Download PREGNANCY, YOUR BABY, AND DIABETES

PREGNANCY,
YOUR BABY,
AND
DIABETES
THIS TOPIC IS DIVIDED INTO TWO MAIN SECTIONS:
Pre-pregnancy and Diabetes
Pregnancy for the Woman with Diabetes
PE 07002 (02/12) 1 of 1
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Pre-pregnancy and Diabetes
•A careful balance of your meal
plan, activity, and insulin needs to
be achieved and maintained before
and during pregnancy.
•Choosing to have a baby is a big
decision and an exciting time. It
may also be a time when you are
more concerned about your health
if you have diabetes.
•Today, the chances are better than
ever that a woman with diabetes
will have a healthy baby. Keeping
blood sugar levels near the target
range before and during pregnancy
helps to ensure a positive outcome
of your pregnancy.
•What are the target blood sugar
values for the non-pregnant
woman with diabetes?
–Fasting: 70 -130 mg/dl
–Before meals: 70 -130 mg/dl
–HbA1c< 7%
•Having diabetes increases the risk
of problems for you and your baby.
During pregnancy, the sugar in
your blood goes to the baby so it
can grow and develop. If your
blood sugars are too high, they can
cause birth defects and other
problems.
•Because the baby’s organs are
formed during the first 12 weeks of
life, the risk for birth defects is
greatest if blood sugars are poorly
controlled during the first trimester.
•You can reduce your risks of birth
defects to that of someone that does
not have diabetes by having a
normal HbA1c and blood sugars
consistently in your target range
before you become pregnant.
•You will need to continue to use
contraceptives until your blood
sugars are in the target range and
your HbA1c is normal. This test
gives you a three month average of
your blood sugars.
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Controlling Your Blood
Sugar Before Pregnancy
•It is a good idea to begin working before pregnancy with the health care team
who will provide your prenatal care. This team includes an obstetrician,
pediatrician, nurse educator, and dietician. Pregnancy can bring out some of the
long term complications of diabetes. Get a check up now of your eyes, kidneys,
heart, and BP.
•If you take oral diabetes medications, you will stop taking them and begin
taking insulin. Oral medications and Glargine insulin may be harmful to the
developing fetus. ACE inhibitors (for kidney disease) should also be discontinued
when you become pregnant. Your doctor will decide on the best substitute
medication for you.
•Your insulin needs may increase, or you may take more than one type to meet
your blood sugar target goals. Two to four injections/day is common before and
during pregnancy.
•Meet with a dietician to develop a meal plan.
•If you have a regular exercise program, continue it. You will need to test more
often when you exercise. You may need an exercise snack before, during, or after
exercise.
•You will need to test and record your blood sugars at least 4 times a day to be sure
your target ranges are working.
•Once your blood sugars are lower, you may experience more low blood sugar
reactions, so you need to carry at all times a quick-acting source of sugar such as
glucose tablets, gel, or hard candies.
•Cigarette smoking and alcohol are harmful to your unborn child. If you smoke,
stop smoking. Alcohol and caffeine should be avoided during pregnancy.
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Other Considerations
 There is very little chance your baby will be born with diabetes.
If you have type 1 diabetes, there is a 1 -2% chance that your
child will develop diabetes over his or her lifetime. Men with
diabetes have a 6% chance of having a child with diabetes. If you
have type 2 diabetes, there is a 30% chance your child will get
diabetes as an adult.
 •There is no ideal age to become pregnant. Women between the
ages of 20 -35 years have fewer health risks.
 •A pregnancy is very demanding when you have diabetes. This
can be a stressful time for you. It takes knowledge, time, effort,
planning, and money for the extra health care cost. You may
need to take time off from work or arrange for help caring for
other children or with housework.
Now is the time to talk and
plan with your partner and
other supporting people
about the demands of
pregnancy and diabetes.
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Pregnancy for the Woman
With Diabetes
•Women with diabetes are affected
by all of the normal changes that
occur during a pregnancy. Some of
these changes can cause problems
with blood sugar control.
•When you have an infection such as
a cold, the need for insulin increases
and the risk for DKA increases. Test
your urine for Ketones if your blood
sugar is greater than 200mg/dl.
•The amount of sugar lost into the
urine increases. Therefore glycosuria
or sugar in the urine can occur with
normal blood sugar levels.
•Diabetes increases the risk for
certain problems in the mother and
baby:
–preeclampsia (a combination of
high blood pressure, protein in
the urine, and swelling in the
hands, face, and feet).
