Diabetes is a condition that affects

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Diabetes is a condition that affects the body's ability to use glucose, a form of sugar, for energy. In type 1 diabetes the body doesn’t produce enough insulin, a hormone used to convert glucose, or sugar, into fuel for the cells. Patients need regular injections of insulin to stay alive. Patients with type 2 diabetes either don't make enough insulin or are unable to effectively use insulin to get enough fuel to the cells. Type 2 can often be controlled with diet, exercise, medications and lifestyle changes.

According to the American Diabetes Association, about 23.6 million people in the U.S. have diabetes. Type 1 accounts for about 10 percent of all cases and is typically diagnosed in childhood or young adulthood. Type 2 accounts for about 90 percent of all cases of diabetes. In the past, it was mostly diagnosed in overweight, sedentary, middle-aged adults. However, doctors are seeing more cases of type 2 diabetes in overweight, sedentary children and teens.

Pregnancy in Women with Diabetes
In women with diabetes, pregnancy puts extra demands on the body and makes glucose control more difficult. Hypoglycemia (abnormally low glucose levels) is common, especially in the early stages of pregnancy. Women may experience anxiety, nausea, palpitations, tremor, confusion and dizziness.

Glucose in the mother’s blood freely crosses the placenta to the fetus. However, insulin doesn’t pass through as readily. Hyperglycemia (abnormally high glucose levels) in the mom leads to elevated levels of glucose in the fetus as well, causing the baby to gain excess weight. An overweight or unusually large baby can cause problems during labor and delivery. Hyperglycemia is also associated with an increased risk for congenital abnormalities, like heart defects, spinal defects, kidney problems and cleft lip. Excess glucose can lead to the development of a blood clot in the placenta, causing miscarriage or stillbirth. For the woman, elevated or uncontrolled glucose levels increases the risk for worsening of diabetes-related complications, like eye disease, kidney disease and heart problems.

Helping Pregnant Women
In the past, women with diabetes were typically told to avoid getting pregnant. In fact, before the availability of medicinal insulin, pregnancy in women with type 1 diabetes was associated with a 90 percent mortality rate for infants and 30 percent for the moms.

Jennifer Wyckoff, M.D., Endocrinologist at the University of Michigan, says today, there are many different types of insulin options and better ways to control and monitor blood glucose levels. And although the health risks are still higher for pregnant women with diabetes, the outcomes are greatly improved.

Wyckoff says female diabetics need to plan their pregnancies carefully. If glucose levels are under good control before pregnancy, it will be easier to maintain that control through the pregnancy and after delivery. Women should have a thorough health check up and screening for cholesterol, high blood pressure, thyroid disease and diabetes complications, like neuropathy, kidney disease and eye disease. Medications should also be evaluated because some diabetes drugs can be harmful to the fetus. Wyckoff recommends that women with diabetes see a maternal fetal medicine specialist, a type of high-risk OB/GYN who is trained in caring for women with higher-risk pregnancies.

During pregnancy, diabetic women need to monitor their blood sugar levels more frequently. As the fetus grows, hormones made by the placenta block the action of the mom’s insulin. Nutrition counseling may be needed to help a woman understand how to plan meals, exercise and continue to maintain tight control over glucose levels. A woman may also need more frequent medical check ups.

During labor, a woman’s insulin needs dramatically drop. Glucose monitoring is crucial during this period. Women become more insulin sensitive and may not require any insulin or diabetes medications for a few days after delivery. However, breast feeding can increase the risk for hypoglycemia. Wyckoff says it can take up to six months for blood sugar levels to return to pre-pregnancy levels.