1. family and parenting
2. motherhood
3. pregnancy

Questions and Answers
About Diabetes and Pregnancy:
Your Guide to Having a Healthy Baby
By
Diabetes Care Program of Nova Scotia
Pregnancy and Diabetes Subcommittee
2004
1
TABLE OF CONTENTS
INTRODUCTION.................................................................................................. 3
HOW TO USE THIS GUIDE ................................................................................ 5
SECTIONS
Preconception (before pregnancy) .........................................................Yellow
I have diabetes. Can I have a healthy baby? ................................................................ .9
How can I ensure the safest pregnancy possible for me and my baby? ......................... 9
What is preconception care and why is it necessary? ..................................................... 9
Who makes up my diabetes health care team? ............................................................ 10
What should I do to prepare for pregnancy? ................................................................. 11
What are the possible risks for me? .............................................................................. 12
What are the possible risks for my baby?...................................................................... 13
What if I am already pregnant? ..................................................................................... 14
Pregnancy ..................................................................................................Green
I am pregnant. What happens now?............................................................................. 17
What should I do to keep my developing baby healthy? ............................................... 17
What tests can I expect during my pregnancy?............................................................. 19
What about hypoglycemia (low blood glucose) during my pregnancy?......................... 21
How should I treat hypoglycemia?................................................................................. 22
What about hypoglycemia at night? .............................................................................. 23
What if I become sick during my pregnancy? ................................................................ 24
How can I deal with the typical pregnancy complaints? ................................................ 25
Should I take any other medications while I am pregnant? ........................................... 26
Will I have to be hospitalized during my pregnancy? .................................................... 26
Delivery ........................................................................................................ Blue
Will I deliver my baby early? .......................................................................................... 29
Will I have a cesarean section? ..................................................................................... 29
What will happen to my insulin during labor and after delivery?.................................... 29
Will my baby need special care after delivery? ............................................................. 30
What will the doctors check my baby for? ..................................................................... 30
How can my diabetes affect my baby at delivery? ....................................................... 30
Breastfeeding ......................................................................................... Salmon
Should I breastfeed? ..................................................................................................... 35
What are the benefits to my baby? ................................................................................ 35
What are the benefits to me? ........................................................................................ 35
What should I do if I want to breastfeed? ...................................................................... 35
Are there any risks associated with breastfeeding? ..................................................... 36
How can I reduce the risk of infection?.......................................................................... 37
Your Guide to Having a Healthy Baby
Diabetes Care Program of Nova Scotia 2004
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Postpartum (after delivery) ....................................................................... Cream
What should I do now that my baby is born?...................................................................41
Is it possible to continue to exercise postpartum? ...........................................................41
What are the possible long-term effects of my diabetes on my baby? ............................41
Will my baby have a chance of developing diabetes later in life? ...................................41
Why do I need to worry about birth control? ....................................................................43
What method of birth control is best for me?. ..................................................................43
Conclusion..................................................................................................... Lilac
Conclusion .......................................................................................................................47
References ......................................................................................................................48
References ......................................................................................................... 48
APPENDIX A:
Public Health Services, Resource Materials, and ........................53
Diabetes Education Centres in Nova Scotia ................................57
APPENDIX B:
Feedback......................................................................................65
Your Guide to Having a Healthy Baby
Diabetes Care Program of Nova Scotia 2004
3
INTRODUCTION
This booklet was produced for women who have diabetes before they become pregnant.
This is referred to as preexisting diabetes - type 1 or type 2 (treated with insulin, diabetes
pills, or diet only). If you have developed diabetes during your pregnancy (gestational
diabetes), your doctor or other health professionals (nurses, dietitians, etc.) may be able
to suggest other reading materials to better answer your specific questions.
If you have diabetes, this booklet will help answer commonly asked questions and
concerns you may have about pregnancy - before, during, and after delivery. It is hoped
that the information in this booklet will result in an increased awareness among women
with diabetes, their family members, and their health care providers about these issues
and the impact they have on pregnancy outcomes. This increased awareness will have a
positive influence on pregnancy outcomes in Nova Scotia for years to come. We hope
you find this booklet helpful.
Women with diabetes determined the ideas behind the development of this booklet and
its content. This booklet is a guide and is not meant to replace information provided by
health care professionals with an expertise and interest in diabetes. We encourage you
to use this booklet to help you ask questions specific to your pregnancy. As this booklet
is intended to address only diabetes-specific questions and concerns, more general
information about pregnancy and breastfeeding can be found in the list of resources
available from the Public Health Offices throughout Nova Scotia (see Appendix A,
pages 53 - 54). In this section, you will also find a complete list of Diabetes Centres
(DCs) in Nova Scotia with their contact numbers.
To improve this guide and ensure we are meeting your needs, we encourage you to
provide us with feedback. Please see contact information in Appendix C (page 63). We
would appreciate your thoughts and ideas for future revisions.
For more information about pregnancy and diabetes, contact your family doctor or other
members of your diabetes health care team (nurse, dietitian, etc.).
Your Guide to Having a Healthy Baby
Diabetes Care Program of Nova Scotia 2004
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Your Guide to Having a Healthy Baby
Diabetes Care Program of Nova Scotia 2004
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HOW TO USE THIS GUIDE
There are five main sections in this booklet. A colored cover page separates each of the
five main sections. This should help you to quickly locate the section(s) you are most
interested in reading.
Preconception (before pregnancy).............................................Yellow
Pregnancy ....................................................................................... Green
Delivery ............................................................................................. Blue
Breastfeeding .................................................................................... Pink
Postpartum (after delivery) ........................................................ Cream
In each section, commonly asked questions and their answers have been identified. The
table of contents will help you to locate specific questions. In addition to these sections,
are appendices that provide you with the following:
Public Health Offices (locations, services, and resource materials)
Diabetes Centres in Nova Scotia (locations)
Preconception Care Pamphlet
Feedback (contact information)
Your Guide to Having a Healthy Baby
Diabetes Care Program of Nova Scotia 2004
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Your Guide to Having a Healthy Baby
Diabetes Care Program of Nova Scotia 2004
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Diabetes Care Program of Nova Scotia 2004
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Your Guide to Having a Healthy Baby
Diabetes Care Program of Nova Scotia 2004
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PRECONCEPTION (BEFORE PREGNANCY)
I have diabetes. Can I have a healthy baby?
YES!! With tight control of your blood glucose levels before you become pregnant (in
the preconception period), you can have a healthy pregnancy and a healthy baby.
How can I ensure the safest pregnancy possible for me and my baby?
The first step is to seek advice before you become pregnant. We call this preconception
care and counseling. With more women seeking preconception care, great progress has
been made in reducing the number of problems in the pregnancies of women with
diabetes.
What is preconception care and why is it necessary?
Preconception care is very important to help prevent complications during your
pregnancy and to ensure a healthy baby. The fact that you have diabetes increases the
risk of your pregnancy. The goal of preconception care is to achieve near normal blood
glucose levels 2 to 3 months before you become pregnant. This will reduce the risks to
you and your baby. You can do this through changes in your diet, exercise/activity, and
insulin regimen. It can take 3 months or more to achieve near normal blood glucose
levels; so it is important to plan ahead. Your diabetes health care team will help you
receive the level of care that you require.
Preconception care consists of the following:
❦ Having a complete medical assessment for any preexisting complications caused by
diabetes.
❦ Reviewing how and when to check your blood glucose, reviewing how and when to
check your blood glucose meter to make sure it is working properly, adjusting your
insulin at home, and achieving target blood glucose values.
❦ Learning about and following an appropriate exercise/activity routine to improve
your physical fitness.
❦ Learning about and following an adequate meal plan that may include changing
your energy intake (calories) to help you achieve a healthier weight before you
become pregnant.
❦ Taking 0.4 to 1 mg folic acid (a specific B vitamin) daily in a multivitamin
supplement during preconception period and up to 13 weeks gestation in addition to
a diet high in folate.
❦ Obtaining information about coping with the more demanding routine required to
help ensure a healthy pregnancy. Such demands include: laboratory blood tests;
frequent visits to the diabetes health care team; activity, diet, and insulin changes;
increased home blood glucose and urine ketone testing.
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Who makes up my diabetes health care team?
Depending on your situation, the members of your diabetes health care team may vary.
Your doctor will help arrange for you to see the most appropriate and available diabetes
health care team members. The need for involvement and the extent of the involvement
of various team members in your care may differ depending on your specific health care
needs at different stages of your pregnancy. Diabetes health care team members may
include:
❦ Your family doctor and/or obstetrician who specialize(s) in pregnancies at increased
risk and is experienced in managing pregnancies of women who have diabetes.
Your doctor will guide you as you try to achieve near normal blood glucose levels
before your pregnancy.
❦ A doctor who specializes in diabetes care (endocrinologist, internist, etc.) and is
familiar with managing diabetes before, during, and after pregnancy.
❦ A nurse (diabetes educator) who can advise and teach you how to manage your
diabetes. Your nurse will help you to understand the effect your pregnancy will
have on your diabetes. She/he will also help you improve your blood glucose levels
through problem solving.
❦ A dietitian (diabetes educator) who will help you ensure your meal plan includes a
variety of nutritious foods. This plan will also help to keep your blood glucose
levels in a healthy range. You will also learn how to achieve a gradual weight gain
during pregnancy and the benefits of breastfeeding as well as weight management
after the baby is born.
