Diabetes With Pregnancy

Before embarking on a discussion about caring for diabetes in pregnancy, we must differentiate between the different types.

For those that are already diagnosed with Type 1 or Type 2 diabetes BEFORE pregnancy, this is considered pre-existing diabetes, often called “diabetes in pregnancy.” It is NOT the same as gestational diabetes, which will be defined in a moment. Often, even for those women that are not previously diagnosed with diabetes BEFORE pregnancy, if they appear to be high risk (overweight, family history of diabetes, etc), a healthcare provider may choose to screen these women for undiagnosed diabetes on their first pre-natal visit. If diagnosed, this would also be considered pre-existing diabetes, or “diabetes in pregnancy.”

Gestational diabetes occurs later in pregnancy in women not previously diagnosed with diabetes. Screening for ALL women for GDM takes place at approximately 24-28 weeks through administration of an OGTT* (oral glucose tolerance test.)  GDM is associated with increased insulin resistance and decreased glucose tolerance during pregnancy. As these two elements are the cornerstone of Type 2 diabetes, those with GDM are at extremely high risk for later development of Type 2.

Regardless of the TYPE of diabetes, the “name of the game” in pregnancy is ABOVE ALL, normal blood glucose. This is recognized by every institution creating guidelines for the treatment of diabetic pregnancies. Why? Because elevated glucose in pregnancy can cause risks to the mother (including pre-eclampsia, eclampsia, as well as worsening retinopathy and nephropathy) and baby (including congenital malformations, large birth weight, and complications of delivery.) Babies born to mothers with uncontrolled diabetes (particularly Type 2 and GDM) are at higher risk of later development of obesity and diabetes.

So if the name of the game is NORMAL blood glucose, then why are HUGE loads of dietary carbohydrate being recommended to women who have increased insulin resistance and decreased ability to tolerate glucose (current recommendation is no less than 175g of carbs, which includes 6-8 servings of grains)? These women are often chastised when they are unable to maintain normal blood glucose when they are following the very (poor) dietary advice they have been given.  Then, these women are often threatened when they attempt to lower carbohydrates to achieve the very blood glucose levels they are being told to achieve.

While the following blood glucose levels are acknowledged by leading agencies to be those common in non-diabetic pregnancy:

Average daily glucose 82
Fasting and pre-meal glucose 69
1 hour post prandial 105
2 hour post prandial back to baseline
A1c 5.0

These are the targets recommended for women with pre-existing diabetes in pregnancy:

Average daily glucose <125
Fasting and pre-meal glucose 60-119
1 hour post prandial 100-149
2 hour post prandial <120
A1c 6.3

Once again, why?

Mothers with diabetes that are lowering carbohydrates to achieve the normal, non-diabetic targets above, are often told that the baby will be harmed without large loads of carbohydrates, as if the baby is directly eating the carbohydrates. The fact is, the baby gets its glucose from the mother’s blood stream. If a normal, non-diabetic mother has enough glucose in her blood at an average daily blood glucose of, for example, 82, then regardless of the carb intake, a diabetic mother with an average blood glucose of 82 has enough glucose in her blood to feed her baby. In other words, any glucose levels that are normal for non-diabetic women and their babies, are safe for diabetic women and their babies.

This is explained extremely well in this video by Dr. Richard Bernstein, the world’s leading diabetologist  HERE

His follow up video  HERE

This is also explained very well in these videos by Dr. Lois Jovanovic, a world leading expert on diabetes in pregnancy:

Pregnancy and Diabetes  HERE

Diabetes and Pregnancy  HERE

Audio Interview with Dr. Jovanovic  HERE

Therefore, those with diabetes that choose to pursue normal non-diabetic glucose targets BEFORE pregnancy, can continue to pursue normal non-diabetic glucose targets DURING pregnancy.

One of the reasons that high carbohydrate intake is suggested for pregnant women with pre-existing diabetes is the concern for hypoglycemia and the effect such could have on a growing baby.  This concern is genuine.  However, as has been explained many times throughout this page, hypoglycemia comes from the use of large doses of medication (insulin), which is necessary when eating large amounts of carbohydrates.  When carbohydrate intake is lowered, insulin needs are lowered as well, resulting in diminished episodes of hypoglycemia.

For women with GDM, normalizing blood glucose by more aggressive dietary modification is extremely beneficial, as it can lessen the chance of needing to take medication to control GDM. The chance of a person with GDM experiencing low blood glucose without any medication is pretty much non-existent…is no greater chance than any pregnant non-diabetic woman getting hypoglycemia.  Remember, GDM is HIGH blood glucose.  What causes LOW blood glucose is MEDICATION, not a healthy diet.  So women with GDM can treat aggressively with diet.

Women all over the world are achieving these blood glucose targets with a healthy, low carb, whole food approach, leading to normal healthy pregnancies for mother and baby.

Here is a collection of resources to help mother and baby be healthy during pregnancy courtesy of TypeOneGrit on Pinterest  HERE

For those wanting information on Keto during pregnancy, click HERE

It is important for young women with diabetes who are considering pregnancy to normalize blood glucose and A1c well before conceiving.  Women with or without diabetes should try to achieve normal weight before pregnancy, especially those with a family history of Type 2.  Above all, it is IMPERATIVE for women with pre-existing diabetes to be extremely knowledgeable about diabetes and pregnancy, preferably, as Dr. Jovanovic suggests, “knowing more than your doctor” about it.  Unfortunately, there are very few physicians that specialize in trying to achieve NORMAL glucose levels in diabetic pregnancies.  Many treat those with pre-existing diabetes and GDM the same, or those with Type 1 or Type 2 the same.  Only YOU can be your own advocate for your health.   This is important for EVERYONE in dealing with their healthcare, but extremely more so in diabetic pregnancies.

Wishing you and your baby health and happiness.

*Diagnosing GDM

1 Step OGTT
Patient must be at fasting state
Fasting BG goal: <92
75g of glucose load consumed quickly
One hour post glucose goal: <180
Two hour goal: <153

2 Step OGTT
50g glucose load at any time (does not have to be fasting)
Fasting BG goal: <95
1 hour post glucose goal: <140 (some use 135)

If this step “failed,” proceed with 100g glucose load at fasting
Fasting BG goal: <95
One hour post glucose goal: <180
Two hour goal: <155
Three hour goal: <140

Special note: in order to achieve an accurate OGTT, it is recommended that women consume 150g carbs for the three days prior to the OGTT.  Eating a low carb diet can cause a false “fail” of an OGTT if this amount of carbs is not eaten before the test.