diabetes is not well controlled.

If you have diabetes or if you are at risk of developing gestational diabetes, you should be aware of the problems that may arise:

• Birth defects
• Macrosomia (very large baby)
• Preeclampsia is high blood pressure during pregnancy
• Hydramnios occurs when there is too much amniotic fluid
• Urinary tract infections
• Respiratory distress syndrome can make it harder for the baby to breathe after birth.

Preparing for Pregnancy
If you have diabetes, preparing for pregnancy can improve your health and that of your future child. Plan to see your doctor before you get pregnant to discuss your care.

Diabetes Control
There are a number of ways that you can measure your glucose level. All are safe and simple to use on a daily basis. You may need to check your glucose often each day to keep it at a normal level. To be most effective, the results should be kept accurately and reported to your doctor.

Home Monitoring
Glucose meters or strips can be used to measure glucose levels.

Diet
A balanced diet is key in pregnancy. This is even more important if you have diabetes. Not eating properly can cause glucose levels to change.

Exercise
Moderate exercise is always good. For women with diabetes it is even more important. Regular exercise reduces the amount of insulin needed to keep blood glucose levels normal.

Insulin
Some women with diabetes need to use insulin shots to keep their glucose at normal levels. Insulin shots can be safely used during pregnancy to control diabetes.

Prenatal Care
You play a key role in controlling your diabetes. Prenatal care helps monitor your condition as well as that of the fetus.

A woman with diabetes often needs to have certain tests done more often in her pregnancy. These tests can help the doctor be aware of any problems and take steps to correct them.

• Hemoglobin A1C is a substance in the woman's blood. Its levels may be higher when the woman's glucose level has been too high.

   

• Alpha-fetoprotein (AFP) is a substance made by a growing fetus. In a normal pregnancy, some AFP passes into the amniotic fluid and the mother's blood.

   

• Ultrasound uses sound waves to create a picture of the fetus.

   

• A kick count is a record of how often you feel your fetus move.

   

• Electronic fetal monitoring helps your doctor detect signs of problems the fetus may be having late in pregnancy.

   

• Amniocentesis is a procedure used to obtain a small amount of amniotic fluid from the sac that surrounds the fetus.

Delivery
In most cases, women with diabetes go into labor normally when the time comes.

Postpartum Care
Problems in the Newborn
After birth, your baby may need to spend a number of days in a special care nursery for the care of high-risk newborns.

Breastfeeding
Women with diabetes can breastfeed their babies in most cases.

Contraception
Women with diabetes or gestational diabetes need to plan future pregnancies with care. In general, women with diabetes can use most of the available methods.

Glucose Control
If you have been taking insulin during pregnancy, the amount of insulin you use will change after delivery. If you had gestational diabetes, you are more likely to develop diabetes later in life.

Weight Control
Weight loss during pregnancy is not a good idea — even if you are overweight. You and your doctor should set up a program of diet and exercise for you to follow after delivery.

Finally ...
Most women with diabetes deliver healthy babies. You and your doctor can work together to plan your pregnancies and control your glucose level.

This excerpt from ACOG's Patient Education Pamphlet is provided for your information. It is not medical advice and should not be relied upon as a substitute for visiting your doctor. If you need medical care, have any questions, or wish to receive the full text of this Patient Education Pamphlet, please contact your obstetrician-gynecologist.