–urinary tract infections
–hydramnios or too much water
in the sac around the baby,
which may cause the uterus to
stretch and may lead to early
delivery. This occurs in 25% of
diabetic pregnancies. Bed rest is
recommended.
–large babies at birth (over 9
lbs)
–low blood sugar and breathing
problems in the baby after birth
–stillbirth
–while it is frightening to hear
about these possible problems, it
is important to know why blood
sugar control is so vital.
Keeping your blood sugar target
range near normal will help
prevent these problems.
•All women produce Ketones more
easily during pregnancy. Ketones
result when body fats are broken
down for energy instead of sugar. So
ketosis and diabetic ketoacidosis or
DKA can occur more rapidly in
women with diabetes when they are
pregnant. Ketones cross the placenta
and affect the fetus. This can be
avoided if blood sugars are in good
control.
•The placenta, the organ that feeds
the baby, produces hormones that go
against the action of insulin. These
hormones increase as pregnancy goes
on. This leads to a change in insulin
needs during pregnancy. You will
need more insulin as the weeks go by.
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Caring for Diabetes During Pregnancy
•The target blood sugar level for pregnancy is:
–60-95 mg/dl fasting before breakfast
–60-105 mg/dl before other meals
–less than 120 mg/dl 90 minutes to 2
hours after meals
–above 60 mg/dl during the night
•Your prenatal care will probably be provided by a team of health
professionals. The team includes an obstetrician, endocrinologist,
nurse educator, dietician, and perhaps a social worker.
•You may need to visit your doctor as often as every other week
during the first and second trimesters, and then every week until
delivery.
•Test and record your blood sugar levels. Use this information to
see how the food you eat, your activity, and your insulin affect
your blood sugar levels. Bring your record with you to each of
your appointments.
•Follow your meal plan as prescribed by your dietician.
•Your insulin dosage will change often, especially during the last
half of pregnancy.
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Gestational Diabetes:
Diabetes Discovered
During Pregnancy
•This type of diabetes appears for
the first time during pregnancy. It
occurs in 7-10% of all pregnant
women.
•Women at risk:
–Women who are older than 35
years
–A previous pregnancy with a
baby weighing 9 lbs. or more at
birth
–family history of diabetes or
previous GDM
–overweight – ethnic
background of African
American or Hispanic
•Gestational diabetes, as this is
called, may occur because hormones
produced by the placenta in all
pregnant women may make insulin
work less well.
•These hormones increase as
pregnancy goes on. More insulin is
needed to maintain normal sugar
levels. If the pancreas is unable to
produce enough insulin, gestational
diabetes occurs.
•Gestational diabetes is usually
found in the 24-28 week of
pregnancy. A special screening
blood test is done at that time called
a glucose tolerance test.
•Gestational diabetes does increase
the risks of certain problems for
the mother and baby. The risks are
greatest in the last trimester and if
the blood sugar levels are not well
controlled. Some of the problems
are:
–large babies at birth (>9 lbs)
–low blood sugar and breathing
problems for the baby after
birth
–jaundice or yellowish skin in
the baby 2-3 days after birth
(temporary)
–stillbirth
–hydramnios (too much water
around the baby) which may
cause the uterus to stretch and
may lead to early delivery
–preeclampsia (a combination
of high blood pressure, protein
in the urine, and swelling of the
hands, face, and feet)
–urinary tract infections
–gestational hypertension
–vaginal yeast infections
•After pregnancy, the symptoms of
diabetes usually disappear. You need
to have your blood sugar tested
following delivery to be sure you no
longer have diabetes.
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Caring for Gestational Diabetes
•The purpose of the treatment is to keep the blood sugar near the target
range. The target blood sugar levels for pregnancy are:
–fasting: less than or equal to 95 mg/dl
–90 minutes to 2 hours after a meal: less than or equal to 120 mg/dl
–This may vary depending on your individual needs.
•The first treatment is a meal plan and exercise with
blood sugar monitoring daily.
•Insulin injections may later be needed for better
blood sugar control.
•Test and record your blood sugar levels. Use this
information to see how food, activity, and insulin
affect your blood sugar. Bring this record with you to each of your
appointments.
•You will be asked to visit your obstetrician more often than women
without gestational diabetes. It is very important that you keep your
appointments. You may be referred to a specialist in diabetes or highrisk pregnancies.
•After pregnancy, the symptoms of diabetes usually disappear. Only 2%
continue to have diabetes immediately after delivery. You must continue
to seek medical care if this is so. You will have another GTT at your
post-partum visit to make sure that your blood sugars are back to
normal.
•If you no longer have diabetes and you plan to become pregnant again,
you should have a screening blood sugar test before your pregnancy and
once you are pregnant.
