Bre Vittitow's first pregnancy didn't go quite the way she had expected.
|"With the second pregnancy, everything was a lot easier, because I made sure my A1C was in a good range before I got pregnant."—Bre Vittitow|
Vittitow and her doctors at first thought the vomiting was just morning sickness. At 20 weeks, she got the diagnosis: She had type 1 diabetes. After a few months, a lot of education, and some serious effort to bring her blood glucose under control, her son, Lennon, was born.
Now, after having a second child (Sayla, born in April), Vittitow, 25, of St. Louis, says there were major differences in her two pregnancies. "With Lennon, because I hadn't been diagnosed yet, my A1C was probably a 9 or 10," she says. "With the second pregnancy, everything was a lot easier, because I made sure my A1C was in a good range before I got pregnant. She didn't have any complications, and I got to bring her home right away."
When you have diabetes, planning for pregnancy can be crucial in making sure you and baby are healthy and safe. Yet more than half of all pregnancies are unplanned. So if motherhood is perhaps in your future, whether you have type 1, type 2, or a predisposition for gestational diabetes, take steps for a healthy pregnancy long before any baby-making begins.
|Who's in Your Corner?|
|Your “preconception” team can include the following people:|
This specialist in reproductive health will monitor your pregnancy and help deliver your child.
This physician specializes in treating disorders of the endocrine system, including diabetes.
This can be a certified diabetes educator, nurse, or other health care provider who works with you on the nitty-gritty of diabetes and pregnancy.
A registered dietitian can help you develop an eating plan and meal and snack schedule that keep your blood glucose and weight in check during pregnancy.
This obstetrician focuses on high-risk pregnancies.
Your pharmacist can explain medication changes and more.
|Mental health professional|
A counselor, therapist, or social worker can help provide you with support while you balance diabetes and pregnancy.
Assemble Your Team
Start by talking with your health care provider. He or she will be able to help you find a "preconception" program or build a preconception care team. Your most valuable players include an endocrinologist, an obstetrician or perinatologist (an OB who specializes in high-risk pregnancies), a diabetes educator, a dietitian, a pharmacist, and a mental health specialist. You may also be referred to an ophthalmologist, a kidney specialist, or other specialist to check for any diabetes complications, such as kidney or heart disease, that could affect your pregnancy, says Denise Charron-Prochownik, PhD, RN, CPNP, author of Reproductive Health Awareness for Teenage Women With Diabetes.
"The woman is the head of the team, but she should have a support team that will help her get into the best metabolic control possible," Charron-Prochownik says. "The discussion has to begin early."
|What is Gestational Diabetes?|
While you're in the preconception stage, using reliable birth control methods until your diabetes and thyroid health are optimal protects you and your future baby. Talk to your doctor about the best contraceptive prescriptions or methods for you. Carol Homko, PhD, RN, CDE, says most contraceptives on the market are safe for women with diabetes and previous instances of gestational diabetes.
Emma Kohler, 27, of Eldred, Pa., says preconception planning has made the difference for her. A year ago, her A1C was almost 14 percent. After working with her planning team, Kohler, who has type 1 diabetes, was able to bring her A1C down to 6.2 by the time she conceived. She's due at the end of November.
Meeting with a certified diabetes educator can help you take what you learn at your doctor's appointments and put it into practice. Jaymi Kovakovich, 30, of Hibbing, Minn., met with the same CDE for her pregnancies with Tayler, 3, and Adam, 3 months. Those appointments and the comforting bedside manner of her perinatologist helped her feel secure before and during pregnancy. "I see my diabetic educator every week, and she is absolutely wonderful," says Kovakovich, who has type 1 diabetes. "She adjusts my pump settings every week, and we share [ideas on how to maintain good glucose control]. I can even call her at home. I've learned a lot along the way."
Bring Down Your A1C
Possibly the most important thing you can do to ensure a healthy pregnancy and baby is to bring your A1C below 7 percent before conception. In Diabetes & Pregnancy, David Sacks, MD, says doing so can prevent birth defects and infant death. Getting blood glucose controlled before pregnancy is important because a baby's organs are typically formed in the first eight weeks of gestation—even before a mother is likely to know that she is pregnant, says Charron-Prochownik. Tight control early in pregnancy can prevent problems such as heart and spinal cord deformities.
