Pregnancy can be a beautiful time of life for women, but it may also be a time of confusion, anxiety and questions. Lots of questions. Your hormones are fluctuating, your body is morphing into part-incubator, and you’re constantly reminded of the hopeful, exhilarating, frightening realization that if all goes, you’ll be birthing a new life at the end of the process.
Being pregnant comes with unique challenges for women—and some of those challenges can be addressed by regular visits with your doctor (and team) to be sure that you’re gaining weight—not too much, not too little; engaging in some important practices (e.g., proper diet including vitamin supplements, regular exercise, plenty of sleep, etc.); and conducting routine tests along the journey to motherhood—all to help keep you and your baby-to-be healthy.
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It’s the testing during pregnancy that we’ll be addressing in today’s blog—specifically the importance of getting your blood glucose levels tested.
Testing Helps with a Healthy Pregnancy
Your pregnancy journey usually starts with a test that “officially” tells you that you’re pregnant. From there, you’ll be tested throughout your pregnancy with routine blood work (e.g., to test for anemia, white blood cell counts, platelets for blood clotting, blood type and Rh factor), urinalysis (e.g., urinary tract infection, glucose levels), and to check for specific diseases (e.g., hepatitis B and C, sexually transmitted infections, rubella, etc.).
There is the option for screening and diagnostic tests for potential birth defects (e.g., spinabifida, chromosome disorders or abnormalities) and you can discuss these options with your OBGYN and/or a genetic counselor.
You should also be screened for B streptococcus (GBS)—a bacteria that can cause serious infection in some newborn babies—and a glucose screening test for gestational diabetes, a potential problem during pregnancy.
Does Blood Sugar Rise When Pregnant?
But it’s the blood glucose (also known as blood sugar) levels that we’re addressing in today’s blog because if your glucose levels are too high, or even too low, during pregnancy, it can cause problems for the pregnant woman and potentially for the fetus.
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There are reasons why your blood sugar levels may rise during pregnancy. According to this post, especially late in your pregnancy, your hormones (specifically estrogen, cortisol and human placental lactogen), my create insulin resistance, not allowing glucose into your body’s cells where it’s needed. And that’s not a good thing.
This can lead to higher levels of blood glucose that could signal issues for the pregnant woman—diabetes or gestational diabetes—and for the unborn child.
Can Pregnancy Cause Blood Sugar to Drop?
On the other hand, many women experience the opposite during pregnancy: low blood sugar. For the mother-to-be, low blood sugar can cause anxiety, heart palpitations, sweating, light headedness and nausea. And when the pregnant woman has health issues, those problems could impact the fetus.
Some women experience both the highs and the lows at different points in their pregnancies, or different points in their day. Low blood sugar may actually be caused by unmanaged, or improperly managed, diabetes. And because pregnancy impacts the way our bodies process sugar, blood glucose testing becomes extremely important for pregnant women.
What if You Already Have Diabetes and are Pregnant?
Let’s start by talking about those women who already have diabetes (also known as diabetes mellitus) before becoming pregnant. Hopefully, if you have diabetes (either Type 1, where your body can’t make its own insulin; or Type 2, where your body doesn’t use its own insulin properly), you are already aware of it and working hard to keep your blood glucose levels in the appropriate target range.
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Unfortunately, 13.1 million women in the U.S. have diabetes and it is estimated that 4.9 million have undiagnosed diabetes. That’s not even counting those in the pre-diabetes range, a condition which could progress to diabetes if left unmanaged.
If you are a woman of child-bearing age, and especially if you are hoping to get pregnant, it’s important to know ahead of time if you are at risk, or have, diabetes. The best way to do this is to talk with your doctor and get tested.
What Happens if Glucose Levels are High?
Here’s why it’s important for women to know, if possible before they get pregnant, if they have diabetes or pre-diabetes: high glucose levels beginning with the first eight weeks of pregnancy—the time when a fetus’ organs start to develop—can cause damage to your baby-to-be. During this time period, if your blood glucose is not kept in check, it may increase the chances of birth defects to the brain, the spine and the heart.
Here’s another thing to be concerned about. High blood sugar levels during your pregnancy may increase the risk of an early birth or a miscarriage or a stillborn baby.
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As this article advises, pregnancy may also impact the way you manage your diabetes. That’s because the changes in your pregnant body—from hormones to added weight—may also change your blood glucose levels. You may need to switch up your meal routine, your physical activity and possibly even switch from oral medications to manage diabetes to insulin. It’s important to be aware of these things, because being pregnant can exasperate health issues associated with long-term diabetes, including eye conditions or kidney disease.
The article also explains that during pregnancy, those with diabetes have an increased risk of experiencing preeclampsia, which can be life-threatening to you and to your baby-to-be.
Tips for Managing Blood Sugar Levels Pre-Pregnancy, For Pregnant
But if you’ve been managing your diabetes before your pregnancy, you understand the importance of managing it during (and after). Here are some tips from the National Institute of Diabetes and Digestive and Kidney Diseases for women with diabetes who are hoping to get pregnant or who are pregnant:
- Get regular check-ups even before your pregnancy
- Work with a team of healthcare practitioners who have experience in diabetes care, including: an OBGYN, an endocrinologist, a diabetes educator, a nurse practitioner, and a registered dietitian. (And if you need a social worker or psychologist during this time period, don’t hesitate to get help.)
- Don’t smoke!
- Be physically active and open to switching your routine to activities that may be more appropriate during pregnancy.
