Managing Diabetes During Pregnancy: A Guide for Expectant Parents

Overview

Diabetes during pregnancy refers to either pregestational diabetes (type 1 or type 2 diabetes that exists before you become pregnant) or gestational diabetes mellitus (GDM), a condition that develops for the first time during pregnancy, usually around 24–28 weeks. With careful, consistent management, most people with diabetes during pregnancy have healthy pregnancies and babies.

Signs & Symptoms

Most people with gestational diabetes have no noticeable symptoms, which is why routine screening is a standard part of prenatal care. If symptoms do appear, they may include increased thirst, frequent urination, unusual fatigue, blurred vision, or recurring yeast or urinary tract infections. People with pregestational diabetes may experience these symptoms before pregnancy, or may have no symptoms if their blood sugar is already well controlled.

Causes & Risk Factors

Gestational diabetes develops when pregnancy hormones make your body less able to use insulin, the hormone that regulates blood sugar levels. Risk factors for gestational diabetes include a family history of diabetes, a body mass index (BMI) in the overweight or obese range before pregnancy, a previous diagnosis of gestational diabetes, polycystic ovary syndrome (PCOS), or being over 25 years old. Pregestational diabetes is caused by the same underlying factors as type 1 diabetes (an autoimmune condition that destroys insulin-producing cells in the pancreas) or type 2 diabetes (insulin resistance and reduced insulin production) that occur outside of pregnancy.

Diagnosis

All pregnant people are screened for gestational diabetes between 24 and 28 weeks of pregnancy with a one-hour glucose challenge test, where you drink a sugary solution and have your blood sugar checked an hour later. If the result is higher than normal, a longer three-hour oral glucose tolerance test (OGTT) confirms the diagnosis. If you have pregestational diabetes, your provider will review your recent blood sugar records and A1C test results (a measure of your average blood sugar over the past 2–3 months) before or early in pregnancy to confirm your diagnosis and assess how well your condition is controlled.

Treatment & Management

The goal of diabetes management during pregnancy is to keep your blood sugar within a target range set by your healthcare team, which is usually lower than the target range for non-pregnant people to keep your baby safe. Treatment typically includes a combination of frequent blood sugar monitoring, a tailored healthy eating plan, regular safe physical activity, and, if needed, pregnancy-safe medications (most often insulin, as many oral diabetes medications are not recommended during pregnancy). Your care team will likely include an obstetrician, endocrinologist, certified diabetes educator, and registered dietitian to coordinate your care.

• Check your blood sugar 4 or more times per day, including first thing in the morning and 1–2 hours after meals, to track how food, activity, and medication affect your levels
• Work with a registered dietitian to create a meal plan that balances carbohydrates, protein, and fat to avoid blood sugar spikes
• Aim for 150 minutes of moderate aerobic activity per week, such as walking, swimming, or prenatal yoga, unless your provider advises against it
• Take insulin or other prescribed medications exactly as directed; never adjust your dose without talking to your provider first
• Attend all prenatal appointments, including extra ultrasounds and fetal monitoring, to track your baby’s growth and your health

Living With It

Managing diabetes during pregnancy can feel overwhelming, but you do not have to do it alone. Many people successfully manage their condition and go on to have healthy pregnancies and babies. It is also important to prioritize your mental health: talk to your provider if you feel anxious, stressed, or overwhelmed by your diabetes management plan. After delivery, people with gestational diabetes will have their blood sugar checked 6–12 weeks postpartum to confirm it has returned to normal, and will be screened for type 2 diabetes every 1–3 years. People with pregestational diabetes will need to continue managing their condition long-term, and work with their care team to adjust their treatment plan after delivery.