A higher A1C during pregnancy also increases the risk for additional complications. For the mother, complications include eye and kidney damage, bladder and vaginal infections, preeclampsia (high blood pressure and protein in the urine—which can require early delivery of the baby), and difficult delivery. For the baby, they include premature delivery, high birth weight, shoulder injury or nerve damage, low blood glucose, jaundice, and respiratory distress.
|"I was told … that I was not allowed to get pregnant until my A1C was under 7."—Jane Bennett|
Jane Bennett knows that good blood glucose control helped her have an easy pregnancy free of complications. Diagnosed with type 1 diabetes while she was trying to get pregnant, the 33-year-old from Westborough, Mass., immediately stopped trying to conceive so she could bring her A1C down from 15. "I was told … that I was not allowed to get pregnant until my A1C was under 7," she says. "At that point I was on a mission, because I knew I wanted a baby."
Bennett started using an insulin pump and was "extremely strict" about what she ate, weighing and measuring all of her food. She had one round of in-vitro fertilization in February 2011, using one embryo. Her A1C was 6.1—and she got pregnant. Her son, Charlie, is now 12 months old. "I was determined," she says.
Heidi Shell, 31, of Pasadena, Md., says wearing a continuous glucose monitor helped her keep her blood glucose in check while she was pregnant with Jesse, now 10 months old. Shell says she "wasn't where I wanted to be" when she got pregnant with an A1C of 7.9, but during pregnancy, she faxed her numbers to her doctors a few times a week for treatment adjustments. "I felt like it was something that I was going to be able to do, with help," Shell says. Jesse was born via cesarean section with no complications.
|Uncontrolled diabetes and low thyroid hormone levels in the pregnant mother are dangerous for a developing baby—especially during the first trimester when the baby’s spine and organs are forming. Risks include:|
|♦ Preterm delivery|
♦ Birth defects
♦ Excessive growth
♦ Difficult delivery
♦ Low blood glucose
♦ Respiratory problems
♦ Low calcium and magnesium levels
Take Further Steps
In addition to blood glucose management, a healthy body weight is baby-friendly.
Weight. Being overweight or obese can lead to having more complications during pregnancy, including a greater risk for gestational diabetes, a difficult labor, and an overweight baby. Being underweight can increase the risk of having a premature baby or a baby who is too small.
|"Be ready and have the mind-set that if you don’t want to do the lifestyle changes for you, do it for someone else, someone more precious. I think I kind of surprised myself, that I have that self-control."—Ycelle Toliver|
Ycelle Toliver’s pregnancy with her son, Noah, was a surprise—she was using birth control when he was conceived (no method is 100 percent effective). But Toliver, 37, of Cypress, Calif., knew she wanted to have a healthy baby, so she immediately enrolled in a state program called Sweet Success, which is aimed at expectant moms with diabetes. Toliver was able to better control her type 2 diabetes, bringing her A1C down from 8 percent to less than 7—and losing weight as directed by her health care team throughout most of her pregnancy. Toliver says her desire to have a healthy-weight baby kept her on her recommended calorie and carbohydrate regimen; she passed up fruit and the slice of cheesecake she craved throughout her pregnancy. But it paid off: Noah weighed 7 pounds, 15 ounces, and had no complications.
Toliver says she hopes her experience can help inspire other women with diabetes who are unexpectedly pregnant. "Be ready and have the mind-set that if you don’t want to do the lifestyle changes for you, do it for someone else, someone more precious," she says. "I think I kind of surprised myself, that I have that self-control."
|Pregnant women who have diabetes (type 1, type 2, or gestational) are at a higher risk for preeclampsia, a condition that causes high blood pressure and protein in the urine. It affects between 5 and 8 percent of all pregnancies and can be life-threatening. Symptoms include swelling, sudden weight gain, headaches, and changes in vision, according to the Preeclampsia Foundation. In Diabetes & Pregnancy, David Sacks, MD, says preeclampsia can be treated with bed rest, medication, and close monitoring until the baby is delivered—and you may need to deliver early. Talk to your health care team about your risks.|
Medications. Women who hope to conceive can prevent other complications by talking to their doctor about the medications they're taking. Homko, the diabetes nurse educator, says statins (used to treat high cholesterol) and ACE inhibitors (used to treat high blood pressure and sometimes prescribed for kidney protection in people with diabetes) can be damaging to a fetus and should be stopped before conception. You and your health care provider can discuss treatment options that are safe during pregnancy.
