10 Ways to Have a Healthy Pregnancy With Diabetesby Ginger Vieira Health Writer & Patient Advocate
Planning a pregnancy when you have type 2 diabetes can feel overwhelming and even frightening. While women with diabetes can absolutely experience successful pregnancies, it is necessary to be extra vigilant. Here are 10 things you can do before you conceive and once you’re pregnant to prepare yourself for the best outcome.
Get the all-clear
While a diagnosis of diabetes alone shouldn’t prevent anyone from considering pregnancy, there are complications and other conditions related to the condition that could complicate your pregnancy or be affected by it. Diabetic retinopathy, for example, can be exacerbated by the stress that pregnancy puts on the body. Discuss your desire to start a family with your health care team to make sure you’re in optimal health.
Get your A1C to the optimal level
Achieving an A1C of 7.0 percent or below is one of the most im-portant things you can do before getting pregnant. Your blood sugars during the six months prior to conceiving actually have significant impact on the first stages of development in a fetus. Even if you’ve never had an A1C below 7.0 before, you’ll likely find the motivation of a pregnancy to get your blood sugars in a tighter range.
Make sure your medications are safe during pregnancy
While you certainly can’t stop taking your insulin during pregnancy, there may be other medications that aren’t safe, including some oral medications often used in type 2 diabetes. Write down everything you’re taking and go over each one with your doctor to determine if it’s safe before you start trying to get pregnant.
Get a continuous glucose monitor
Particularly for those with type 1 diabetes, wearing a continuous glucose monitor (CGM) prior to and during your pregnancy will help you achieve a lower A1C and keep a much closer eye on your blood sugars without having to prick your finger 15 times a day. It can take a few months to get approval from your insurance, so get the ball rolling ahead of time by asking your doctor or calling DexCom or Medtronic directly.
Fine-tune your basal/background insulin doses
It’s nearly impossible to keep your blood sugars in a tighter range if your insulin doses aren’t accurate to begin with. Just because you needed 18 units of basal-rate insulin or long-acting insulin two years ago doesn’t mean that’s what your body needs now. Even an adjustment of 1 or 2 units can have a tremendous impact on your ability to keep your blood sugars in that tighter range.
Fine-tune your rapid-acting insulin doses
Constantly struggling with high blood sugars after you eat? Just like your background insulin dose, the doses you take for meals and to correct highs may also need some adjusting. Take the time to test your insulin-to-carbohydrate ratio and your correction factor before getting pregnant because that number will gradually shift as your baby grows. You want to start off on the right dose.
Focus on clean eating and the '80/20 rule'
For some, pregnancy can turn into a free-for-all around food, causing you to gain far more than the recommended 25 to 35 pounds. Take a close look at how much of your diet is processed versus whole foods. A very sustainable approach to treats and junk food is to aim for getting 80 percent of the day’s nutrition from whole, fresh foods and 20 percent from treats or more processed food.
Sure, there’s occasionally a woman on YouTube sprinting at 8 months pregnant or competing in CrossFit while carrying twins, but for most of us, the realistic form of exercise during pregnancy will be walking. If you haven’t been exercising at all, getting even just 20 to 30 minutes of steady walking four to five days a week will help keep your blood sugars in that tighter range prior to pregnancy and help you manage weight gain during pregnancy.
Check in with your partner
The stress that comes with pregnancy when the mama-to-be has diabetes can be overwhelming during those nine months, so it’s especially important that your partner knows what kind of support you need and appreciate. Have a simple conversation to talk about what does and doesn’t feel like support to you (i.e.,nagging versus helpful reminders).
Practice positive self-talk for tough days
The hardest part of pregnancy as a woman with diabetes is the constant pressure to be as perfect as possible. There will be days when that pressure feels like more than you can handle, and days when you feel like a “horrible mother” because of inevitable high blood sugars due to shifting hormone levels. Learning how talk yourself through those days instead of beating yourself up for being imperfect is going to be a crucial part of surviving the journey.