❦ Other specialists may include the following:
•
A physiotherapist who will discuss the benefits of an appropriate
exercise/activity routine. He/she will also discuss body mechanics/posture to
help you reduce the risk of back pain during pregnancy.
•
A social worker who will help you deal with the changes that occur as a result of
preparing for your pregnancy. This will help you better manage stress. The
social worker will also help you identify and address any risks, problems, or
barriers that may affect your emotional and physical health during your
pregnancy.
•
An eye specialist (ophthalmologist) who will help you deal with any changes to
your vision. To ensure your eyes are properly cared for, a visit to your
ophthalmologist before you become pregnant is recommended.
•
A dentist who will help you care for any changes in your gums and teeth during
pregnancy.
❦ YOU, the most important member, along with other members of your family. You
have an active role to play as a member of the health care team. You will be
responsible for nutritional management, self-monitoring of blood glucose and urine
ketones, as well as keeping yourself mentally and physically fit through stress
management and exercise/activity. Your spouse or partner and other family
members and/or support persons are also an important part of the health care team.
Their support and understanding of your health care needs before, during, and after
pregnancy will decrease your stress and help you to manage your health care.
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Diabetes Care Program of Nova Scotia 2004
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What should I do to prepare for pregnancy?
❦ Tightly control your blood glucose to normal levels and watch it closely by checking
your blood glucose levels regularly at home. Record your blood glucose carefully in
a book provided by the diabetes health care team. Your insulin dose may need to
change.
Ideally, you and your diabetes health care team should aim for the following:*
• A1C levels less than 7% (less than or equal to 6% is optimal).
(Note: This is the test that measures overall blood glucose control for the
previous 2 to 3-month period.)
• Blood glucose levels before a meal less than 5.3 mmol/L.
• Blood glucose levels 1 hour after a meal less than 7.8 mmol/L.
• Blood glucose levels 2 hours after a meal less than 6.7 mmol/L.
• Pre-bedtime snack levels less than 6.0 mmol/L.
*
Not all women will be able to achieve these degrees of control. It is
important to aim for the best possible control and to discuss this with your
diabetes health care team.
❦ Arrange for a complete medical assessment and have your eyes checked by an eye
specialist (ophthalmologist).
❦ Exercise regularly; be active. This will help you reduce stress, manage your blood
glucose, and provide a sense of general well being.
❦ Get enough rest.
❦ Follow your meal plan and eat a variety of nutritious foods. Use foods with little or
no nutritional value sparingly. You may want to start to use a meal plan that is
appropriate for the early stages of your pregnancy before you become pregnant.
This will help you to keep your blood glucose levels in control once you become
pregnant.
❦ Start taking 0.4 to 1 mg of folic acid (a specific B vitamin) each day in a multivitamin
supplement in addition to a folate-rich diet. This will reduce the risk of neural tube
(spinal) defects in your baby. Your dietitian can help you with this and also help
you choose foods that are good sources of folate (green leafy vegetables, beans, peas,
orange juice, wheat germ, nuts, etc.).
❦ Try to attain and maintain a healthy weight before you become pregnant.
❦ Take steps to manage stress as stress can affect your blood glucose levels. Gather as
much information about diabetes and pregnancy as needed to make you feel
comfortable. Talk to your spouse/partner about your feelings and concerns as well
as their feelings and concerns. This may help to reduce your stress. Remember to
ask questions and discuss any concerns with members of your health care team.
❦ If you are on insulin, continue to take as prescribed. If you are taking diabetes pills,
your doctor or diabetes specialist should switch you to insulin if you are planning a
pregnancy.
•
If you are taking high blood pressure medication, discuss this with your
physician to ensure it is safe during pregnancy.
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❦ Prepare for the demands of pregnancy. To make sure you have a successful
pregnancy, you will require frequent check-ups and more tests than women without
diabetes.
❦ Practice the general principles of good health. These include avoiding smoking and
second hand smoke, alcohol, and unnecessary drugs.
❦ Talk to someone with diabetes who has experienced preconception care and
pregnancy. Your diabetes health care team should be able to arrange this for you.
What are the possible risks for me?
There are some risks that you should be aware of and that you should discuss with your
diabetes health care team. Planning for pregnancy and achieving near normal blood
glucose levels before becoming pregnant reduces the chances of developing
complications.
Some of the possible risks for you include:
❦ Hypoglycemia (low blood glucose):
Blood glucose levels below normal (less than 4 mmol/L). Low blood glucose levels
are more common with the tighter blood glucose control recommended during
pregnancy. Frequent testing of your blood glucose helps to identify patterns of
when lows occur. This will make it easier to adjust various aspects of your diabetes
management such as diet, insulin, and exercise routine. Mild hypoglycemia is not
harmful, but being aware of mild symptoms of low blood glucose can help prevent
more serious symptoms.
❦ Hyperglycemia (high blood glucose):
Blood glucose levels above normal (greater than 5.2 mmol/L before meals; greater
than 7.7 mmol/L at 1 hour; and greater than 6.6 mmol/L by 2 hours after eating).
High blood glucose levels increase the risks for you and your baby and should be
avoided if possible. However, high blood glucose levels are expected at times and
diabetes management should be adjusted as necessary.
❦ Ketoacidosis (ketones and high glucose in the blood):
The breakdown of body fat into acids occurs when there is not enough food or
insulin to provide energy for the body. This is a serious, but rare, complication in
pregnancy and needs to be treated right away by medical staff to avoid loss of the
pregnancy.
❦ Worsening of Established Chronic Diabetes Complications:
It is important to be assessed and treated as required for diabetes complications
before and during your pregnancy. Eye problems (retinopathy) can worsen during
pregnancy. The risk is increased with poor blood glucose control and can occur up
to 1 year after delivery. Eye problems can be treated during pregnancy if necessary.
Kidney problems (nephropathy) and nerve disease (neuropathy) vary in severity
and should be discussed with your doctor. Heart disease (cardiac disease) may be
reason to avoid pregnancy in a woman with diabetes and should be discussed with
your diabetes health care team.
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There are other things that can happen in any pregnancy but occur more often
when a woman has diabetes. Some of these are:
❦ Pregnancy Induced Hypertension (PIH):
High blood pressure caused by your pregnancy. This complication may occur in any
pregnancy but is a higher risk if the woman has diabetes (especially those with type
2 diabetes). Your doctor will check your blood pressure and your baby’s well-being
at each visit.
❦ Urinary Tract Infections:
Infection in your bladder and/or kidneys. While this complication is seen in
pregnant women who do not have diabetes, it is more common in women with
diabetes. Glucose in the urine contributes to the growth of bacteria that causes
infection. Maintaining good blood glucose control will help prevent this. Urinary
tract infections are treated with antibiotics.
❦ Preterm (early) Birth:
Delivering your baby before it is due (before 37 weeks gestation). This also occurs in
women who do not have diabetes. However, you can help prevent it with good
diabetes management.
❦ Miscarriage:
Loss of the pregnancy before 20 weeks gestation. This is a problem also faced by
women who do not have diabetes. It is more common in women with diabetes who
do not have tight blood glucose control.
❦ Cesarean Section:
Delivery of the baby through an incision in the abdomen and uterus. This method of
delivery may be necessary for many reasons. Women with diabetes sometimes
deliver this way if the baby is large or vaginal delivery is not possible for other
pregnancy-related reasons.
What are the possible risks for my baby?
Babies born to women who do not have tight control of their diabetes have a higher risk
of complications and birth defects.
Some of the possible risks for your baby include:
❦ Prematurity:
Birth before 37 weeks gestation. Babies are often born early if there is a problem
with the mother or baby. It is now common for women with diabetes to have their
pregnancy go to 40 weeks gestation or “full term.”
❦ Macrosomia (large baby):
The term used to describe babies who grow larger than normal. This happens in
response to the mother’s high blood glucose levels especially after meals. The baby
stores this extra sugar as fat. A very large baby may be more difficult to deliver and
is more likely to experience temporary problems at birth.
❦ Birth Defects:
Infants of women with poorly controlled diabetes in early pregnancy are at a higher
risk of developing birth defects. Taking folic acid in a multivitamin supplement
before you become pregnant and during the first 13 weeks of pregnancy can reduce
the chance of your baby having a spinal defect.
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The following complications are most apparent at the time of delivery. A more detailed
explanation of these can be found on pages 30 and 31 of the “Delivery” section.
❦ Neonatal Hypoglycemia (low blood glucose in the newborn):
Your baby is at risk for developing temporary low blood glucose levels after birth
and will need to be monitored carefully. This can be easily treated.
❦ Respiratory Distress Syndrome (difficulty breathing):
Immature lung development. This causes temporary problems with your baby’s
breathing. This is more common in babies born prematurely.
❦ Jaundice (yellow color of the skin caused by a build up of bilirubin in the blood).
See page 30.
❦ Hypocalcemia (low blood calcium).
See page 31.
Tight control of blood glucose levels, especially before pregnancy and in the early weeks
of pregnancy, decreases the risk of problems for both you and your baby. Nearly all
diabetes-related problems can be prevented with tight control of blood glucose levels
before and during your pregnancy.
What if I am already pregnant?
Many problems can still be prevented with good diabetes management practices during
the remainder of your pregnancy. Your diabetes health care team will guide you
through your pregnancy and after delivery.
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PREGNANCY
I am pregnant. What happens now?
Every woman experiences physical and emotional changes during pregnancy. You will
probably experience extra stress due to the demands of your developing baby,
managing your diabetes, and your increased appointments with your doctor and/or
members of your diabetes health care team.
