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Preconception Planning with Diabetes

Brooke Marsal, MS, RD
6
September 2, 2021

Dreaming of the future and planning a family can be very exciting. Preconception planning, planning before pregnancy, helps to make sure that both you and your baby are healthy during and after pregnancy. This is especially important for women who have diabetes. 

Uncontrolled blood sugar levels for the mother increase the risk of diabetes-related complications and having a miscarriage. For the baby, it increases the risk of developing brain, spinal cord, and heart malformations. Luckily, we know more about diabetes management than ever before. Through working with your care team to manage your diabetes, you can have a safe and successful pregnancy. 

Putting Together a Care Team

The first step in preparing for pregnancy is to get connected with a care team. Tell your primary care physician that you are interested in starting a family and they will be able to help you connect with the following healthcare professionals:

  • A doctor trained and experienced in working with women who have diabetes 
  • An obstetrician, trained in high-risk pregnancies 
  • A pediatrician or neonatologist, who knows how to treat special problems that can occur in babies born to women with uncontrolled blood sugar
  • A registered dietitian
  • A diabetes educator
  • An ophthalmologist (eye doctor)

Although it seems tedious to meet with all these professionals, it’s important to do so before you start trying to get pregnant. Because the fetus’ brain, spinal cord, and heart start developing within the first few weeks of pregnancy, uncontrolled blood sugar at this time can impact the development of these organs. Your team can help to get your blood sugar under control before you get pregnant. 

Prenatal Medical Checklist

To best support both you and your baby, discuss the following items with your doctor during prenatal appointments:

1. Potential fetal and neonatal complications of uncontrolled blood sugar 

It is important to understand the risk of fetal and neonatal complications that may result from uncontrolled blood sugar levels. The better your blood sugar control, the less likely complications will occur! 

2. Diabetic complications during pregnancy

Uncontrolled blood sugar during pregnancy increases your risk of developing hypertension, including a particularly dangerous form of hypertension called preeclampsia. Preeclampsia is a condition when blood pressure gets so high during pregnancy that it damages the kidneys and liver. 

It also increases the risk of developing other diabetes-related complications including nephropathy, neuropathy, and cardiovascular disease. Speaking with your doctor before becoming pregnant will help have an understanding of your degree of risk. 

3. Getting all medical conditions under control (e.g. asthma, epilepsy, etc.)

Many medical conditions, if uncontrolled, will put you and your baby at risk during pregnancy. Make sure your doctor is aware of all medical conditions and work with them to get everything as well under control as possible before conceiving.

4. Ensuring your medications are safe for use during pregnancy

Your doctor may change your medications to ones that are safer to use during pregnancy. For example, your doctor will likely switch you to insulin as opposed to oral diabetes medications. Insulin is very safe to use during pregnancy, but the research is not clear on the safety of most oral medications. 

5. Screening for sexually transmitted infections and diseases 

Getting Nutrition Right 

Do’s and Don’ts

There are a few big do’s and don’ts when it comes to what you put in your body when trying to conceive and during pregnancy. 

Do: Take a prenatal vitamin daily (this should include at least 400 mg of folic acid)

  • Prenatal vitamins contain important nutrients that support pregnancy including folic acid, iron, and omega-3s. Taking a prenatal vitamin is important to make sure that you are getting adequate nutrients to meet your own needs as well as for the development of your baby’s brain, spinal cord, eyes, and bones. 

Don’t: Smoke or drink alcohol

  • Both smoking and drinking increase the risk of preterm birth, low birth weight, birth defects, and sudden infant death syndrome (SIDS). Alcohol also increases the risk of the baby developing physical, behavioral, and intellectual disabilities. 

What to Eat

As long as you are taking a prenatal vitamin, your nutritional needs don’t change much before pregnancy. Focus on eating the following foods:

  • Fresh fruits and vegetables
  • Lean protein (e.g. chicken and lean beef)
  • Fish (selective list, see below which fish to NOT eat)
  • Whole grains 
  • Beans and legumes
  • Nuts and seeds
  • Low-fat dairy

We recommend filling ½ of your plate with veggies, ¼ with protein, and ¼  with carbohydrate-rich foods (e.g. grains, legumes, potatoes, and fruit). Feel free to customize your meal plan based on your own body’s tolerance to carbohydrates and the recommendations of your dietitian.

What NOT to Eat

  • Unpasteurized dairy (milk, cheese, etc.)
  • Hot dogs and luncheon meats (unless heated to steaming)
  • Raw and undercooked seafood, eggs, and meat (including sushi)
  • Refrigerated pâté and meat spreads
  • Refrigerated smoked seafood
  • High mercury fish (tuna or swordfish)

All of these foods greatly increase the risk of contracting foodborne illnesses which could seriously hurt your developing baby. Since many people don’t know they are pregnant until a few weeks after conception, it is best to avoid these if you are trying to conceive.

Ideal Blood Sugar Control

The following blood sugar goals are recommended by the American Diabetes Association for those trying to conceive. 

Fasting/ before meal: 60-99 mg/dL

2 Hours after a meal: 100-120 mg/dL

A1c Goals: <6%

Work closely with your doctor and dietitian to achieve the best blood sugar control without experiencing hypoglycemia (low blood sugar). While high blood sugar levels can be harmful, low blood sugar levels are even more damaging to you and your baby. The goal is to find the right medication regimen and dietary pattern that supports the lowest possible blood sugar level without causing hypoglycemic episodes. 

Takeaways 

Preconception planning is important, especially if you have diabetes. Before ditching your birth control, work with your care team to get your diabetes as under control as possible. This will make sure that your future child is protected from the potentially damaging effects of high blood sugar. It also ensures that you have established a healthy routine that can be carried with you through pregnancy.