Diabetes is the most common complication during pregnancy. Risks associated with pre-existing diabetes (Type 1 or Type 2) and diabetes during pregnancy include:
- Macrosomia
- Premature birth
- Birth defects
- Miscarriage or Stillbirth
- Pre-eclampsia
- Hypoglycemia for baby after delivery
- Cesarean Section
Macrosomia is a newborn who weighs over 8 lbs 13 oz regardless of gestational age. Having diabetes can cause your baby to gain more weight, especially if your blood glucose is not well-controlled. Having a large baby increases your baby’s risk of having shoulder dystocia, or his or her shoulders getting stuck on the way out of the vagina.
Some doctors recommend a cesarean section to prevent shoulder dystocia from happening, however shoulder dystocia doesn’t always happen with big babies. Small or average size babies can have shoulder dystocia. Likewise, big babies may not have shoulder dystocia. There is no great way to predict if your baby will have shoulder dystocia other than to attempt a vaginal birth. During labor, there are signs that may indicate shoulder dystocia before it actually happens. In our opinion, to help reduce the cesarean rate, cesareans should only be used for emergencies, not as a preventative for something that may not even happen.
Keeping your blood glucose under control during pregnancy lowers your risk of having a large baby, however, do take into account your and your partner’s genetics. Some people, no matter how tight of blood glucose control, just have big babies.
Premature Birth is when a baby is born before thirty seven weeks gestation. Scientists do not know why Type 1 Diabetes increases your risk of preterm birth, but they do know that preterm birth accounts for the most infant deaths. Keeping your blood glucose under control during pregnancy lowers your risk of premature birth.
Studies show that risk of premature birth increases if the mother develops gestational diabetes before the twenty-fourth week of pregnancy. After the twenty-fourth week, the risk of preterm birth goes down.
Birth Defects are abnormalities that are present at birth. Babies born to mothers with Type 1 Diabetes have an increased risk of birth defects with baby’s heart and neural tube. For this reason, it is important to have your blood glucose well-controlled at least six months before getting pregnant. The first trimester is when the neural tube is developing and is most vulnerable to defects. If you have an unplanned pregnancy and your blood glucose is not well-controlled, be sure to work with your endocrinologist to get them under control as soon as possible.
Miscarriage is when the baby dies in the womb before twenty weeks gestation. Stillbirth is when the baby dies in the womb after twenty weeks gestation. Either of these things can happen when the mother’s blood glucose is not well-controlled. Having well-controlled blood glucose can prevent these from happening.
Most doctors like to induce mothers with diabetes before thirty-nine weeks because the risk of stillbirth increases as they get closer to forty weeks. However, the studies on this subject included mothers who are not in good health (i.e. high blood glucose, smoking, etc.). If you are taking good care of yourself and your blood glucose, you may be able to negotiate with your care provider to have more Non-Stress Tests (NST) and closer monitoring of baby and wait for spontaneous labor.
Pre-eclampsia is when a woman has high blood pressure accompanied by protein in the urine and the organs such as kidneys and liver start to not function properly. Signs of pre-eclampsia include: vision changes, excess swelling (especially in the hands and face), persistent headaches, and sudden weight gain. Although scientists have not figured out what causes pre-eclampsia, eating a balanced diet that includes 80-100 grams of protein daily starting early in pregnancy has been shown to significantly decrease your chances of getting pre-eclampsia. We recommend all of our clients look into Dr. Brewer’s Pregnancy Diet.
Unfortunately, if you do get pre-eclampsia, the only cure is delivery of the baby and placenta. If your pre-eclampsia is mild, your doctor may recommend:
- bed rest
- more water
- more doctor visits
Some doctors recommend decreasing your salt intake, however, you should be salting to taste. Salt helps with osmosis and moves the water out of your cell membranes and reduces swelling. Too much salt is bad, just as is too little.
Hypoglycemia for baby after delivery – hypoglycemia is low blood sugar, as anyone 
who has diabetes is all too familiar with. If the mother’s blood glucose is higher toward the end of pregnancy and/or during labor, baby may struggle with hypoglycemia after delivery. This is another reason to keep your blood glucose well-controlled. Using a breast pump before delivery and collecting any colostrum you get will be helpful if baby’s blood glucose drops after delivery. Try to breastfeed baby as soon after delivery as possible and/or you can use a spoon or syringe dropper to feed your baby what you have previously collected. Studies suggest breastfeeding can lower the risk of diabetes for your baby, which we all want!
It is helpful for you to be in control of your insulin and monitoring during labor because you are familiar with what works for you. If the nurses or your doctor is in control of it, this is their first time controlling your blood glucose and you will have more ups and downs than if you did it yourself. More doctors now are wanting their patients to control their own blood glucose and insulin during labor and delivery. Discuss who will control and monitor your blood glucose during delivery, and if they want to do it, it might be worth looking into a different care provider.
Cesarean Section is the surgical delivery of the baby by cutting through the mother’s abdomen. Having diabetes increases your risk of cesarean delivery for two reasons: (1) large baby, (2) induced labor.
Having a large baby, as we discussed above, may lead some doctors think that your baby will not fit through your pelvis. If your doctor sincerely thinks this, PLEASE get a second opinion from a doctor with a low cesarean rate and discuss attempting a vaginal delivery and looking for signs of dystocia during labor.
Having an induced labor increases your risk of cesarean section because sometimes your body just isn’t ready for labor, but the doctor wants the baby out, so they have to do it another way (cesarean). Another reason induction increases your risk of a cesarean is because sometimes baby can’t handle the unnatural contractions caused by Pitocin, Cytotec (Misoprostol), and/or Cervidil.
To reduce your risk of cesarean, be informed, take an out-of-hospital birthing class, keep your blood glucose levels well-controlled, and hire a doula. Doulas decrease your chance of cesarean by 30%! Doulas also know which doctors you can talk with to help you have your ideal birth experience.
Having diabetes during pregnancy does increase your risks, but there are things you can do to help prevent them. The number one thing in helping prevent problems is to keep your blood glucose under control. Having an A1c between 5-6% is ideal.
Karina was diagnosed with Type 1 Diabetes at the young age of 4. In spite of her diabetes, she has had three healthy children. Her first was born completely un-medicated (natural) at the hospital weighing 8 lbs 13 oz. He had shoulder dystocia, but it was resolved. Her second was born via cesarean weighing 9 lbs 14 oz. Her third was born completely un-medicated (natural) at the hospital weighing 9 lbs 10 oz and was a vaginal birth after cesarean (VBAC) with NO shoulder dystocia. You can find out more about her and her birth experiences at our About Us page.
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