If you have negative feelings about your pregnancy, your diabetes health care team can
offer support.
What should I do to keep my developing baby healthy?
You need to achieve and maintain tight blood glucose control, get enough rest, exercise,
follow your meal plan, and manage your stress. Your pregnancy will have an affect on
your diabetes control, and you will have to make some changes in how you manage
your diabetes. Your diabetes health care team will help guide you as needed with some
or all of the following factors.
❦ Insulin adjustments:
During your pregnancy, your body will be rapidly changing as your baby develops
and grows. These changes will affect your blood glucose levels.
You will have to adjust your insulin doses throughout your pregnancy. Most women
need to make frequent changes to their insulin regimen. The number of injections
you take each day may have to increase. Many women feel better on this routine and
choose to continue it even after their pregnancy. During the first three months of
your pregnancy, blood glucose control may be more unstable than usual and nighttime hypoglycemia (low blood glucose) is common.
As your pregnancy progresses, you will have to increase how much insulin you take.
Your insulin needs may double or even triple. Your higher insulin needs do not
mean your diabetes is getting worse. It is the changes in the hormones made by the
placenta and the demands of the growing fetus that cause the increase in your
insulin requirements. The placenta is the organ that attaches to your uterus and
supplies oxygen and nourishment to your baby. It also removes waste products.
To make these insulin changes, you will have to test your blood glucose levels more
often. If you are unsure how to adjust your own insulin dose(s), ask your doctor or
other members of your diabetes health care team to help you.
❦ Blood Glucose Monitoring:
You will have to increase the number of times you test your blood glucose level each
day. It is common for women who are pregnant to test at least 4 times a day. You
may be asked to check your blood glucose one hour after meals as this blood glucose
value has been found to be more closely related to the size of the baby.
You should keep track of your blood glucose levels. By testing regularly and writing
the results in your diabetes diary, you can better see patterns develop to manage
your diabetes. Remember to bring your meter or diabetes diary/record book to all
appointments with your diabetes health care team. Your meter should be checked
with a lab for accuracy at least every six months before pregnancy and more often
during pregnancy.
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❦ Ketone Monitoring:
Ketones occur when there is not enough food or insulin to provide energy for the
body as in the case of an illness. Fat is then broken down into acids and ketones.
This results in a higher level of ketones in your blood and urine with resulting
acidosis (too much acid in the blood and tissues). This can cause problems for you
and your baby. If your ketones are too high or are present on a regular basis, your
diet may need to be changed to give you the energy that your body requires. More
food may need to be added, and/or your night snack may need to be changed. Your
dietitian will help you make adjustments in your meal plan. Your diabetes health
care team can decide how often and when you should check your urine for ketones.
❦ Nutrition:
You need to seek nutritional advice and counseling from your dietitian. Such
counseling will help you develop a meal plan to follow during your pregnancy. This
plan will meet both your needs and the needs of your growing baby. Good nutrition
is necessary for the health of your baby. It is important to take charge of your own
nutrition and understand that how and what you eat affects the health of your
developing baby.
Your meal plan will include three meals a day and two or more snacks. You may be
asked to restrict the amount of carbohydrate you consume at breakfast. The
carbohydrate you consume during the rest of the day will be measured, and your
insulin will be adjusted to prevent hyper or hypoglycemia. You will need to eat a
well balanced diet with extra protein, calories, calcium, iron, fiber, and folate. The
extra nutrients are necessary to meet the needs of your growing baby and to prepare
your body for the demands of the pregnancy. Your dietitian will help you adjust
your meal plan to meet your needs and your baby’s needs. She/he will also help
ensure you have a healthy weight gain.
❦ Exercise/Activity:
Exercise is safe during pregnancy. Your exercise/activity routine might have to
change to help control your blood glucose levels and to accommodate your growing
baby. All pregnant women with uncomplicated pregnancies are encouraged to
participate in aerobic and strength conditioning exercise. Your doctor and/or
physiotherapist can help you determine if you can participate in physical activities
during pregnancy.
Exercise/activity is good for you and your baby. It helps to lower your blood
glucose levels and improve your circulation and heart function. Exercise can also
give you a feeling of well-being and help prepare your body for the demands of
pregnancy. Specific exercises can help reduce leg or back pain and reduce
discomfort associated with the later stages of pregnancy. To maintain aerobic
conditioning and a good fitness level, brisk walking, stationary cycling, cross
country skiing, and swimming or aqua fit classes are recommended. These activities
will minimize your risk of loss of balance and potential fetal trauma. Exercise at a
comfortable intensity where you are still able to “talk” and always in a safe setting
where there is no danger of falling.
The best time to exercise is dependent on the type of insulin you use and your blood
glucose levels prior to the activity. You should avoid exercise/activity during peak
periods of insulin action. In order to prevent low blood glucose, it is important to
coordinate your exercise/activity program with your meals and insulin. Do not
begin exercise/activity if your blood sugar levels are too low or too high and/or if
ketones are present. It is important to check your blood glucose levels before,
during, and after exercise/activity. Blood sugar levels can continue to drop 12 to 18
hours following exercise. The most appropriate time to exercise can be discussed
with your health care provider.
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Listen to your body. If pregnancy is causing you to slow down, change your
exercise/activity routine to one that makes you feel better. Your physiotherapist
and/or doctor can help you with this.
❦ Frequency of Appointments:
The frequency of appointments will increase. You may be required to have weekly
tests. You will have tests done to monitor your diabetes, and you will also have tests
to monitor your baby as she/he grows and develops.
What tests can I expect during my pregnancy?
Tests to Monitor Your Diabetes
Careful monitoring of your blood glucose levels and health status is necessary to allow
your diabetes health care team to recommend adjustments in your treatment.
The following table shows the expected frequency of testing for women with preexisting
diabetes during pregnancy.
Test
Frequency
A1C (Glycated Hemoglobin)
Initially and every 3 months.
Blood glucose
Reviewed during appointments with the
diabetes health care team. Self-testing at
home, usually 4 or more times a day. Each
trimester (three times during your
pregnancy) your meter should be compared
with the lab sample to ensure your testing
method is accurate.
Ketones
Urine and/or blood ketone levels tested 1 to
2 times a week, more frequently as
indicated; for example, during sickness, if
blood glucose greater than 10 mmol/L,
weight loss occurs, etc.
Urine test for culture and sensitivity.
(Test for urinary tract infection.)
Each trimester.
Kidney function – 24-hour urine
clearance and total protein.
Each trimester.
Eye status
First trimester and then as necessary
according to the eye specialist.
Repeat 1-year postpartum.
Thyroid Stimulating Hormones (TSH)
Those with type 1 diabetes require
assessment of this thyroid test in the first
trimester unless completed in the past year.
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Tests to Monitor Your Baby
You will undergo two types of testing to monitor your baby during your pregnancy diagnostic testing and fetal surveillance testing. These are tests to evaluate the health of
the developing baby.
Diagnostic Tests
Diagnostic testing is done during the first half of the pregnancy. The purpose is to
detect structural or genetic disorders in the baby. Not all of these tests are done
routinely but should be discussed with your doctor.
❦ Maternal Serum Screening:
This is a blood test done between 15 and 20 weeks gestation that shows if your baby
is at risk for developing problems such as spinal abnormalities. It only indicates if
there is a problem; it cannot identify what the problem is. Further tests are needed if
this test is positive.
❦ Amniocentesis:
This is a common test. It may be done early in the pregnancy to assess the risk of
developing genetic disorders. It may also be done later in the pregnancy before 38
weeks gestation to assess the baby’s lungs. This will show if the lungs are developed
enough for her/him to breathe on their own. It is performed by taking a sample of
the amniotic fluid that surrounds the baby. If recommended for you, this test and
the procedure will be explained by your doctor.
❦ Ultrasound:
This test shows a picture of your developing baby. It can be used to determine the
age, the position of the baby in the uterus, the outline of the body structure and
organs, and the number of babies present. It will also be used to track your baby’s
growth and development. You will probably have an ultrasound early in your
pregnancy to confirm your due date and check for abnormalities. You may have one
or two more during your pregnancy to check the baby’s structure and possibly to
measure the size of the baby.
Fetal Surveillance Tests
Fetal surveillance tests are done later in the pregnancy and usually continue until birth.
These tests can help to detect problems with your baby, but you must understand that
no test can assure that a baby will be perfectly healthy. These tests are used to evaluate
the health of your developing baby. Different doctors prefer to use different tests.
Discuss with your doctor which tests are best for you. All methods are designed to
provide similar information.
Your doctor may use one or more of the following tests:
❦ Kick Counts:
You will be asked to count the number of times you feel your baby move during
certain times each day. If you detect a change in the pattern of your baby’s
movement, you should notify your diabetes health care team. This counting is
usually started after 28 weeks gestation.
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❦ Biophysical Profile (BPP):
This is also called a planning score. This test uses an ultrasound to evaluate your
baby’s movement, muscle tone, chest movements, and the amount of amniotic fluid
surrounding her/him. This test is often done weekly after 28 to 32 weeks gestation.
Emotional Support
It is important to involve your partner and/or other supporting individuals in your
pregnancy. Support is needed to achieve tight blood glucose levels and will make it
easier for you to adapt to your diabetes and pregnancy lifestyle. You will be better
motivated if you receive support from your partner and/or significant others. You
should be encouraged to accept help from others and feel free to express any frustration,
fear, anger, or anxiety you may be having related to your pregnancy and diabetes. Your
diabetes health care team is there for you - ask questions!
