The Importance of Preconception Planning with Diabetes

College of DuPage Nursing Student V. Martinez shared that according to the Centers for Disease Control and Prevention (CDC, 2020), uncontrolled glucose levels (blood sugar) can cause serious birth defects in a developing fetus. Even if your glucose levels are under control, they can become unstable from many physiological changes that occur during pregnancy. Ideally, all women who have diabetes (and young women of reproductive age) should undergo preconception planning prior to becoming pregnant. Unfortunately, less than 20% of diabetics in the U.S. take the additional steps to better manage their own health and the health of their fetus (Cashion, 2018).

Why Obtain Preconception Planning?

Preconception planning involves meeting with your doctor to make sure that you are healthy and safely able to carry a pregnancy, and that your medications will not harm your growing fetus. Your doctor may suggest weight loss, more exercise, or eating a more nutritious diet. To protect the mother and fetus, the obstetrician or midwife will recommend daily folic acid to prevent neural tube defects such as spina bifida (CDC, 2018) and before becoming pregnant, any necessary vaccinations.

Blood Glucose and Pregnancy

Changes in hormones levels influence glucose levels throughout the course of pregnancy. In the first trimester, a significant increase in estrogen and progesterone stimulates the pancreas to produce more insulin (Cashion, 2018). As a result, diabetics may likely experience hypoglycemia and a decreased need for their insulin medication (if insulin-dependent). During the second and third trimesters, the body may become insulin resistant from the increased level of insulin during the previous weeks and months. As a result, in the latter half of pregnancy the insulin needs may double or quadruple (Cashion, 2018). These changes make it incredibly important to monitor glucose levels and administer the correct type and amount of medication to manage diabetes.

Complications of Pregnancy

Women with diabetes are at an increased risk for several complications during pregnancy. Uncontrolled glucose levels early in the first trimester can contribute to miscarriage (Cashion, 2018). The early loss of a fetus can be devastating to any expectant mother. Diabetic women also carry an increased risk for infections which tend to be more serious and harmful to the fetus (Cashion, 2018). Diabetic women are also more at risk to develop polyhydramnios in the third trimester of pregnancy (Cashion, 2018). Polyhydramnios is an excessive amount of amniotic fluid in the amniotic sac which may contribute to severe bleeding in the immediate period after delivery. Finally, excessive exposure to glucose in the latter half of pregnancy can contribute to a larger than normal (9 to 10 pound) fetus (Cashion, 2018) which contributes to a prolonged and potentially more difficult labor. It is more difficult for a large fetus to move through the birthing canal, increasing the risk for a cesarean section which subsequently increases the risk of other potential complications.

Planning for Your Baby’s Future

When the time comes to plan a family, consider preconception planning with your doctor or healthcare provider. A short 35 to 45-minute appointment may be all you need to ensure a safe and healthy pregnancy. The worst thing that could happen is that your doctor identifies a health issue and then creates a plan to manage it. Keep in mind that your body supports and nourishes the growing baby for nine months, so a healthy body is essential for the health of the mother and the baby.

References

Cashion, K. (2018). High-Risk Perinatal Care. In M. J. Hockenberry, D. L. Lowdermilk, D.

Wilson, K. Cashion, C. C. Rodgers, & K. R. Alden (Eds.), Maternal Child Nursing Care (6th ed., pp. 244–280). Elsevier.

Centers for Disease Control and Prevention. (2020, July 14). Type 1 or type 2 diabetes and

pregnancy. https://www.cdc.gov/pregnancy/diabetes-types.html.

Centers for Disease Control and Prevention. (2018, April 11). Folic acid.

https://www.cdc.gov/ncbddd/folicacid/about.html.