Diabetes and pregnancy

Women who have diabetes mellitus and become pregnant must receive careful specialist care. Then they have a good chance of a pregnancy without major complications and a healthy child.

Medical support for pregnant women with diabetes

Just under one percent of all pregnant women in Germany, about 7.500 women, have diabetes – most of them type 1, about 20 percent type 2. There is also gestational diabetes, which only occurs during pregnancy. Around 4.5 percent of pregnant women (just under 35.000) are affected. However, gestational diabetes will not be discussed in detail below.
For women with diabetes who become pregnant, it is important that they receive close care from diabetes specialists, midwives, and gynecologists. With good blood sugar control and consistent adherence to the values, you have a good chance of experiencing a complication-free pregnancy and giving birth to a healthy child.

If you have type 1 or type 2 diabetes, it is best to schedule your pregnancy. Then you can already positively influence the course of pregnancy in advance. If you are unplanned pregnant, it is advisable to talk to your diabetology and gynecology specialists as soon as possible.

Blood glucose: as good as possible during pregnancy

For a good course of the pregnancy and a healthy development of the child, it is particularly important that the blood glucose values are individually adjusted as optimally as possible. However, this is complicated by hormonal fluctuations during pregnancy. At the beginning of pregnancy until about 14. The need for insulin decreases during the first week of pregnancy. It rises steeply from the middle of pregnancy and falls sharply again at birth.

For pregnant women with type 1 diabetes, it is therefore advisable to take at least seven measurements a day. It is best to measure in the morning on an empty stomach, one hour after breakfast, then before lunch, one hour after lunch, before and after dinner, and before bedtime. Modern measuring devices store the values, which your doctor can then read out and discuss with you. Many women also use apps to document blood glucose levels, their diet and exercise, and other relevant values.

The German Diabetes Association states that the optimum blood glucose level during pregnancy is

before meals: 60 to 90 mg/dl (3.3 to 5.0 mmol/l)
one hour after eating: less than 140 mg/dl (7.7 mmol/l)
two hours after eating: less than 120 mg/dl (6.6 mmol/l)
before bedtime: 90 to 120 mg/dl (5.0 to 6.6 mmol/l)
at night (around two to four o’clock): 60 to 90 mg/dl (3.3 mmol/l)

In addition, the HbA1c value is determined by a blood test at intervals of four to six weeks. It is a reliable long-term average that provides information about how your blood glucose level has been adjusted over the past few weeks.

Also have it clarified at which blood glucose levels a ketone test is necessary. If ketone levels are too high, there is a risk of what is known as ketoacidosis. The blood glucose levels are then so high that the metabolism is dangerously derailed. Ketoacidosis must be treated immediately or a life-threatening condition may result.

The diet of pregnant women with diabetes

As for all pregnant women, it is also important for women with diabetes to adapt their diet to the special calorie and nutrient requirements during pregnancy. Diabetes nutrition counseling that specifically addresses pregnancy conditions may be able to give you helpful tips and support.

The B vitamin folic acid is particularly important for the healthy development of the child. It is best to start taking folic acid when you are planning a pregnancy. For women with diabetes, it may also make sense to take a higher dose than is recommended for healthy women. Foods containing folic acid also contribute to a good supply of folic acid during pregnancy. This reduces the risk of malformations of the child’s spine, spinal cord and brain, as well as in the area of the lips, jaw and palate.

An adequate supply of iodine also contributes to the healthy development of the child. A daily intake of at least 0.1 to 0.2 mg (100 to 200 μg) of iodine and an iodine-rich diet are recommended. Since the individual iodine supply depends on many factors, such as personal dietary habits, it is advisable to discuss your iodine requirements with your doctor at the beginning of pregnancy.

If you are a smoker, you should stop smoking for a good pregnancy and healthy development of your child.

Diabetes therapy and medications during pregnancy

There is no binding therapy scheme for all – the best individual approach must be determined for each pregnant woman. Due to the metabolic fluctuations during pregnancy and the individual differences in insulin requirements, the insulin dose must be continuously and carefully adjusted. Therefore, have your values checked every two weeks by your diabetologist.