What about hypoglycemia (low blood glucose) during my pregnancy?
It is important that you are aware of hypoglycemia and that you know how to treat it.
Regular blood glucose testing and recording of the results are necessary in preventing
and managing hypoglycemia. You may be required to test your blood glucose more
often if you have changing blood glucose levels or if you cannot feel the symptoms of
hypoglycemia. Always carry/wear your diabetes identification. The pregnancy value
for hypoglycemia is lower than that used in the non-pregnant or preconception period
and is now defined as ≤ 3.3 mmol/L.*
Signs and symptoms of hypoglycemia will develop when there is not enough glucose in
the blood to allow your body to function normally.
Symptoms of hypoglycemia may include:
 shakiness/tremors
 sweatiness
 palpitations
 hunger, nausea
 headaches
 dizziness
 blurred vision
 confusion
 feeling tired, anxious, or afraid
Hypoglycemia may be caused by:
•
•
•
•
•
Taking too much insulin (insulin errors).
Not eating enough food.
Not adjusting your insulin or food intake when you are active.
Consuming alcohol (not recommended when pregnant).
Too much unplanned exercise/activity.
It is important to eat your meals and snacks on time to help prevent hypoglycemia. You
should watch for the patterns of hypoglycemia so you can better plan and prevent
recurrence.
It is very important that you treat hypoglycemia
properly. Over-treating will cause your blood glucose
levels to become too high. If possible, check your blood
glucose to confirm the presence of low blood glucose
before treatment.
*This value will be determined on an individual basis with members of your
diabetes health care team. They will take into consideration your degree of control
as well as safety and comfort issues.
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How should I treat hypoglycemia?
Hypoglycemia may be mild, moderate, or severe. Each has different symptoms and
each needs to be treated in a special way to avoid over-treating.
❦ Mild and Moderate Hypoglycemia:
The symptoms of mild hypoglycemia do not interfere with normal activity but may
cause shaking, palpitations, anxiety, hunger, sweating, nausea, and tingling. With
moderate hypoglycemia, in addition to the symptoms of mild hypoglycemia, you
may experience trouble moving and doing simple tasks. You may also behave
inappropriately, but you should still be alert enough to help yourself. If you are
feeling confused or irrational, you may need help with treatment.
The treatment of mild or moderate hypoglycemia consists of eating or
drinking 15 grams of glucose or sucrose. The best sources are glucose
tablets, sugar (3 teaspoons/15 mL), juice or regular soft drink (3/4 cup/
175 mL), Lifesavers (6), or honey (1 tablespoon/15 mL). This will
produce an increase of blood glucose of 2.1 mmol/L in 20 minutes. Wait
15 minutes and retest blood glucose level. Re-treat with another
15 grams of carbohydrate if the blood glucose level remains below
4.0 mmol/L.
•
•
If the next meal or snack is less than 1/2 hour away, have your meal or snack
right away.
If the meal or snack is more than 1 hour away, take a 15 grams portion of
carbohydrate immediately (see the table below) as well as 1 protein choice. Have
your meal or snack at the regular time.
EXAMPLES OF 15 grams PORTIONS OF CARBOHYDRATE
•
•
•
•
•
•
•
•
*NOTE:
250 mL (1 cup or 8 oz) glass of milk
175 mL (3/4 cup or 6 oz) glass juice
175 mL (3/4 cup or 6 oz) regular soft drink
4 Dextrosol or Dextro Energy tablets
3 teaspoons (15 mL) sugar
3 sugar cubes
1 tablespoon (15 mL) pasteurized corn syrup or honey
6 Lifesavers (1 = 2.5 grams carbohydrate)
If you are still experiencing symptoms 30 minutes after treatment, test your
blood glucose again. If your blood glucose is less than or equal to 3.3 mmol/L,
take another 15 grams of carbohydrate.
It may take up to 15 to 20 minutes for blood glucose levels to be near normal. You
can resume normal activity once you have treated mild or moderate hypoglycemia.
If driving, you should wait 15 to 20 minutes before proceeding.
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❦ Severe Hypoglycemia:
Although this happens rarely, you and your family members should know how
to treat this form of hypoglycemia. The symptoms of severe hypoglycemia
include confusion, seizures, and/or coma. A relative or friend must know what
to do before it happens. Treatment is the same in pregnancy as when you are not
pregnant.
You will need help from others to treat severe hypoglycemia.
If you are conscious, consume 20 grams of carbohydrate preferably as glucose
tablets. Wait 15 minutes and retest your blood glucose level. Re-treat with another
15 grams of carbohydrate if your blood glucose level is less than 4 mmol/L. If your
meal or snack is due, be sure to eat it. If a meal is more than 1 hour away, a snack of
15 grams of carbohydrate and a protein source is recommended.
If you are unconscious, you should be treated with glucagon.
Speak with your diabetes health care team about the role of glucagon by injection,
where to purchase glucagon, and how to use it. Glucagon is a hormone produced by
the pancreas. Once injected, it helps to raise your blood sugar by releasing the
stored sugar in your liver. Caregivers or support persons should call for emergency
services, and the episode should be discussed with the diabetes health care team as
soon as possible.
What about hypoglycemia at night?
❦ Nocturnal hypoglycemia
If you have low blood glucose at night, talk to your diabetes health care team.
Possible Causes:
• Delayed response to intense exercise.
• Too much insulin before supper or bedtime snack.
• Not enough carbohydrate and protein in the night snack.
• Night snack eaten too early.
Symptoms:
• Nightmares.
• Headaches when you wake up.
• An unusually restless sleep.
• Unusually clammy skin.
Treatment:
• If you suspect that you are experiencing hypoglycemia during the night, you
may need to test your blood glucose at 3 a.m.
• Your bedtime snack should be taken later in the evening, or you may need two
snacks. The snack should contain at least 25 grams of carbohydrate. You may
also need to take intermediate- or long-acting insulin later in the evening.
Hypoglycemia in any degree does not always mean you should reduce your insulin
dose. With the help of your diabetes health care team, you should determine the cause
of your hypoglycemia and the best way to prevent it. Remember that the way you treat
your low blood glucose is very important; you do not want to over-treat.
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What if I become sick during my pregnancy?
Aside from the normal signs and symptoms associated with pregnancy, you may
become sick with the flu, a cold, etc., during your pregnancy. It is very important to
keep tight control of your blood glucose while you are sick. The following are some
guidelines on managing your diabetes when you are sick.
Monitoring
❦ It is important to check your blood glucose regularly at home to determine your
need for additional rapid- or short-acting insulin during the time you are sick.
❦ Blood glucose and blood or urine ketones should be checked every 4 hours, 24 hours
a day. More frequent checks will be required if:
• You are vomiting.
• You are unable to follow your meal plan.
• You have moderate to large ketones present.
• You have a blood glucose greater than 10 mmol/L.
❦ You should continue to check your blood glucose as long as it is greater than or
equal to 10 mmol/L.
❦ You should check for urine ketones as long as they are present.
❦ You should continue to monitor your blood and urine if your regular meal plan
cannot be followed.
Insulin Adjustment
❦ You should never stop taking your insulin when you are sick.
❦ Insulin should be adjusted as needed. Your diabetes health care team can help you
make the appropriate adjustments.
Adequate Intake
❦ If you have trouble eating solids, take a 10 to 15 grams portion of carbohydrate in the
form of liquid or soft foods every 1 to 2 hours.
❦ If blood glucose levels are greater than 10 mmol/L and you are vomiting, you can
wait up to 4 hours to eat. Blood sugar levels must be monitored at least every
2 hours.
❦ Take extra fluids (e.g., water, clear broth, sugar-free Kool Aid®, sugar-free soft
drinks, etc.) to prevent dehydration and help with the removal of ketones in your
urine.
Contacting a Health Professional
It is important that you contact a member of your diabetes health care team immediately
when:
❦ You have been vomiting for more than 4 hours or have more than 5 diarrhea bowel
movements in one day.
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❦ Ketones are still present and high blood glucose levels persist even after insulin
adjustments.
❦ You develop hypoglycemia during illness (blood glucose levels less than or equal to
3.3 mmol/L).
❦ You have been unable to eat or drink anything for 4 hours.
❦ Your illness lasts longer than 24 hours, is very severe, or worsens.
If you have any questions or concerns about sick day management, contact a member of
your diabetes health care team and they will be able to help you.
How can I deal with the typical pregnancy complaints?
❦ Morning Sickness:
Nausea and vomiting are very common symptoms of early pregnancy. Because you
have diabetes, nausea and vomiting may affect your insulin dose. If you are taking
insulin and experience nausea and vomiting, keep taking your insulin.
The following are some tips for controlling nausea:
• Eat some dry crackers or a piece of toast before getting out of bed.
• Eat small meals every 2 1/2 to 3 hours.
• Avoid caffeine.
• Avoid fatty and spicy foods.
• Drink fluids (e.g., water, clear broth, sugar-free Kool Aid®, sugar-free soft drinks,
tea, etc.) between meals, not with meals.
• Take prenatal vitamins after dinner or at bedtime.
• Always carry food for snacks.
• Have a snack containing carbohydrate and protein before bed.
Your nausea may also be a symptom of hypoglycemia (low blood glucose);
therefore, it is essential that you check your blood glucose levels often. It is also
important that you carry food with you at all times to treat hypoglycemia or nausea.
