Women with diabetes prior to pregnancy have an increased risk for pre-eclampsia, retinopathy, macrosomia, hypoglycemia during pregnancy, and more. However, these risks can be decreased when glucose control is achieved prior to pregnancy and is continued to be managed throughout pregnancy. Preconception A1c goals of <7.0% have been shown in research to have the best outcomes.
Outside of glycemic control, increased micronutrient intake and supplementation have been found useful in increasing fertility and positive pregnancy outcomes in women with diabetes. These needs are associated with increased utilization of micronutrients based on glucose metabolism, medications used and body weight and are highly individual.
Once pregnant, managing blood sugars can become increasingly difficult due to changes in hormones. It is important that women are consistently counting their carbohydrates and checking blood sugars in order for the healthcare team to best assess the patients needs.
Fasting and post-meal blood sugar targets during pregnancy are different than pre-pregnancy with a fasting goal of </99 mg/dL and a peak post-meal blood sugar of 129 mg/dL. A1c goals during pregnancy are to maintain <6.0%.
These goal look different for women who develop diabetes for the first time during pregnancy which would be referred to as Gestational Diabetes or GDM. GDM risk factors include a previous pregnancy with GDM, a previous pregnancy with delivery of an infant who was greater than 9lbs., diagnosis of PCOS, family history of Type 2 Diabetes, weight status before pregnancy and increased weight gain in the early months of pregnancy, and mothers of certain ethnic backgrounds (Black, Hispanic, American Indian and Asian American). Glucose goals for patients diagnosed with GDM are fast blood glucose <95 mg/dL, 1 hour post-meal blood glucose level of 140 mg/dL and 2 hour post-meal blood glucose levels of 120 mg/dL.
As the pregnancy continues, carbohydrate needs will increase. Working with a prenatal dietitian to plan how to address this increase is important to ensure adequate blood sugar
control, nutrient intake and weight gain that will provide best outcomes for mother and baby.
Managing blood sugars leading up to delivery is important to help baby transition to life outside the womb with a little interventions as possible. This will also promote better wound healing for mom after delivery! If planning to breastfeed, it is important to note that women with diabetes may have a delay in breastmilk production and are at a higher risk of mastitis. Despite these challenges, breastfeeding is still encouraged and can help manage blood sugars postpartum.
Visit with our certificate trained fertility or pregnancy dietitian today! www.panhandlenutritiontherapy.com.
Diabetes Care. Management of Diabetes During Pregnancy. American Diabetes Association; 2024.
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