Navigating Pre-Conception Care With Diabetes

Lindsay Cohen, RDN

Credit: Mama-Betes

Thinking of adding a little one to your crew is such an exciting time, but if you’re navigating life with diabetes, you might have some extra stressors and worries on your mind as you plan for pregnancy. That’s where the importance of pre-conception care comes in. This article will guide you through the most crucial steps of pre-conception care, empowering you on your journey to a healthy pregnancy.

Why Pre-Conception Care is Important

For women living with diabetes, pre-conception care is a key first step in ensuring a healthy and successful pregnancy. Being proactive before becoming pregnant can significantly reduce potential risks.

Without tight blood sugar control during early pregnancy, the risks of complications such as birth defects, preeclampsia, macrosomia (large birth weight) and miscarriage may increase. The good news is that optimizing your blood sugar levels before you conceive dramatically reduces these risks.

Pre-conception care also allows you to find a health care team that you trust. You will work closely with this health care team throughout your pregnancy, so it is important that you are on the same page.

Your Pregnancy Care Team

A collaborative team of health care providers is needed for a successful pregnancy with diabetes. This team will likely include:

• Endocrinologist: You may already have an endocrinologist. Your endocrinologist will focus on helping you achieve optimal blood sugar control leading up to pregnancy. They will discuss hemoglobin A1c goals and help you adjust your medication regimen to reach these goals. If needed, they can also help you access technologies like continuous glucose monitors (CGMs) and insulin pumps. Some endocrinologists prefer to have you work directly with a maternal-fetal medicine (MFM) specialist for blood sugar control and insulin adjustments during pregnancy.
• Obstetrician/MFM specialist: An OB experienced with high-risk pregnancies or an MFM specialist will monitor your health and the baby’s development, collaborating closely with your endocrinologist. Many MFMs have registered dietitians or certified diabetes care and education specialists as part of the team in their office that you will work with regularly.
• Registered dietitian: A registered dietitian will help you develop a personalized nutrition plan that takes into account the timing and frequency of meals and snacks to maintain stable blood sugar levels. They will ensure that you include adequate nutrients crucial for pregnancy, like folic acid, iron, calcium and omega-3 fatty acids. They also help with strategies for healthy weight gain during pregnancy and can offer dietary advice to help with common pregnancy issues like nausea, constipation and heartburn.
• Certified diabetes care and education specialist (CDCES): A CDCES can provide education on all aspects of diabetes management, including monitoring, taking medications, being active, healthy eating, reducing risks, problem-solving and healthy coping, reinforcing the guidance you receive from your endocrinologist and dietitian. Some registered dietitians are also certified diabetes care and education specialists.

Key Pre-Conception Tests and Assessments

Before you conceive, your doctor will perform a thorough evaluation involving several key assessments to better understand your overall health status. This process often begins with a comprehensive medical history review, during which your doctor will ask you about your diabetes management, any existing complications, other health conditions you may have and all medications you are currently taking. Your vaccination status will be reviewed to ensure you are up to date on all recommended immunizations. Following this, your doctor will likely perform a physical exam.

Your doctor will likely want you to get an updated hemoglobin A1c test, which reflects your average blood sugar levels over the past three months. The target for conception is generally below 6.5%, or below 7.0% if you experience frequent hypoglycemia.

Blood and urine tests evaluating kidney function are typically conducted. Additionally, a dilated eye exam is recommended to screen for diabetic retinopathy. Thyroid function tests may also be performed. Depending on your medical history, a cardiovascular evaluation might be needed to assess your heart health.

Lifestyle Modifications for a Healthy Pregnancy With Diabetes

Making healthy lifestyle changes before becoming pregnant will significantly impact you and your future baby’s well-being. The following lifestyle modifications are recommended.

Nutrition

Aim to eat a balanced diet that includes plenty of fruits, vegetables, whole grains, lean protein and healthy fats.

Exercise

Incorporating regular physical activity into your routine can be beneficial for both your physical and mental health, as well as to prepare your body for the demands of pregnancy. Aim for a variety of activities such as strength training, yoga and endurance exercises (like walking or swimming).

Stress Management and Sleep

Getting plenty of sleep and managing stress should not be overlooked when you’re planning for a pregnancy, especially with diabetes. When well rested, your body can manage blood sugar levels more effectively.

Stress can impact your blood sugar, so finding healthy ways to cope with stress, such as exercise, yoga, meditation or spending time doing hobbies you enjoy can have a positive impact. A strong support network can also help you prepare for a healthy pregnancy with diabetes.

Medication or Supplement Adjustments

Review all of your medications (including prescription, over the counter and supplements) with your health care team. Some may need to be adjusted or discontinued for pregnancy safety. Always consult your doctor before you stop taking a medication.

If you are not already taking folic acid, it is recommended that you begin taking a daily supplement at least one to three months before conception to prevent neural tube defects.

Prioritizing pre-conception care is the most empowering step you can take when planning a pregnancy with diabetes. By working closely with your health care team and making lifestyle modifications before becoming pregnant, you are significantly improving your chances of a healthy and successful pregnancy.

Remember, even though you have diabetes, a healthy pregnancy and a thriving baby are absolutely within reach!