❦ Constipation:
Constipation often becomes a problem during pregnancy because your intestinal
muscles relax, and the growing baby puts more pressure on your intestines.
The following are some tips to help with constipation:
• Drink plenty of liquids (sugar-free).
• Eat high-fiber foods including whole grain breads, bran cereal, raw fruits, and
vegetables.
• Get plenty of exercise/activity.
• If the problem persists, discuss it with your doctor.
❦ Cravings:
Many women experience strange cravings during pregnancy. You may no longer
like foods you once loved, and you may crave foods you normally would not eat. It
is important to try to fit these new cravings into your meal plan. Your dietitian can
help you with this.
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Should I take any other medications while I am pregnant?
Any medication you take during pregnancy will not only affect you but also your
unborn baby. During pregnancy you should avoid smoking, the use of alcohol, herbal
supplements, and illicit drugs such as marijuana and cocaine.
❦ The following are some guidelines to follow when taking medication during
pregnancy:
•
Tell your doctor what drugs you normally use (including caffeine, tobacco, and
prescription and nonprescription drugs including herbal supplements). Ask for
advice about their use during your pregnancy.
•
Even if your doctor agrees with you about taking a nonprescription drug during
pregnancy, read the label carefully and look for any warnings about use during
pregnancy.
•
If you think labor is about to begin, do not use any medications unless you are
instructed to do so by your doctor.
•
Ask your pharmacist for additional information on any drugs you may be
concerned about.
Will I have to be hospitalized during my pregnancy?
It is possible that you may have to go into the hospital if your blood glucose levels are
not well controlled. Being admitted to the hospital can increase your level of stress. It
may be helpful to view your hospitalization as an escape from a difficult situation.
Depending upon your circumstances, the length of your hospital stay will vary. During
your stay in the hospital, you should try to keep yourself busy by visiting the day room,
exercising, or doing volunteer work at the hospital. Your diabetes health care team can
help arrange this for you.
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DELIVERY
Will I deliver my baby early?
The timing of your delivery depends on how well controlled your blood glucose levels
were during your pregnancy and how well your baby is growing and developing.
Control of your blood glucose levels is important right up until you deliver your baby.
Will I have a cesarean section?
Women with diabetes have cesarean births (assisted delivery through an incision in the
abdomen) more often than women without diabetes. However, due to the use of home
blood glucose monitoring and intensive therapy (frequent injections and fine tuning of
insulin dose with food and exercise), more women with diabetes are able to continue
their pregnancy to their intended due date (term). This also helps to reduce the chances
of having a very large baby. By keeping your blood glucose near normal throughout the
pregnancy, you can reduce the need for a cesarean section.
What will happen to my insulin during labor and after delivery?
The goal during labor and delivery is to maintain your blood glucose levels near normal.
This will result in changes to your insulin dose.
❦ If labor is to be started by induction (labor started by your doctor using induction
drugs), you may be instructed not to take your insulin the morning you are
scheduled for the induction.
❦ Your blood glucose will be checked hourly and may be maintained by an
intravenous (IV) insulin drip and dextrose (sugar) solution.
If you are delivering your baby by cesarean section:
❦ You will be asked to have nothing to eat or drink overnight unless you have a low
blood glucose reaction (hypoglycemia).
❦ Your cesarean section should be scheduled for early in the morning. For this reason,
your breakfast and morning insulin will not be given.
❦ Your blood glucose will be checked prior to the cesarean section and an IV started.
Different IV solutions will be used during and after the delivery to help stabilize
your blood glucose levels until you are able to eat. Insulin will be given as required.
After delivery, your insulin requirements will decrease and your insulin dose will have
to be adjusted. Your blood glucose levels will be monitored carefully. Your doctor will
help you adjust your insulin, and you should monitor your insulin and blood glucose
carefully for some time after the birth of your baby.
If you go into labor:
❦ Your blood glucose will be checked every 2 hours. This will help determine your
need for insulin or a sugar solution to help keep your blood glucose near normal.
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Will my baby need special care after delivery?
Due to the nature of your pregnancy and the risks associated with it, your baby will
receive special care immediately after delivery. You will still have a chance to see your
baby, but holding your baby may be delayed. Your doctor will check to make sure that
your baby is okay. If there is a special care unit in the hospital where you are delivering,
your baby will be taken to this unit. You will have opportunities to visit, hold, and
touch your baby on a regular basis.
A tour of the special care unit may be helpful in preparing you for what will happen to
your baby after delivery. Touring this unit and/or discussing the special care your baby
will receive will help reduce some of the stress you might experience at the time of
delivery. Ask your diabetes health care team if a tour can be arranged.
What will the doctors check my baby for?
As with all newborns, your doctor will check to see if your baby has any physical
abnormalities, ensure there are no injuries caused by the delivery, and that her/his
breathing, colour, and heart rate are normal. Your baby will also be observed for risks
related to your diabetes such as low blood glucose.
How can my diabetes affect my baby at delivery?
The most common complications are low blood glucose (hypoglycemia), immature
lungs (respiratory distress syndrome), and jaundice (hyperbilirubinemia).
❦ Neonatal Hypoglycemia:
Refers to low blood glucose levels in the baby shortly following birth. This occurs in
the baby who has been exposed to high blood glucose levels from her/his mother.
As a result of this high blood glucose, the baby’s pancreas makes extra insulin. Once
the umbilical cord is cut, the source of glucose from your body stops. Therefore, the
baby’s blood glucose can drop after birth. Your baby’s blood glucose levels will be
tested frequently after birth so treatment can begin immediately if her/his glucose
levels are low. If it is necessary to watch for the signs and symptoms of low blood
glucose in your baby, the nursing staff will explain these to you. The first feeding
may be given by one hour of age to prevent hypoglycemia.
The treatment of hypoglycemia is to feed your baby or to start IV glucose as needed.
❦ Jaundice (yellow colour of the skin):
Jaundice (a build-up of bilirubin in the blood) is common in newborns and causes
the skin to turn yellow. It may occur earlier or be more severe in a baby whose
mother has diabetes.
Signs to look for:
• Early skin changes such as yellow colouration.
• Sleepiness.
• Shows no interest in feeding.
Contact your nurse or doctor if you notice any of these signs.
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❦ Respiratory Distress Syndrome (immature lungs):
Occurs when the lungs of the infant are not fully mature at birth, and the baby has
trouble breathing on her/his own. As mentioned before, this is more common in
babies born prematurely. If this happens, your baby will be given oxygen and other
assistance to breathe until her/his lungs are ready to do the work on their own.
Mild cases do not result in long term breathing problems.
❦ Hypocalcemia:
Refers to a low level of calcium in the blood of the newborn baby. There is a greater
chance of this occurring in a baby of a mother with type 1 diabetes who had
difficulty controlling blood glucose levels.
The treatment for hypocalcemia is to give calcium supplements until the level of
calcium returns to normal.
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BREASTFEEDING
Should I breastfeed?
Yes, if you can! But don’t feel guilty if you cannot. Breast milk is the best source of
nutrition for all babies. It is recommended that women, including those with diabetes,
breastfeed. One of the main advantages of breastfeeding is that it naturally lowers the
mother’s blood glucose levels without increasing insulin needs. Glucose is used as
energy to produce the milk. Fasting blood glucose levels are lower in women who
successfully breastfeed.
What are the benefits to my baby?
❦ Attachment with the mother.
❦ Helps protect the baby from infection.
❦ Provides the baby with the best nutrition for growth and digestion.
❦ May help prevent your child from developing diabetes later in life.
What are the benefits to me?
❦ Attachment with your baby.
❦ Prolonged breastfeeding (longer than six months) may promote weight loss as it uses
fat stores accumulated during pregnancy.
❦ Controls uterine bleeding after delivery.
❦ Economical (no formula cost).
❦ Time saving (no preparation).
❦ Decreased insulin needs.
What should I do if I want to breastfeed?
Before Delivery
❦ Attend a breastfeeding class in your community.
❦ Ask your diabetes educator to introduce you to a woman with diabetes who has
recently breastfed her baby. She can help answer any questions you may have.
❦ Discuss with a diabetes educator possible obstacles to breastfeeding.
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After Delivery
❦ Maintain tight control of blood glucose levels.
❦ Monitor blood glucose levels carefully and closely.
❦ Include snacks before or during each feeding and at bedtime to prevent
hypoglycemia.
❦ Test blood glucose levels more frequently to determine the need for extra snacks or
less insulin.
❦ Consider each feeding as an “activity.” When you do more, you need more food. Be
especially attentive to nighttime blood glucose levels.
❦ Eat an extra 500 to 800 calories a day above non-pregnant needs to meet the extra
energy requirements. Your dietitian can help you with this.
❦ Choose “extra” fluids with little or no sugar content such as water or sugar-free
liquids to supplement your fluid intake and quench your thirst.
❦ See your dietitian to determine your nutrition needs during breastfeeding.
❦ Continue to take insulin while breastfeeding. Your insulin may have to be adjusted;
especially, the overnight dosage. This is because your blood glucose levels may
drop quickly during your baby’s bedtime or overnight feedings. Your diabetes
health care team can help you determine the correct insulin dosage during
breastfeeding. If you were on an oral agent (diabetes pill) prior to pregnancy, check
the safety of this medication with your physician before taking it while
breastfeeding. These pills may cause hypoglycemia in the infant as small amounts of
the drug can pass through the breast milk. If an oral agent is used while
breastfeeding, your infant’s blood glucose levels should be monitored.
