12 ways to manage diabetes during pregnancy

A close-up of a pregnant woman having her blood sugar/ glucose checked. (Jovanmandic)

A healthy pregnancy is a priority for every mother-to-be, but for women who have diabetes, including those who are diagnosed with gestational diabetes, their health care can become more complex.

Women with diabetes who are diagnosed prior to pregnancy have a higher risk for complications, including miscarriage and birth defects. As the pregnancy progresses, women with diabetes are at risk for high blood pressure, preeclampsia, eclampsia, preterm and prolonged labor, cesarean section and its associated complications.

Up to 9.2 percent of women have gestational diabetes, according to the Centers for Disease Control and Prevention (CDC), and for these women in particular, their babies have a higher risk for high birth weight and shoulder dystocia, a complication during delivery. Babies born with low blood sugar (hypoglycemia) will likely have to be in the NICU for a few days after birth.

The good news is that with a plan, healthy strategies and support, you can control your diabetes, have a healthy pregnancy, and deliver a healthy baby.

Follow these expert tips:

1.     See your doctor before you get pregnant.

If you have diabetes and plan to conceive, you should talk to your doctor to make sure your A1C levels are normal, talk about medication if it’s necessary or ask for a referral to a nutritionist. Women with Type 1 diabetes should ask their doctors about a kidney function test, a thyroid test and an eye exam because other conditions can worsen, said Dr. Lois Jovanovic, an endocrinologist and clinical professor of medicine at the Keck School of Medicine of the University of Southern California in Los Angeles.

2.      Lose weight.

One of the best ways to ensure you will have a healthy pregnancy is to make sure you start out at a normal weight. If your pregnancy was unplanned— 50 percent are— don’t despair.

“[Weight loss] can begin from the very day they discover they become pregnant,” said Dr. Jennifer Lang, a board-certified OB-GYN in Los Angeles and author of “The Whole 9 Months: A Week-By-Week Pregnancy Nutrition Guide with Recipes for a Healthy Start.”

Eat a primarily plant-based diet, avoid excessive added sugars, preservatives, processed foods, and those high in saturated fats.

3.      Move more.

Exercise will help you metabolize food better, control blood glucose and help you control your weight during and after pregnancy, said Marina Chaparro, a spokesperson for the Academy of Nutrition and Dietetics (AND) and a certified diabetes educator in Miami who has Type 1 diabetes and recently gave birth to her first child. The CDC recommends pregnant women get 150 minutes of moderate-intensity aerobic activity every week.

4.      Count carbs.

When planning your meals, know how many carbohydrates are in each food and limit the amount you eat because it will raise your blood sugar. This is especially important if you have Type 1 diabetes because you have to dose insulin based on carbohydrates, Chaparro said.

5.      Load up on veggies.

Vegetables are filled with phytonutrients and fill-you-up fiber, plus they aid digestion and prevent excess weight gain. They also are low calorie and low in carbohydrates so they won’t affect your blood sugar. Non-starchy vegetables like lettuce, carrots, cucumber and broccoli are all good choices.

6.      Cope with morning sickness.

Make sure you eat every two to three hours during the day to keep nausea at bay. If you take insulin or pills, eat a few saltine crackers before getting out of bed in the morning and then take your medication to make sure you can keep food down, Chaparro said.

A small source of fast-acting carbohydrates such as glucose tablets, honey, or juice can help if your blood glucose levels are low. Then have breakfast that includes a healthy protein source like eggs or plain Greek yogurt.

7.      Deal with food aversions.

If the thought of vegetables makes your stomach turn— especially in the first trimester— try a fresh green vegetable juice, which is a good source of folate and calcium. This can control your appetite and prevent sugar cravings. Avoid juices with a lot of fruit because it can spike your blood sugar.

8. Watch what you drink.

It’s important to drink plenty of water to stay hydrated during pregnancy. Be sure to avoid juice, soda, sports drinks and sweeteners in coffee and tea.

“Avoid these or substitute them with something that has no calories and no carbohydrates because that’s going to be the first source of raising blood sugar,” Chaparro said.

9.      Let yourself indulge.

It’s OK to enjoy a slice of pumpkin pie or holiday cookies, but take stock of the total amount of carbohydrates you’ll be eating with dessert and if you will need to compensate with medication. If you want dessert, consider having a salad instead of a sandwich as your meal, for example. Or ask for a sliver of pie instead of a large piece.

10.  Use technology.

Look for apps that help you log blood sugar, food or count carbs and sensors and continuous blood glucose monitors.

11.  Continue with care.

“My opinion is all gestational diabetes is undiagnosed Type 2 diabetes,” Jovanovic said.

In fact, studies show 35 to 60 percent of women with gestational diabetes will develop Type 2 diabetes within 5 to 10 years.

If you have gestational diabetes, it’s important to talk to your doctor about monitoring your blood glucose and making lifestyle changes after your pregnancy.

12.  Get support.

You might have misconceptions about diabetes, blame yourself or need advice. Seek out the help of a certified diabetes educator, a registered dietitian nutritionist who can help you create a realistic and delicious meal plan or a community of pregnant moms who have diabetes.

It’s important to realize that you will need a plan, make healthy lifestyle choices for you and your baby and seek out information. But stick with it, and you can have a healthy pregnancy and a healthy baby.