Diabetic Treatments for Pregnant Women Dearborn Heights MI

Long before you're ready to take an at-home pregnancy test and pray that the stick turns blue, you should start planning for your baby.

Before becoming pregnant, it's crucial for a woman with diabetes to get her hemoglobin A1C within the normal range, or risk both miscarriage and birth defects.  She should strive to have blood sugar levels within the normal range, too, so she can give birth to a healthy baby.

Here's what you need to know when you are considering getting pregnant.

• The good news is that diabetic women who have a normal hemoglobin A1C carry no additional risk to the pregnancy than women without diabetes, says Dr. Ellen Landsberger, associate professor of obstetrics and gynecology at the Diabetes Center at Montefiore Medical Center in New York City.
• Make an appointment for preconception counseling with your doctor to assess your blood glucose control, advises Landsberger. "You'll sit down with a high-risk obstetrician/gynecologist to learn the steps that you should take to make sure you have a healthy pregnancy," she explains.
• If you have type 2 diabetes and are on oral medications, you may be taken off these medications and started on insulin, Landsberger says. Many of the oral medications are not recommended for use during pregnancy, so insulin therapy fills in, just for the duration of the pregnancy. "It's better for someone with type 2 to make the switch to insulin before the pregnancy," Landsberger says. "This way, she can become accustomed to the monitoring that is inherent with being on insulin"
• If you've had diabetes for a long time and are on certain medications for renal disease, these, too, may either be stopped or switched to a different medication that is considered safe during pregnancy. "If you are on medication because you have protein in the urine, it may be stopped during pregnancy," Landsberger says.
• Once you become pregnant, you will be asked to monitor your blood sugar levels extra closely, says Carlos Hamilton, MD, professor of internal medicine at the University of Texas Health Science Center in Houston, Texas. "Women whose blood sugar is not extremely well controlled tend to have an increased incidence of congenital malformations in the baby," he says. "And they tend to be very large babies, or to have breathing troubles at birth."
• Even if you are using syringes, you may be asked by your doctor to get an insulin pump, Hamilton says, since it's possible to maintain tighter blood sugar control wit...

If you are a woman with diabetes, you must be extra vigilant about certain conditions. The good news is that you're less likely to get some of them if your blood sugar is in good control, says Jeffrey Powell, MD, endocrinologist at the Mount Kisco Medical Group in Mount Kisco, New York. Even if you experience these symptoms, fortunately, they're treatable; so it's important that you feel comfortable talking to your health care provider about any symptoms or concerns.

The Most Common Female Complications

Yeast infections and vaginal irritation. Chronic hyperglycemia promotes both, says Powell, so it pays to strive for optimum blood sugars. "If you are in good control this is less likely to happen," agrees Howard Wilson, MD, an endocrinologist at Park Plaza Hospital in Houston, Texas. For women with diabetes, having elevated blood sugar can affect the ability of the white blood cells to fight infection, he says. And this lays women open to yeast infections.

Urinary tract infections (UTIs). These infections are more common in women with diabetes. When there is neuropathy, or nerve damage, in the bladder area, paralysis of the bladder can result. And when this happens, the nerves in this area don't respond when urine fills the bladder. The result? Urine remains in the bladder and a UTI can result. There also can be problems with incontinence.

Vaginal dryness. Nerve damage can occur when diabetes is not well controlled in various parts of the body. When it happens in the genital area, it can cause vaginal dryness and even interfere with a woman's ability to feel aroused and sexy. A woman could also encounter difficulty having an orgasm.

Pregnancy complications.  These complications can occur in diabetic women when blood sugars are high. "The higher the blood sugar at the time a woman gets pregnant, the higher the incidence of not completing the pregnancy," Wilson says. "An optimal blood sugar to have if you are trying to get pregnant is around 90." A high maternal blood sugar causes the baby's pancreas to produce insulin in utero. This increased insulin could cause macrosomia (a very large baby), which increases the risk of complications to the mother and to her baby.

Treatments that Work

First off, know that you still can enjoy a satisfying sex life. A variety of water-based lubricants are on the market today. Be sure to check with your health care provider if you want to get pregnant, since some lubricants could damage sperm ...

If you're a woman with diabetes and would love to be a mom some day, here's good news: diabetic women can give birth to a beautiful, healthy baby. Careful planning, however, is crucial. High blood sugar in a mother can harm a developing fetus, and since most of the vital organs, like the brain, heart and spine, are formed in the first month after conception, before a woman even knows she is pregnant, it's important to get levels under control before even trying to conceive.

The brain, spine, and heart are all vulnerable to birth defects in the presence of high blood sugars, explains Brita Boyd, MD, assistant clinical professor in the division of maternal fetal medicine at Duke University's Department of OB/GYN. "A planned pregnancy is important for women with diabetes," she says. "With an unintended pregnancy, if the blood sugars are high, it's more likely for birth defects to occur."

Potential Risks

Cardiac malformations, vascular malformations, and skeletal abnormalities are the most common birth defects. The good news is that a diabetic woman with good blood sugar control has nearly the same chance as a non-diabetic woman to deliver a healthy baby.  

For all women, diabetic or non diabetic, the risk of having a baby with a birth defect is about three percent. If you find out you are pregnant and your hemoglobin A1C is below seven, your risk for having a baby with a birth defect is just very slightly higher than a woman without diabetes, Boyd says. For a woman who's been running an average blood sugar in the 300s, that risk could be as high as 1 in 3, Boyd says.

Birth defects aren't the only possible consequence of high blood sugars. Keeping levels in the normal range also will help ensure that your baby will not be born too large. Infants born to women with poorly controlled diabetes can have low blood sugar and low calcium at birth, Greene explains. "If they have low blood sugar, they usually have to get intravenous glucose for a couple of weeks," she says.

Vital Information

● Pay rigorous attention to blood sugar levels and maintain good control, says Loren Wissner Greene, MD, an endocrinologist at NYU Langone Medical Center in New York City and the author of The Unofficial Guide to Living with Diabetes. Women with type 2 diabetes should lose weight and get their blood sugars under control so they won't need to take oral medications during a pregnancy. "It's generally recommended that you not use any medications except ...