❦ Continue to exercise regularly. It may be necessary to feed the baby right before
exercising or 1 hour after due to the possibility of lactic acid produced during
exercise altering the taste of breast milk.
Are there any risks associated with breastfeeding?
There are two risk factors for the mother—hypoglycemia and infection. To reduce the
risk of hypoglycemia, you should monitor your blood glucose levels carefully and
include snacks in your meal plan where necessary.
Infection is a possible risk factor to the woman who breastfeeds. Women with diabetes
are more prone to infection. The two most common infections are mastitis (breast
infection) and candida albican (yeast infection or thrush). Be aware of the signs and
symptoms of infection (see Table 1). Contact your doctor, breastfeeding (lactation)
consultant, or other health professionals if these signs occur.
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Table 1:
Mastitis (Breast Infection)
Possible signs and symptoms
•
•
•
•
•
Feeling achy and rundown –
“flu-like.”
Fever greater than 38.4° C (101° F).
Discomfort and pain in breast.
Breast may be hot and red.
Usually occurs in one breast.
Candida Albican
(Yeast Infection or Thrush)
Possible signs and symptoms
•
•
•
•
•
Prolonged or sudden onset of sore
nipples after newborn period cracked nipples.
Shooting pain in breast during or after
feeding.
Vaginal yeast infection.
Baby may have white patches on
inside of mouth or tongue.
Baby may be refusing breast because
of sore mouth.
How can I reduce the risk of infection?
You can reduce your risk for infection by:
❦ Changing breast pads frequently. A cotton-based pad is preferred.
❦ Wearing a supportive bra; yet not too tight.
❦ Showering/bathing daily or washing breasts with warm water.
❦ To treat infection (at any sign of infection, contact your doctor):
❦ Get adequate rest.
❦ Drink plenty of fluids and maintain a healthy diet.
❦ Feed frequently on both sides.
❦ Apply warm moist compresses to breasts for 10 minutes prior to feeding.
❦ Change/rotate feeding position.
❦ Antibiotics may be required.
Breastfeeding is the perfect way to nourish your baby and should be considered.
Optimal blood glucose levels, avoiding hypoglycemia, and eating adequate calories
from a nutritionally balanced and complete meal plan are all important for a positive
breastfeeding experience.
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POSTPARTUM (AFTER DELIVERY)
What should I do now that my baby is born?
Meet with your diabetes health care team to discuss your continuing care. You will
require an adjustment to your insulin requirements or diabetes medication, meal plan,
and exercise/activity routine.
❦ Your insulin requirements will decrease after delivery by 1/2 to 2/3 of your prepregnancy dosage.
❦ Your dietitian will adjust your meal plan. She/he may increase or decrease your
calories depending on your decision regarding breastfeeding.
❦ Continue to monitor your blood glucose levels at least 4 times a day.
❦ Your activity may change due to fatigue and/or method of delivery.
❦ You, no doubt, will have questions about the relationship of diabetes to the health of
your child.
❦ Discuss birth control options with your physician.
❦ If you have type 1 diabetes, it is important that you have an eye assessment within
the first year postpartum.
Is it possible to continue to exercise postpartum?
Most women can continue to exercise postpartum. Fatigue may interfere with the
intensity or length of activity in the early postpartum weeks. Women who have had
cesarean delivery may slowly increase their aerobic and strength training depending on
their level of discomfort. Women who do pelvic floor exercises immediately postpartum
may reduce the risk of future urinary incontinence. The six-week postpartum visit is a
good time to discuss these issues with your doctor or physiotherapist.
What are the possible long-term effects of my diabetes on my baby?
Obesity and excessive weight are more common in children of mothers with diabetes. If
your baby was very large, she/he is more likely to have weight problems later in life.
Promoting proper nutrition and an active lifestyle in your child will help prevent
obesity.
Will my baby have a chance of developing diabetes later in life?
There is a chance that your child may develop diabetes later in life. The odds are about
1 in 8. However, certain people are more likely to develop diabetes than others because
of certain risk factors. The factors are different for developing type 1 than they are for
developing type 2 diabetes. In both cases, genetic risk seems to be a major determining
factor.
Other environmental/lifestyle factors such as nutrition, obesity,
exercise/activity, and viruses also play a role in the development of diabetes; especially,
when a genetic predisposition exists.
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Genetic Factors
It has been shown that children of women with type 1 diabetes have a slightly greater
chance of developing diabetes than children of women without diabetes. It has also
been shown that the risk for developing diabetes in a child whose mother has type 2
diabetes is somewhat greater than for children of mothers with type 1 diabetes.
The estimated risk of developing diabetes is as follows:
LIFETIME RISK OF TYPE 1 DIABETES
General population
Mom with type 1 diabetes
0.4%
3%
Dad with type 1 diabetes
5 to 8%
Sibling with type 1 diabetes
5 to 8%
HLA-identical sibling with type 1 diabetes
12 to 19%
Identical twin with type 1 diabetes
33 to 50%
Only 5 to 15% of individuals with type 1 diabetes have a first degree relative
with type 1 diabetes.
Source: Epstein F. NEJM. 1994;331:1429
Environmental Factors
Type 1 Diabetes
The most common form of type 1 diabetes is caused by destruction of pancreatic beta
cells. This destruction may be started by environmental factors in genetically
predisposed persons. Studies are presently underway to find safe and effective
prevention therapies.
Type 2 Diabetes
Factors such as obesity, diabetes in the mother, and lifestyle issues, such as diet and lack
of physical activity, have been shown to contribute to the risk of developing type 2
diabetes.
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Contraception (Birth Control)
Why do I need to worry about birth control?
It is important that you start using a method of birth control to prevent an unplanned
pregnancy before you are ready to have another baby. If you want to have another
baby, it is best to wait until you have achieved near normal blood glucose levels. It will
probably be easier for you to obtain near normal blood glucose levels with another
pregnancy as you will be less anxious and will have had experience managing your
diabetes from your previous pregnancy.
A reliable method of birth control is necessary to prevent unplanned pregnancy and to
give you time to obtain good blood glucose control before you become pregnant.
Planning is necessary for women with diabetes to have a successful pregnancy. Should
pregnancy occur during a time when blood glucose levels are not tightly controlled,
there is a greater risk of losing the baby or having problems with the baby. (See
“Preconception” section.) It is important to recognize that breastfeeding is not a reliable
form of birth control. You can get pregnant while breastfeeding.
What method of birth control is best for me?
The following is a list of available kinds of birth control. Your doctor can help you
choose the method that is best for you and your partner.
❦ The Pill (oral contraceptive): Birth control pills with a low estrogen or progesterone
dose should be recommended and your blood pressure should be monitored
regularly. This method of birth control is 98% effective when taken as directed.
There is no reason not to use the pill because you have diabetes.
❦ Depo-Provera: This is a hormone injection that is given 4 times a year. It keeps
ovaries in the resting state so that eggs are not released. It is considered to be 99.7%
effective and can be used while breastfeeding. Because it may cause hyperglycemia,
careful monitoring of blood glucose levels is recommended.
❦ Intrauterine Device (IUD): This is a copper-bearing device that is inserted into the
uterus. It can be an excellent choice for women with diabetes who have had no
history of pelvic infection or tubal pregnancies, who are with a single sex partner,
and who are seeking long-term contraception. It has no metabolic side effects and is
reversible. It is 97% effective.
❦ Diaphragm: A diaphragm is a rubber cap that is lubricated with a gel that kills
sperm and is inserted into the vagina before intercourse. It fits over the cervix and
acts as a barrier to prevent sperm from entering the cervix and passing to the uterus.
It can be 82% effective when used correctly.
❦ Condom: A condom is a thin sheath that fits over the penis. When used alone, these
have a high failure rate. If used correctly with a sperm-killing foam or gel, they are
80% effective. However, condoms are the only barrier method that protects you
against sexually transmitted diseases.
❦ Sterilization: This is a surgical procedure that cuts the fallopian tubes making
pregnancy impossible. This is a permanent method of birth control and is only
suggested for the woman who has already completed her family. This is 99%
effective.
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❦ Vasectomy: Male sterilization may be another option for you and your partner. It is
a surgical procedure that prevents the sperm from entering the semen. This is a
permanent method of birth control. It is greater than 99% effective.
The effectiveness of the following methods is not well documented. You should ask
your doctor for more information.
❦ Sponge: This is a small sponge-like object that contains a sperm-killing gel. It is
placed in the vagina before intercourse. It is only 72% effective; so it is not
recommended.
❦ Rhythm Method: Because women with diabetes often have irregular periods, this
method is an unreliable form of birth control. This requires a highly motivated
couple and careful planning. You must use your body temperature to determine
when you could become pregnant and not have intercourse during that time. It is
only 80% effective when followed carefully.
It is up to you to decide what method of birth control you want to use. Discuss the
different kinds with your doctor. The more information you have, the easier it will be
for you to find a method of birth control that will be best for you and your partner.
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CONCLUSION
With hard work, it is very likely you will have a healthy baby. You must remember that
in order to care for your healthy baby, you must care for yourself first - healthy babies
need healthy mothers. Continue to follow an exercise/activity program and maintain a
healthy diet.
After the birth of your baby, if you decide to have another child, you should re-enroll in
preconception care and make follow-up visits with your family doctor or Diabetes
Centre. This will make planning for the next pregnancy easier. Make sure that you have
excellent control of your blood glucose levels and a normal A1C level before you try to
become pregnant.