•Type 2 diabetes is likely to return later in life. If you are at your ideal
body weight, you have a 25% chance of developing type 2 diabetes. If
overweight, your chances increase to 60%.
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More About Controlling
Your Blood Sugar
DIET
INSULIN
• Eating meals and snacks spread
out throughout the day and at
bedtime will help to keep your
blood sugar levels in the target
range.
• Do not go on a weight-reduction
diet. More calories are needed to
meet the energy needs of the baby
(300 more calories/day).
• Follow your meal plan as set out
for you by your dietician.
• You will learn about carbohydrate
counting.
EXERCISE
• Exercise burns calories, decreases
blood sugar levels, and increases
feelings of well-being.
• Check with your doctor about the
exercise program that is right for
you. Walking and swimming are
good activities.
• Check your blood sugar levels
more often when you exercise. If
you are prone to low sugars, carry
fast acting sugar with you or eat an
exercise snack.
• Most women take more than one
injection of insulin per day,
usually with two types of insulin.
This helps keep the blood sugar in
the target range.
• You will be taught how to inject
insulin and you may be taught to
adjust your insulin dose based on
your blood sugar readings and
carbohydrate meal content.
HYPERGLYCEMIA
• Signs and symptoms of
hyperglycemia or high blood
sugar are:
•
•
•
•
•
•
high blood sugar
Ketones in your urine
more urine output than usual
increased thirst
dry skin and mouth
decreased appetite, nausea, and
vomiting and blurry vision
• fatigue, drowsiness, or no
energy
• Vaginal yeast infections
• Call your doctor right away if
you have these symptoms. Do
not skip insulin.
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Team Care
•At each visit to your obstetrician, your weight, blood pressure,
general health, and growth of the baby will be checked.
•Your urine will be checked each time for glucose, Ketones,
protein, and bacteria.
•Your meal plan will be reviewed with you. Be sure to bring
your blood sugar logbook and meter. You may meet with a
dietitian to learn more about your meal plan or with a nurse to
learn more about diabetes during pregnancy.
•Between visits, write down any questions or concerns you have
so that you remember to ask them during your visits to your
health care team.
•Contact your doctor right away if you notice:
 more than trace Ketones in your urine
 blood glucose values consistently above target
 decreased movement of your baby (less than 4 kicks/hr after 28 weeks)
 any infection or illness (fever, nausea, or vomiting)
 lower abdominal (stomach) cramps
 vaginal bleeding or leakage of fluid
 sharp back pain or abdominal pain
 burning or pain when passing urine
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Team Care Continued...
 dizziness, fainting, blurred vision, or spots before your eyes
 rapid weight gain
 swelling of your hands, face, or feet
 low sugar that someone else has to help you treat, or so severe that you
pass out
 severe nausea or vomiting with high sugar and Ketones in your urine
Special tests and procedures during pregnancy
‒ An ultrasound test to determine the size, growth, and position of
the baby and placenta, this uses sound waves to measure and it is
safe.
‒ A 24 hour urine test done every so often to test for protein and
creatinine. These tests measure kidney health.
‒ Ophthalmology visit to check the health of your eyes.
‒ Non stress test done periodically to record your baby’s movements
and changes in heart rate. How often depends on how well your
diabetes is controlled.
‒ Drawing of your blood to measure A1C or 3 month average of
your blood sugars.
‒ Quadruple screen is a blood test done at 16 -18 weeks of
pregnancy. This gives information about whether your baby is at
high risk for birth defects.
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Meal Planning for Diabetes in
Pregnancy
To control your blood sugar, you need to watch what, how much, and when you
eat. It is important to consume balanced meals and snacks, paying special attention
to amounts and types of carbohydrates. Here are some general guidelines.
1. Eat consistently during the day, distributing your carbohydrate choices evenly.
The best way is to eat 3 meals a day.
•Try not to go longer than 4 hours without eating during the day
•Healthy snacks are ok if you become hungry
2. Include a good source of protein at every meal and snack. High protein foods
are:
●Low-fat meats
●Natural peanut butter
●Chicken
●Nuts
●Fish
●Low fat cottage cheese
●Low fat cheese
●Eggs
3. Eat breakfast soon after waking
•Have no more than 2 carbohydrate servings
•It is best to avoid fruit, fruit juice, and cold cereal with milk
•Include some protein and healthy fat
4. AVOID SUGAR AND CONCENTRATED SWEETS. These include:
●Table sugar
●Regular soda
●Honey
●Chocolate
●Molasses
● Ice cream
●Candy
●Fruit canned in heavy or lite
●Jams and jellies
syrup
●Cookies
●Sugar-sweetened drinks (like
●Cakes
Kool-Aid, Hi-C, and sweet tea)
5. Artificial sweeteners may be used to sweeten foods and drinks
•Studies have shown that moderate amounts are safe for you and your baby
6. Choose high fiber foods, such as:
•100% whole wheat bread or “White Wheat”
•Fresh and frozen vegetables
•Beans and legumes
•Fresh fruit
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7.