- Target blood glucose levels. These targets may change during pregnancy. Work with your medical team.
- Test your blood glucose levels. How often you do this, or whether you start doing it, may change during pregnancy.
- Test your A1C numbers. Prior to pregnancy, your target was ideally below 6.5%. During pregnancy, that target may shift even lower. Ask your healthcare practitioners for best advice.
- Take vitamins as recommended by your medical experts.
If you’re fortunate enough not to have diabetes going into your pregnancy, you’re still not completely out of the woods yet. Many of the above tips are just as important for pregnant women without diabetes—that’s because there is a type of diabetes that is specifically associated with pregnancy. It’s known as gestational diabetes and it develops in pregnant women who have never had diabetes, according to the Centers for Disease Control and Prevention (CDC).
What is Gestational Diabetes?
When you’re carrying a baby-to-be, there are extra demands on your pregnant body. And when you can’t properly produce and use your body’s insulin during pregnancy, your blood glucose levels may be consistently too high. That’s what’s known as gestational diabetes. According to the American Diabetes Association (ADA), “nearly 10% of pregnancies in the U.S. are affected by gestational diabetes every year.”
And not only is gestational diabetes a concern for the pregnant woman, but it also leads to complications for the fetus. For example, there may be complications during labor, and once born, your baby may experience breathing problems, low blood sugar, and a high birth weight if gestational diabetes is not properly managed during the pregnancy. In addition, having gestational diabetes may increase the risk of your child developing diabetes.
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Certain populations of pregnant women may be at greater risk for developing gestational diabetes. According to this article, age, weight and family history play a factor in gestational diabetes:
- Getting pregnant after the age of 25 years increases the risk.
- If you are overweight or have a body mass index (BMI) of 25 or higher, you’re at greater risk.
- African American, Native American, Asian American, Hispanic American and Pacific Island women are more likely to develop gestational diabetes.
- If someone in your family has type 1, type 2 or gestational diabetes it raises your risk.
- Having gestational diabetes during one pregnancy, makes it more likely that you’ll encounter it again in future pregnancies.
- If you have prediabetes going into, or during your pregnancy, be vigilant as it could turn into gestational diabetes.
If you develop gestational diabetes, your risk of developing type 2 diabetes increases 7-fold. On the other hand, for many women, gestational diabetes, when properly managed, is not permanent and your blood sugar levels should return to normal following a postpartum period.
Your doctor should test you for gestational diabetes, generally around 24 to 28 weeks of your pregnancy. If have risk factors, he or she may test earlier. While it’s normal for your blood sugar to rise during your pregnancy, the concern occurs when those levels remain too high.
What Tests Will Doctors Use to Measure Blood Sugar Levels During Pregnancy
This in-lab test is a 2-hour glucose tolerance test. You will need to fast prior to the test (your doctor will give you specific fasting instructions). You will drink a liquid with 75 grams of glucose. Your blood will be drawn prior to drinking and then, following drinking, at the one-hour mark and the two-hour mark.
If one of your blood sugar test results is higher than normal, your doctor may suggest that your change your diet, then take the test again. However, if more than one of the blood sugar tests is higher than normal, you have gestational diabetes.
Normal results for this test are as follows:
- Fasting: equal or less than 92 mg/dL (5.1 mmol/L)
- 1 hour: equal or less than 180 mg/dL (10.0 mmol/L)
- 2 hour: equal or less than 153 mg/dL (8.5 mmol/L)
Your doctor will likely start with a glucose screening test to determine your blood glucose levels. There is no prior preparation involved and no change in diet needed. You’ll be given a liquid drink with glucose, and your blood levels will be checked an hour afterwards.
If your blood sugar levels are equal to or below 140 mg/dL (7.8 mmol/L) you do not have gestational diabetes. If they are above those numbers, your doctor will ask you to return for a glucose tolerance test.
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For the glucose tolerance test, you will be asked to fast overnight and first have your blood drawn to determine your blood fasting level. You’ll then drink a liquid glucose (100 grams) drink. Your blood sugar levels will be checked at 1-hour, 2- hour and 3-hour intervals.
Abnormal blood values for the 3-hour (100 gram) glucose tolerance test are:
- Fasting: greater than 95 mg/dL (5.3 mmol/L)
- 1 hour: greater than 180 mg/dL (10.0 mmol/L)
- 2 hour: greater than 155 mg/dL (8.6 mmol/L)
- 3 hour: greater than 140 mg/dL (7.8 mmol/L)
This informative article goes into more depth about testing for gestational diabetes.
A1c or HbA1c testing
The ideal time to first take this test is prior to pregnancy. According to the ADA, if your A1c is 10 percent or higher, your risk for having a baby with heart, kidney, brain or spinal cord defect increases. Taking this test early—and every three months or so—gives you a good reason to get your blood sugar in normal range. Learn more about OmegaQuant’s HbA1c test here.
Managing Diabetes and Gestational Diabetes During Pregnancy
Whether you already have diabetes prior to pregnancy or develop gestational diabetes during pregnancy, don’t despair. Work with your healthcare team to develop a plan that will work for you to help manage your diabetes. Although the plan should be specific to your own circumstances, it will generally include these steps:
- Limit the amount of simple carbohydrates and added sugar in your diet.
- Exercise regularly.
- Take steps to reduce stress.
- Get plenty of sleep.
- Monitor and test your blood glucose levels regularly.
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