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REFERENCES
The following references were used to prepare this booklet. These resources are written for health
professionals and not readily available outside health science libraries.
American Diabetes Association. Preconception Care of Women with Diabetes. Diabetes
Care. January 2003;26(suppl 1):S91-S105.
American Diabetes Association Council on Pregnancy. Diabetes and Pregnancy What to
Expect: Your Guide to a Healthy Pregnancy and a Happy, Healthy Baby. 4th ed. Alexandria,
VA: Author, 2000.
American Diabetes Association. Medical Management of Pregnancy Complicated by
Diabetes. 3rd ed. Alexandria, VA: Author, 2000.
Briggs GG, Freeman RK, Yaffe SJ (eds). Drugs in Pregnancy and Lactation. Vol. 6.
Philadelphia, PA: Lippincott, Williams and Wilkins, 2002:174-181, 469-476.
California Diabetes & Pregnancy Program. Sweet Success: Guidelines for Care. California:
Maternal and Child Health Branch, 1998.
Canadian Diabetes Association. Clinical Practice Guidelines Expert Committee.
Canadian Diabetes Association 2003 Clinical Practice Guidelines for the Prevention and
Management of Diabetes in Canada. Canadian Journal of Diabetes. December 2003;
27:(suppl).
Correa A, Lorenzo B, Liu Y, et al. Do multivitamin supplements reduce the risk for
diabetes-associated birth defects? Pediatrics. May 2003;111(suppl 5):1146-1151.
Creed M. Diabetes: Antepartum, Intrapartum, Postpartum, and Newborn Nursing Care: A
Self-Paced Learning Packet. Vancouver, BC: Salvation Army Grace Hospital, 1991.
Davies G. Antenatal Fetal Assessment. SOGC Position Paper. June 2000: No.90. Retrieved
from: www.sogc.ca (March 26, 2004).
Feig D, Palda VA. Type 2 diabetes in pregnancy: a growing concern. Lancet.
2002;359;1690-1692.
Gabbe S, Graves C. Management of diabetes mellitus complicating pregnancy.
Obstetrics and Gynecology. October 2003;102(4):857-868.
Health Canada. Nutrition for a Healthy Pregnancy: National Guidelines for the Childbearing
Years. Ottawa, ON: Minister of Public Works and Government Services Canada, 1999.
Health Canada. Preconception Health: Folic Acid for the Primary Prevention of Neural Tube
Defects: A Resource Document for Health Professionals. Ottawa, ON: Minister of Public
Works and Government Services Canada, 2002.
Joslin Diabetes Center. Guidelines for Detection and Management of Diabetes in Pregnancy.
Retrieved from: www.joslin.harvard.edu (February 13, 2003).
Jornsay DL, Prisco M. Fetal monitoring: how’s your baby doing in there? Diabetes SelfManagement. May/June 1996:33-40.
Your Guide to Having a Healthy Baby
Diabetes Care Program of Nova Scotia 2004
49
Kalergis M, Schiffrin A, Gougeon R, Jones PJ, Yale JF. Impact of bedtime snack
composition on prevention of nocturnal hypoglycemia in adults with type 1 diabetes
undergoing intensive insulin management using lispro insulin before meals: a
randomized, placebo-controlled, crossover trial. Diabetes Care. January 2003;26(1):9-15.
Ludwig S. Risks to children of women with diabetes: fact or myth? Canadian Diabetes.
Winter 2003;16(4):5, 7.
Manderson JG, Patterson CC, Hadden DR, et al. Pre-prandial versus postprandial blood
glucose monitoring in type 1 diabetic pregnancy: a randomized controlled clinical trial.
American Journal of Obstetrics and Gynecology. August 2003;189(2):507-512.
Motherisk Program. The Hospital for Sick Children, Toronto, ON.
Phone: (416) 813-6780.
National Academy of Sciences. Dietary Reference Intakes for Thiamin, Riboflavin, Niacin,
B6, Folate, B12, Pantothenic Acid, Biotin and Choline. Washington, DC: National Academy
Press, 1998.
Shandro MTL, Toth EL. Preconception evaluation and counseling of patients with type
1 and type 2 diabetes. Canadian Diabetes. Winter 2003;16(4):2-6.
Society of Obstetricians and Gynecologists of Canada. Antenatal Fetal Assessment. SOGC
Position Paper. June 2000: No. 90. Retrieved from www.sogc.ca (March 9, 2004).
Society of Obstetricians and Gynecologists of Canada/Canadian Society for Exercise
Physiology. Exercise in Pregnancy and the Postpartum Period. SOGC Position Paper, June
2003: No. 129. Retrieved from: www.sogc.ca (February 13, 2004).
The Pregnancy and Diabetes Subcommittee of the Diabetes Care Program of Nova
Scotia. The Pregnancy & Diabetes Management Guidelines Manual. Halifax, NS: Author;
2000.
Wolever T, Barbeau M-C, Charron S, et al. Guidelines for the nutritional management of
diabetes in the new millennium: a position statement by the Canadian Diabetes
Association. Canadian Journal of Diabetes Care: 1999.
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Your Guide to Having a Healthy Baby
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APPENDIX A
PUBLIC HEALTH SERVICES,
RESOURCE MATERIALS, AND
DIABETES CENTRES IN NOVA SCOTIA
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Public Health Services
By contacting the Public Health Office closest to your home, you should be able to
obtain additional information on family resource centres, support groups, and other
services in your area. To verify phone numbers or to obtain fax numbers, visit the
Public Health Services web site
(www.gov.ns.ca/health/publichealth/content/addresses.htm).
Serving:
Halifax Regional Municipality, West Hants, and Mount Uniacke.
How Can You Reach Us?
Dartmouth................................................................................................................(902) 481-5800
Halifax ......................................................................................................................(902) 481-5920
Head of Jeddore ......................................................................................................(902) 889-2143
Middle Musquodoboit ...........................................................................................(902) 384-2370
Sheet Harbour .........................................................................................................(902) 885-2470
Windsor ....................................................................................................................(902) 798-2264
To register for prenatal classes in the Metro area, call (902) 481-5842 or 481-5868. In
rural areas, call the nearest office.
The Breastfeeding Support Line is available Monday to Friday 8:30 a.m. to 4:30 p.m.
Call (902) 481-5852. You can leave a message on off-hours, and a Public Health Nurse
will return your call as soon as possible. There are also prerecorded messages on
frequently asked questions.
Serving: Cape Breton, Victoria, Inverness, Richmond, Antigonish, and Guysborough
Counties
How Can You Reach Us?
Arichat ......................................................................................................................(902) 226-2944
Antigonish ...............................................................................................................(902) 863-2743
Baddeck ....................................................................................................................(902) 295-2178
Canso ........................................................................................................................(902) 366-2925
Cheticamp ................................................................................................................(902) 224-2410
Glace Bay..................................................................................................................(902) 842-4050
Guysborough...........................................................................................................(902) 533-3502
Inverness ..................................................................................................................(902) 258-1920
Neil’s Harbour.........................................................................................................(902) 336-2295
New Waterford .......................................................................................................(902) 862-2204
Port Hawkesbury ....................................................................................................(902) 625-1693
Sherbrooke ...............................................................................................................(902) 522-2212
Sydney Mines ..........................................................................................................(902) 736-6245
Sydney ......................................................................................................................(902) 563-2400
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Serving: Colchester, Cumberland, and Pictou Counties and most of the Municipality of
East Hants
How Can You Reach Us?
Amherst....................................................................................................................(902) 667-3319
New Glasgow ..........................................................................................................(902) 752-5151
Shubenacadie...........................................................................................................(902) 758-2050
Truro .........................................................................................................................(902) 893-5820
Serving: Annapolis, Kings, Lunenberg, Queens, Digby, Yarmouth, and Shelburne
Counties
How Can You Reach Us?
Annapolis Royal......................................................................................................(902) 532-2381
Barrington Passage .................................................................................................(902) 637-2430
Berwick .....................................................................................................................(902) 538-3700
Bridgewater .............................................................................................................(902) 543-0850
Chester......................................................................................................................(902) 275-3581
Digby ........................................................................................................................(902) 245-2557
Liverpool ..................................................................................................................(902) 354-5737
Lunenburg ...............................................................................................................(902) 634-8730
Meteghan .................................................................................................................(902) 645-2325
Middleton.................................................................................................................(902) 825-3385
New Germany .........................................................................................................(902) 644-2710
Shelburne .................................................................................................................(902) 875-2623
Wolfville ...................................................................................................................(902) 542-6310
Yarmouth .................................................................................................................(902) 742-7141
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Resource Materials
Written material available in Nova Scotia through the Public Health Offices.
1.
Nova Scotia Department of Health. A Healthy Start. Halifax, NS: Author; 2002.
2.
Nova Scotia Department of Health. Becoming a Father. Halifax, NS: Author;
2002.
3.
Nova Scotia Department of Health. Choosing to Breastfeed. Halifax, NS: Author;
2002.
4.
Nova Scotia Department of Health. Healthy Activity. Halifax, NS: Author; 2002.
5.
Nova Scotia Department of Health. Healthy Birthing. Halifax, NS: Author; 2002.
6.
Nova Scotia Department of Health. Healthy Eating. Halifax, NS: Author; 2002.
7.
Nova Scotia Department of Health. Nine Months of Changes. Halifax, NS:
Author; 2002.
8.
Nova Scotia Department of Health. Breastfeeding Basics. Halifax, NS: Author;
2003
9.
Nova Scotia Department of Health, Public Health Promotion. Year One: Food for
Baby. Halifax, NS: Author; 2003.
10.
Nova Scotia Department of Health, Public Health Promotion. After Year One:
Food for Baby. Halifax, NS: Author; 2003.
11.
Health and Welfare Canada. Canada’s Food Guide to Healthy Eating. Ottawa, ON:
Author; 2002. (Available in English and French.)
12.
Health and Welfare Canada. Why all women who become pregnant should take folic
acid. Ottawa, ON: Author; 2003.
13.
Nova Scotia Department of Health, Public Health Promotion. Drugs and Your
Unborn Baby. Halifax, NS: Author; 2001. (Adapted from “Is It Safe for My
Baby?” with permission from Addiction Research Foundation, Toronto, ON.)
14.
Nova Scotia Department of Health. Breastfeeding Series. Halifax, NS: Author.
(Reproduced with permission from Hamilton-Wentworth Regional Lactation
Committee, 2002.)
•
•
•
•
•
15.
Breastfeeding is Easy to Learn
Breastfeeding Feels Good
Breastfeeding Does Not Have to Change the Way You Eat
Breastfeeding When You Are Away From Your Baby
Breastfeeding After the First Six Months
Society of Obstetricians and Gynecologists of Canada. Healthy Beginnings: Your
handbook for pregnancy and birth. Ontario: Author; 1998.
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Website Resources:
American Diabetes Association .......................................... www.diabetes.org
Canadian Diabetes Association .......................................... www.diabetes.ca
Capitol Health District, Nova Scotia.................................. www.cdha.nshealth.ca
Diabetes Care Program of Nova Scotia .............................www.diabetescareprogram.ns.ca
Health Canada....................................................................... www.healthcanada.ca
Nova Scotia Public Health...................................................www.gov.ns.ca/health
Health Canada....................................................................... www.healthcanada.ca
Society of Obstetricians and Gynecologists of Canada ... www.sogc.org
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DIABETES CENTRES IN NOVA SCOTIA
There are over 35 Diabetes Centres in Nova Scotia. They provide initial and
ongoing education and support for people with diabetes – adults, children, and
pregnant women. These programs are staffed by nurse and dietitian teams who
offer advice and guidance in consultation with your family doctor. Through these
programs, people learn how to care for and manage their diabetes. These
programs provide an excellent means for keeping up-to-date and for reviewing
present practices.
Remember, diabetes education is ongoing. Make sure you have the most
recent information and access to the best. Give the Diabetes Centre closest
to your home a call!
DHA 1 – South Shore District Health Authority
Fishermen’s Memorial Hospital ................................................. P: (902) 634-7338
(Health Services Organization of South Shore) ........................ F: (902) 634-7334
Lunenburg, NS
Queen’s General Hospital ......................................................... P: (902) 354-3436
Liverpool, NS............................................................................. F: (902) 354-2018
DHA 2 – South West Nova District Health Authority .........................................
Digby General Hospital .............................................. P: (902) 245-2501, Ext. 274
Digby, NS .................................................................................. F: (902) 245-5517
Roseway Hospital ..................................................................... P: (902) 875-3011
Shelburne, NS ........................................................................... F: (902) 875-1580
Yarmouth Regional Health Centre ............................. P: (902) 742-3542, Ext. 245
Yarmouth, NS............................................................................ F: (902) 742-0512
DHA 3 – Annapolis Valley District Health Authority ..........................................
Annapolis Community Health Centre ......................... P: (902) 532-2381, Ext. 149
Annapolis Royal, NS ................................................................. F: (902) 532-2113
Soldier’s Memorial Hospital........................................ P: (902) 825-3411, Ext. 243
Middleton, NS............................................................................ F: (902) 825-0599
Valley Regional Hospital .............................P: (902) 679-1849, Ext. 1367 or 1366
Kentville, NS.............................................................................. F: (902) 679-1794
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DHA 4 – Colchester East Hants District Health Authority
Colchester Regional Hospital ............................................................... P: (902) 893-5528
Truro, NS
F: (902) 895-2599
Lillian Fraser Memorial Hospital ........................................................... P: (902) 657-2382
Tatamagouche, NS
F: (902) 657-9380
DHA 5 – Cumberland District Health Authority
Cumberland Regional Health Care Centre .........................P: (902) 667-5400, Ext. 6432
Amherst, NS
F: (902) 667-4460
North Cumberland Memorial Hospital .................................................. P: (902) 243-2521
Pugwash, NS
F: (902) 243-2941
DHA 6 – Pictou County District Health Authority
Aberdeen Hospital...............................................................P: (902) 752-8311, Ext. 2110
New Glasgow, NS
F: (902) 755-2356
Sutherland Harris Memorial Hospital ................................................... P: (902) 485-2306
Pictou, NS
F: (902) 485-8835
DHA 7 – Guysborough Antigonish Strait Health Authority
Eastern Memorial Hospital ................................................................... P: (902) 366-2794
Canso, NS
F: (902) 366-2740
Guysborough Memorial Hospital .......................................................... P: (902) 533-3702
Guysborough, NS
F: (902) 533-4066
St. Anne Community & Nursing Care Centre ....................................... P: (902) 226-1911
Arichat, NS
F: (902) 226-0075
St. Martha’s Regional Hospital ............................................ P: (902) 863-2830, Ext. 4249
Antigonish, NS
F: (902) 867-4700
St. Mary’s Memorial Hospital ............................................................... P: (902) 522-2882
Sherbrooke, NS
F: (902) 522-2556
Strait-Richmond Hospital ..................................................................... P: (902) 625-7270
Cleveland, NS
F: (902) 625-2078
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DHA 8 – Cape Breton District Health Authority
Cape Breton Regional Hospital ................................................. P: (902) 567-7745
Sydney, NS ............................................................................... F: (902) 567-7970
Eskasoni Primary Health Care Centre ...................................... P: (902) 379-3200
(Funded by Health Canada)
Eskasoni, NS............................................................................. F: (902) 379-2421
Glace Bay Health Care Facility ................................................. P: (902) 842-2826
Glace Bay, NS........................................................................... F: (902) 842-2853
Inverness Consolidated Memorial Hospital ............................... P: (902) 258-1905
Inverness, NS............................................................................ F: (902) 258-3061
New Waterford Consolidated Facility ........................................ P: (902) 592-3327
New Waterford, NS ................................................................... F: (902) 592-3312
Northside General Hospital ....................................................... P: (902) 794-5404
North Sydney, NS ..................................................................... F: (902) 794-5454
Sacred Heart Community Health Centre................................... P: (902) 224-4013
Cheticamp, NS .......................................................................... F: (902) 224-2903
Victoria County Memorial Hospital ............................................ P: (902) 295-2112
Baddeck, NS ............................................................................. F: (902) 295-3432
DHA 9 – Capital District Health Authority
Dartmouth General Hospital and Community Health Centre .... P: (902) 465-8532
Dartmouth, NS .......................................................................... F: (902) 465-8597
Eastern Shore Memorial Hospital ............................................. P: (902) 885-3606
Sheet Harbour, NS .................................................................... F: (902) 885-3210
Hants Community Hospital........................................................ P: (902) 792-2052
Windsor, NS .............................................................................. F: (902) 798-5107
Musquodoboit Valley Memorial Hospital ................................... P: (902) 384-4103
Middle Musquodoboit, NS ......................................................... F: (902) 384-3310
QEII Health Sciences Centre .................................................... P: (902) 454-1600
Halifax, NS ................................................................................ F: (902) 473-3770
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DHA 9 – Capital District Health Authority (cont)
Canadian Forces Health Services Ctr Atlantic ......... P: (902) 427-0550, Ext. 8847
(Funded by the Department of National Defense)
Halifax, NS ................................................................................ F: (902) 427-0356
Twin Oaks/Birches Continuing Care Centre ............................. P: (902) 889-4105
Musquodoboit Harbour, NS....................................................... F: (902) 889-2470
IWK Health Centre
Children and Adolescents with Diabetes Program .................... P: (902) 470-8707
Halifax, NS ................................................................................ F: (902) 470-7264
Pregnancy and Diabetes Clinic ................................................. P: (902) 470-6710
Halifax, NS ................................................................................ F: (902) 470-7942
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APPENDIX B
FEEDBACK
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Questions and Answers About Diabetes and Pregnancy
Your Guide to Having a Healthy Baby
Feedback
Please feel free to advise us or your diabetes health care team of any comments,
suggestions, and/or problems you had as you read this booklet. In order to
make this booklet more useful, we need the feedback that only actual use of the
resource can provide. Your comments and suggestions will help us with future
revisions.
Thank you! Please mail or e-mail your comments to:
Diabetes Care Program of Nova Scotia
1276 South Park Street, Bethune Building, Suite 548
Halifax, NS B3H 2Y9
Tel: (902) 473-3219; Fax: (902) 473-3911
E-mail: [email protected]
Optional:
If you would like us to contact you about your comments, please feel free to
include your name and phone number.
Name:
Phone:
Your Guide to Having a Healthy Baby
Diabetes Care Program of Nova Scotia 2004
1276 South Park Street
Bethune Building, Suite 548
Halifax, NS B3H 2Y9
Tel: (902) 473-3219; Fax: (902) 473-3911
E-mail: [email protected]