8.
White-colored foods may cause your blood sugar to rise significantly. These
foods, and healthy alternatives, include:
Lower your total fat intake
“White Food”:
Try This:
•Eat lean sources of protein
•Chicken
•Roast beef
•Turkey
•Ham
•Fish
•2% or low-fat cheese
White rice
White bread
Regular pasta
Potatoes
Brown rice
Whole wheat bread
Wheat pasta
Sweet potato
•Look for leaner cuts of red meat, such as round and loin
•Look for less marbling
•Remove all visible fat and skin from meats
•Bake, broil, steam, boil, or grill foods (rather than frying)
•Use skim or 1% low fat milk and dairy products
9. Watch sodium intake
•Limit lunch meat, bacon, sausage, and hot dogs
•Rinse canned beans and vegetables
•Resist the urge to use the salt shaker
•Limit frozen and pre-prepared meals/snacks and canned soups
•Guidelines: < 100 mg for snacks and side dishes and < 400 mg for meals
10. Include small amounts of healthy fats, such as:
•Olive and canola oil (rather than vegetable oil)
•Nuts, peanuts, almonds, and walnuts
•Avocados
11. Food safety is important!
•Avoid undercooked meat
•Avoid shark, swordfish, king mackerel, and tilefish
•Limit all other fish to 12 oz. or less per week
•Eat no more than 6 oz. (1 can) of light tuna per week (avoid albacore)
•Cook eggs until done
•Only consume pasteurized milk and dairy products
•Watch out for cross-contamination (i.e. handling raw meat and eggs)
12. Regular exercise can help control blood sugar levels. Try these things:
•Walking
•Swimming
•Housework
•Playing with kids
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Breakfast:
Snack:
Lunch:
Snack:
Dinner:
Snack:
2 Carbohydrate servings
1 Carbohydrate serving
3 Carbohydrates servings
1 Carbohydrate serving
3 Carbohydrates servings
1 Carbohydrate serving
Carbohydrate Food Choices
1 serving = 15 g carbohydrate
Starch
 Supplies energy and fiber
 An example of a serving is 1 slice of
bread
Fruit
 Supplies vitamins, minerals, and fiber
 An example of a serving is 1 small fresh apple
Milk
 Supplies calcium, phosphorous, protein, and vitamins
 An example of a serving is 1 cup of milk (8 oz.)
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Sample Menus for Diabetes in
Pregnancy
Breakfast
Breakfast Sandwich
Oatmeal
1 poached or scrambled egg
1 whole grain English muffin (2)
1 slice cheese
1 slice Canadian bacon
1 cup cooked oatmeal (2)
1 tsp Splenda ®
1 tsp cinnamon
¼ cup of nuts
Lunch
Ham Sandwich and Yogurt
Soup and ½ Sandwich
2/3 cup light yogurt (6 oz. container) (1)
2 slices low sodium ham
2 slices whole wheat bread (2)
Lettuce and tomato
Mustard and/or mayonnaise
1 cup low sodium vegetable soup (1)
1 slice whole wheat bread (1)
1 slice reduced-fat American cheese
2 oz. deli turkey
1 slice tomato
1 small apple (1)
Dinner
Chicken Fajitas
Healthier Hamburger
3 oz. chicken breast
1 6-inch flour tortillas (1)
2/3 cup rice (2)
1 oz. 2% shredded cheese
Shredded lettuce
2 Tbl reduced-fat sour cream
3 oz. hamburger patty
1 hamburger bun (2)
Green salad with non-starchy veggies
1 corn on the cob (1)
1/3 cup salsa
Snacks
3 cups air-popped popcorn (1)
½ banana and 1 Tbl of natural peanut butter
(1)
2/3 cup (6 oz.) light yogurt 2 Tbl nuts (1)
6 crackers with 2 oz. tuna (1)
½ cup peaches with ½ cup non-fat cottage
cheese (1)
3 graham crackers with natural peanut butter
(1)
1 small apple (1) and 1 oz. of low-fat cheese
1 cup carrot sticks with 2 tbsp low-fat ranch
dressing
½ medium baked potato with ¼ cup shredded
2% cheese (1)
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