What types of diabetes can happen in pregnancy?

When a baby is born to a mother with diabetes, the baby is at risk for problems.

People with diabetes have high levels of sugar in their blood (hyperglycemia). Over time, this can lead to serious health problems. Keeping your blood sugar under control lowers your risk for complications. You can manage diabetes by eating a healthy diet, getting regular exercise, and taking medicine.

Two types of diabetes can happen in pregnancy. These are:

• Gestational diabetes. In this condition, you don’t have diabetes before pregnancy. You develop it during pregnancy. This type of diabetes goes away after your baby is born.

• Pregestational diabetes. In this condition, you have diabetes before getting pregnant. You may have type 1 or type 2 diabetes.

  • People with type 1 diabetes don’t make insulin. Your body needs insulin to use blood sugar. You’ll need to take insulin shots.

  • People with type 2 diabetes can’t use the insulin they make. Or their bodies don’t make enough insulin. You’ll need blood sugar-lowering medicine and possibly insulin.  

It’s important to manage your blood sugar during pregnancy. This can lower your baby’s risk for problems.  

How can having diabetes during pregnancy be harmful to your baby?

In pregnancy, the placenta gives a growing baby nutrients and water. It also makes hormones you need for healthy pregnancy. Some of these hormones can block insulin. This often starts at 20 to 24 weeks of pregnancy. 

As the placenta grows, it makes more of these hormones. This means that the pancreas must make more insulin. Normally, the pancreas is able to make enough insulin. If it doesn’t, gestational diabetes occurs.  

Pregnancy may also change the insulin needs of a woman who already has diabetes. If you have type 1 diabetes, you may need more insulin. If you have type 2 diabetes, you may need to start using insulin or you may need more insulin.

When you have diabetes, your baby is at risk for many problems. These issues can happen in pregnancy and after birth. The problems happen when your blood sugar isn’t controlled well.

Who is at risk for gestational diabetes?

The following factors increase your risk for gestational diabetes:

• Older than 25

• Overweight and obesity

• Gestational diabetes in past pregnancies

• Family history of diabetes

• Have given birth to a very large baby

• Have had a stillbirth

• Are African American, American Indian, Asian American, Hispanic, Latina, or Pacific Islander

What are the symptoms your baby may have?

During pregnancy, the following can happen to your baby:

• