Will my baby be born with diabetes?
No. The infant will not have diabetes at birth and will not be expected to develop diabetes. Your baby does, however, have the same genes as you and therefore has a slightly increased risk of developing diabetes. If the father has diabetes, the risk for the infant is usually greater than if the mother has diabetes.
Will I automatically get a Caesarian-Section?
Not usually. In some women who have extensive eye disease so that the vessels are fragile, a C-section is recommended. However, for the usual diabetic patient, a vaginal delivery is suggested. As outlined above, however, if any complications arise during pregnancy, a C-section may be recommended. About 50-60% of women with diabetes have a C-section.
Can I breastfeed?
Absolutely yes and it is encouraged. Most women find that their diet is more easily managed if they breastfeed. It is also better for your baby. Bottle-feeding is fine, too, if breast-feeding does not work out for you.
What will happen to my eyes during the pregnancy?
Generally there is a risk of a slight deterioration to your eyes during pregnancy and the more damage there is at the start, the more likely there will be changes throughout the pregnancy. You should try and see an opthamologist during the pregnancy. There is a risk that the eyes may show changes up to a year after the baby is born, so the eye doctor should continue to check your eyes during the first year post-delivery.
What will happen to my kidneys during the pregnancy?
Normally your kidney function drops slightly but returns to normal after the baby is born. However, if you have significant kidney disease at the start, your kidneys may show some deterioration and will not revert to their pre-pregnancy state.
What will happen to any nerve damage I have during the pregnancy?
Generally this stays the same. Some women get tingling in the hand or carpal tunnel syndrome that improves after the birth.
Are analogue insulins safe?
The short acting insulins (insulin lyspro and aspart, Humalog and Novorapid in Canada) are considered safe. Studies (see Research -type 1, 25th Marcch 2011) are ongoing for the long acting analogue insulins (detemir and glargine, Levemir and Lantus in Canada). Neither of these two long acting analogues are officially approved for use in pregnancy in North America although both are used in Europe during pregnancy. That being said most just continue on the long acting insulin analogue.
What about insulin pumps?
Insulin pumps work well in pregnancy though they do not necessarily give better results than an intensive multiple daily insulin regimen. If the pump malfunctions there is a risk of diabetic ketoacidosis (DKA) developing in a short period of time which can be fatal for the fetus. Thus, if on a pump and the correction doses do not seem to be working, confirm the pump is functioning properly and use insulin by pen or needle in the interim to make sure the glucose comes down.
Should I test for ketones routinely?
Ketones are a sign of starvation: if the body senses it is starving it will break down body fat and these fats are converted into ketones that are tested for in the urine. Ketones should be specifically tested in two main situations.
If the glucose is uncontrolled in the mother because of a lack of insulin especially in the presence of infection, the body senses this as starvation because the energy can not get into the cells, breaks down fat, forms ketones which in excess will build up as diabetic ketoacidosis (DKA), a very serious situation for the mother and baby. Thus if the sugars start to rise unexplainedly as may happen if you have an infection, you should check your urine ketones and if positive take extra insulin and fluids. If the situation persists for more than three hours you should go to the emergency room or talk to your caregivers. In this setting if you start vomiting and can’t keep fluids down for more than an hour you need intravenous fluids at the hospital. Do not delay.
Pregnancy needs extra calories for both mother and to feed the growing fetus. If you are not gaining weight appropriately it is worthwhile checking the urine for ketones first thing in the morning and if positive it is a sign more calories are needed particularly at bedtime.
Outside these two times the testing for ketones once a week or so is reasonable.
Are lows bad for the baby?
Low blood sugars do not seem to harm the baby. Low sugars are more common in the first trimester but in later pregnancy as the mother is so resistant to insulin they are less of a problem. Animal studies suggest the hypoglycemia has to be very severe and very prolonged before any harm could come to the baby.
As a general guide a fasting sugar below 3.5 mmol/l (63 mgs/dl), a one hour after meal value of 4.5 mmol/l (81 mgs/dl) or a two hour after meal value of 4.0 mmol/l (72 mgs/dl) would be considered low and if on therapy would prompt a reduction in the insulin.
Does the insulin go into the baby?
Insulin does not cross the placenta and thus will not harm the baby. The high glucose if left untreated crosses the placenta and can harm the baby. There are rare situations where antibodies to insulin can cross the placenta but the antibodies to the newer human insulins are usually very low and do not cause problems.
What about saving cord blood?
Whether having cord blood saved may be useful if new treatments with stem cells become available is unknown. One study using cells from cord blood did not achieve success. There are usually costs involved and if you have the money and like to cover all possibilities then you should look into what is available locally.
If you have any other questions, ask your health care team or physician. If any questions come to mind at home, write them out as you think of them so that you can remember everything you want to ask your providers.