5 tips for a healthy pregnancy with diabetes

Are you at risk?

If you’re pregnant, you might be thinking about the amount of folic acid in your multivitamin. Or maybe you’re just thinking about where to find pickle-flavoured ice cream at 2 a.m. You’re probably not aware of how your body’s elevated hormones are messing with insulin in your cells and spiking your blood sugar. But if you’re within the three to seven percent of pregnant women who develop diabetes during pregnancy-called gestational diabetes-you should be.

A further 5.5 percent of Canadian women have either type 1 or type 2 diabetes, and while most are older, the disease is becoming more common among women of reproductive age. Luckily, having a healthy pregnancy with diabetes is also common, with the right help and proper self-care. Read on for what you need to know to keep yourself and your baby in good health for those nine months, and beyond.

1. Plan your pregnancy

Dealing with complications caused by diabetes can be a game-changer during pregnancy. Gestational diabetes tends to show up later on (around weeks 24 to 28) and the tricky part is, there are usually no symptoms. (Occasionally gestational diabetes is associated with excessive thirst and increased urination.)

Risk factors can include advanced maternal age, family history, obesity and ethnic background, the same as for type 2 diabetes. “It’s the same disease,” says Dr. Erin Keely, chief of endocrinology and metabolism at Ottawa Hospital. “It’s just that pregnancy brings it out earlier.” She calls pregnancy an insulin-resistant state, meaning that a woman’s body is under pressure to make more insulin to keep her blood sugar down.

If you have type 1 or type 2 diabetes, the most critical time to seek help is before you conceive. “It’s so important for these women to plan their pregnancies,” says Jennifer Snyder, a nutritionist and Perinatal Clinical Activities Specialist at McGill University Health Centre who also works with the Canadian Diabetes Association. Complications can include eye disease, kidney disease, nerve damage and blood-vessel damage for you, and congenital defects and a bigger birth size for your baby, which might mean a difficult pregnancy.

2. Don’t skip tests

Screening tests for gestational diabetes are fairly common, although it can depend on your doctor. The Canadian Diabetes Association calls for all pregnant women to be screened, while the Society of Obstetricians and Gynecologists of Canada advises screening only for women with risk factors.

Once you’ve been diagnosed, your doctor will give you a glucometer to measure your blood sugar four times a day, first thing in the morning and after every meal. Controlling blood sugar, based on frequent testing, is the absolute best way to ensure a healthy pregnancy for mother and baby.

For gestational diabetes, the a.m. test is the most telling. “When a woman with gestational diabetes ends up going on insulin, it’s usually to control high blood sugar in the morning, after her overnight fast,” Snyder says. Women with type 1 and type 2 diabetes should follow their same pre-pregnancy regime. But, if you’re taking insulin tablets, you might be switched to injections, since pregnancy hormones raise blood sugar higher-sometimes two to three times-than what’s typical. The last three months of pregnancy often require extra high doses of insulin since the hormones associated with the baby’s growth block insulin production.

3. Eat often

Although most women eat healthily during their pregnancy (Snyder calls it “the nine-month motivation”) having diabetes of any type means being extra attentive. Diet alone can control gestational diabetes in about two-thirds of cases, according to Dr. Eddie Ryan, director of Diabetes Metabolic Centre at the University of Alberta Hospital.

A typical diet is three meals a day, plus three snacks in-between, with carbs, protein and fats at every meal. “Breakfast needs to be particularly small, since it’s the time of day when the hormones of pregnancy increase the blood sugars more,” Snyder says. She suggests one piece of toast (or carb equivalent), compared to two pieces of toast at lunch or dinner, alongside a balanced assortment of vegetables, fruits and dairy products. A bedtime snack is also crucial. “Because women are transferring so much glucose to the fetus, they’re more prone to have low blood sugar if they go for a long period-say, from supper until breakfast the next morning-with nothing to eat,” Snyder explains. Peanut butter and crackers, or a glass of milk with bread and cheese are good options.

4. Take a walk

No need to run a marathon. Even a 10-minute walk right after a meal can help bring down blood sugar levels, no matter what type of diabetes you have. With gestational and type 2 diabetes, regular exercise, combined with healthy eating, can delay or even prevent the need for extra insulin.

According to the Mayo Clinic, physical activity stimulates glucose transfer into cells, where it’s used for energy, and increases cells’ sensitivity to insulin so your body doesn’t need to produce as much to keep blood sugars low. Swimming, yoga and cycling are also good options for pregnant women, even late into their terms, but always check with your doctor before starting a new exercise habit. If you haven’t been active for a while, start slowly and build up gradually, advises the Mayo Clinic.

5. Get tested post-delivery

Care for gestational and other types of diabetes doesn’t end with a healthy delivery. Recently, the Canadian Diabetes Association launched an education program designed at getting women who’d had gestational diabetes back in their doctors’ offices for postnatal tests.

University of Toronto researchers linked gestational diabetes to an increased risk of type 2 diabetes within nine years after giving birth. “By diagnosing prediabetes and managing it with lifestyle counseling-for example, diet, weight loss and exercise-we can reduce the risk of diabetes by 60 percent,” Snyder says.

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