Diabetes and Pregnancy: What Every Expecting Mom Should Know

Diabetes affects millions of women. While the disease is generally manageable with good lifestyle habits and medication when needed, diabetes can raise the risk of some health complications, such as high blood pressure and heart disease. For pregnant women with diabetes, these risks can be higher for both mom and baby. 

In this video, San Diego Health host Susan Taylor talks with Daniela Gomez, MD, an OB-GYN specializing in maternal and fetal medicine at Scripps Clinic, about how diabetes can affect pregnancy.

Diabetes during pregnancy is a concern for several reasons, especially if blood sugars are not well-managed. 

“For mom, there can be worsening of pre-existing conditions and needing medications, such as insulin during the pregnancy,” says Dr. Gomez. “There’s an increased risk of needing a C-section. For the baby, there can be increased risks of birth defects, of potentially needing to go to the neonatal intensive care unit (NICU), as well as other complications.”

Another potential complication of diabetes during pregnancy is having a large baby. If the mother’s blood sugars are high, the baby may grow too big and develop increased adipose tissue, otherwise known as fat, particularly around their shoulders. This can lead to a condition known as shoulder dystocia during delivery; the baby may become stuck, which is considered an emergency.

“There are also increased risks of miscarriages if blood sugars are elevated, particularly before getting pregnant and in the first trimester. If blood sugar is not well-controlled later in the pregnancy, there is increased risk of a stillbirth,” says Dr. Gomez.

High blood sugar also means potential complications for the baby. If sugars are very elevated around the time of delivery, the baby may make a lot of their own insulin. After delivery, their blood sugars will rapidly drop, resulting in neonatal hypoglycemia or low blood sugar. Another potential complication is decrease in the development of the fetal lungs, which can lead to respiratory distress syndrome after birth. Both conditions could require treatment in the NICU.

Additionally, high blood sugar levels may increase the baby’s risk of developing diabetes in the years ahead.

“Exposure to high sugar levels in the womb leads to an increased risk for metabolic disease,” says Dr. Gomez. “If we don’t control your blood sugars adequately, we are, in fact, increasing the risk for your child to have high blood pressure, diabetes or obesity in the future.”

Women with type 1 diabetes tend to have a slightly higher risk of complications than those with type 2 diabetes or gestational diabetes, which is diabetes that develops during pregnancy. However, many of the same risk factors apply to all three types; the risk level depends very much on the woman’s medical profile and how well her diabetes is managed.

That’s why it’s important to have a multidisciplinary team of providers with experience in caring for pregnant women with diabetes.

Along with a specialist in maternal and fetal health, this often includes an endocrinologist to help manage diabetes-related medication and thyroid issues, as well as a cardiologist to address high blood pressure and cardiac concerns. Some women may need a nephrologist to monitor pre-existing kidney disease or an ophthalmologist to screen for eye disease, both of which can be related to diabetes.

“At Scripps, each case is individualized based on the needs of the mom,” explains Dr. Gomez. “It is truly very important for all of us to work together as a team, to keep our mom healthy and to keep her baby healthy as well.”

Healthy pregnancies begin with a healthy mom. Any woman who is planning pregnancy should meet with her OB-GYN to talk about how best to prepare for pregnancy. For women with diabetes, it is especially important to also see an endocrinologist to ensure blood sugar levels are under control and review any medications that may not be safe during pregnancy.

“Preparation is key in this situation,” says Dr. Gomez. “All of us are here to help you, and our intent is for you to have a happy and healthy pregnancy.”