Thyroid. Ask to have your thyroid hormone levels tested well before attempting pregnancy; if abnormal, make sure levels are back to normal before you conceive. Thyroid hormone levels can change during pregnancy, and dose requirements can change if you already are treated with thyroid hormone. Women with type 1 are at much higher risk for low thyroid levels (hypothyroidism).
Exercise. Physical activity is another health factor before and after conception. Sacks recommends that women trying to get pregnant exercise for at least 30 minutes a day, five times a week. Megan Beatie, 42, of Chatsworth, Calif., who has type 1 diabetes, took that advice to heart: She exercised regularly while pregnant with Luke, 4, and Boden, 8 months. "Up until the day before my cesarean section, I was swimming laps in the pool. Up until the week before, I was doing spin class," she remembers. "It really helped me mentally as well."
Pregnancy can be stressful enough, but adding the literal highs and lows of diabetes can take a lot out of a woman deluged with hormones and a baby bulge. That's why Charron-Prochownik recommends that every preconception and pregnancy care team include a social worker, therapist, or other mental health professional. "I think it helps with diminishing stress and improving coping," she says. "Having diabetes is stressful enough. Going into a pregnancy, you're going to be asked to do a lot of tests. Maintaining that blood sugar is going to be a really tough task. You’re going to need as many support systems as you can have."
|People may wonder: “Can I pass diabetes on to my baby?” The risk depends on what type of diabetes you have and when you were diagnosed. To learn more, visit diabetes.org/genetics.|
Beatie says seeing a therapist during pregnancy was helpful, especially for a perfectionist like herself. "There's so much of a focus on your numbers. It's hard not to fall into that [good/bad] mind-set," she says. "Diabetes is just one more aspect where I want to excel. But you can never be perfect. Even with the best preparations, you still will fall short. And with pregnancy … it's not just your own body you're responsible for; you have another human being who has no say in the matter. For me, the mental part was just as important."
|"I started working out and exercising, which I was never into, and I started doing yoga."—Kara de Alvare|
Some women find a little exercise can help burn off some steam—and high blood glucose levels. Kara de Alvare, 30, of Holland, Mich., picked up a new activity while she was pregnant with Elena, now 6 months old. "I started working out and exercising, which I was never into, and I started doing yoga," de Alvare says. "That was a great stress reliever, which helps when you’re diabetic." That outlet, coupled with support from family and friends, helped de Alvare manage her type 1 diabetes well during pregnancy. Elena was treated for low blood sugar for 24 hours after birth, before her own body was able to normalize her blood glucose levels.
Finding other women who can relate can be a great comfort. When Teré Dickson, MD, MPH, started planning her pregnancy, she wanted to talk to other women with diabetes who were hoping to conceive. When she couldn't find such a resource, she started one herself: The 36-year-old from Brooklyn, N.Y., started a diabetes and pregnancy support group. "One of the things that I experienced is there's so much negativity around women with diabetes who want to become pregnant. There's so many naysayers," says Dickson, who has type 1 diabetes. "Many women with diabetes can go on to successful pregnancies. We want to give positive reinforcement to women who are doing the best that they can in order to support [each other]." Dickson is expecting her first child in March.
|"One of the things that struck me was how many people reached out to me to say, 'I know exactly what you mean.' "—Ophir Busel|
Some women seek confidants online. Ophir Busel, 40, of Pennington, N.J., conceived twins Aria and Ethan, now 14 months old, and began blogging (theconsciousdiabetic.blogspot.com) about the ups and downs of a high-risk pregnancy—her age, diabetes, and having twins all played a role in her early delivery at 34 weeks. Finding a community she could share with was so important, she says. "One of the things that struck me was how many people reached out to me to say, 'I know exactly what you mean,' " she says. "You open yourself up and you don't know who's reading it, but every time people were positive and asking questions."
Roll With the Punches
In the toughest phases, remember why you're working so hard to achieve good health: a healthy bundle of joy—or two, in Busel's case. "There's just nothing logical about having kids," she says. "You just do it because of love. ... It's just a beautiful experience, and I had a pretty traumatic and challenging experience. But I wouldn't trade motherhood for the world."
Ready to learn more? Visit diabetes.org/pregnancy for more information.