Prenatal care and check-ups

Good medical care can help you feel as safe as possible during pregnancy despite diabetes:

Your specialist or. Your specialist may want to see you more often for prenatal care than a metabolically healthy woman.
Have your retina examined once or twice before the planned pregnancy, at the beginning of pregnancy and depending on the findings and the risk.
Measure your blood pressure as regularly as possible and have your urine tested for protein as part of prenatal care.
Between the 18. and 22. Detailed fine diagnosis of the fetal organs and structures is possible at a specialized center during the first week of pregnancy. Subsequently, further ultrasound examinations can be performed every two to four weeks.
More frequent CTGs before birth to check the heart and contractions, as well as checking the thyroid gland for over- or underactivity, are recommended.

What are the risks for pregnant women with diabetes and their children??

In the first period of pregnancy the internal organs of the child are developing. If the blood glucose levels of the pregnant woman are not optimally adjusted during this time, this can lead to malformations in the child. If, on the other hand, the values are well adjusted, the risk of fetal malformations is significantly lower.

Children of mothers with type 1 and type 2 diabetes have an increased risk of malformations, especially of the heart, lungs and nervous system, compared to children of healthy women. Deformities of the bones, urinary tract, bile ducts, and spleen are also more common. Because the child has to process the increased maternal blood sugar and produces a lot of insulin in the process, it may store more fat in the course of the pregnancy and therefore be born with a too high birth weight. In addition, the maturation of the lungs is delayed, which can be associated with breathing problems after birth.

For women with type 1 diabetes, there is a risk of blood glucose levels dropping too low (hypoglycemia), particularly at the beginning of pregnancy and especially at night. From the 20. After the second week of pregnancy, the risk is lower and blood glucose levels become more stable and predictable.

Based on current knowledge, occasional maternal hypoglycemia is not problematic for fetal development, but it does pose a risk to the mother. Therefore, it is even more important than usual for you to know which symptoms indicate hypoglycemia in order to be able to react appropriately.

If you have diabetes-related diseases, for example of the eyes, kidneys, thyroid gland or nerves, they can worsen during pregnancy. Often, however, the changes recede again after birth. Retinal changes (diabetic retinopathy) and diabetic kidney disease (diabetic nephropathy) must be treated in good time.

As pregnancy progresses, high blood pressure may develop, especially if diabetes has been present for some time. In this case, it is best to check your blood pressure yourself every day. The thyroid gland should also be tested for hyper- or hypothyroidism.

How does childbirth proceed for women with diabetes?

Women with diabetes are recommended to have their child in a so-called perinatal center with the level 1 or 2. Hospitals with this designation specialize in high-risk pregnancies and premature births and have an affiliated pediatric clinic with a neonatal intensive care unit.
Since women with diabetes have a higher risk of preterm birth before 37 weeks of gestation, breastmilk is not only important. week of pregnancy is significantly increased, it is good to look for a suitable clinic with a diabetes-experienced team early in the pregnancy.

If the expected delivery date is reached, but the birth does not start on its own, the birth is usually induced in women with diabetes. If the baby’s weight is estimated to be more than 4.500 grams estimated, you may be advised to have a cesarean section.
During birth, your blood glucose levels should be between 90 and 130 mg/dl (5.0 to 7.2mmol/l) if possible. To maintain these levels, blood glucose levels are usually checked every one to two hours and corrected as needed.

After birth

After birth, mother and child need intensive care. In women, insulin requirements decrease in the hours after delivery, increasing the risk of hypoglycemia. The insulin supply must therefore be adjusted to the new requirement.

If possible, put your baby to breastfeed within the first half hour after birth. If the baby is not yet able to suck for itself, you or the midwife can also express the colostrum by hand and give it to the baby via an eyedropper. After that, his blood glucose levels should be checked every three hours for the first day until they are stable.

Breastfeeding and diabetes

If possible, breastfeed your child for at least six months. Breast milk not only reduces the child’s risk for later diabetes, but also for obesity.

Because your own insulin needs decrease when lactation begins, your insulin dose will need to be readjusted. As a guideline, use the requirement before pregnancy. If you do need to switch to bottle feeding, you should discuss the switch with your diabetic team.

Depending on your personal situation, you may also be eligible for family assistance, home help financed by health insurance, or other special assistance for disabled and chronically ill parents.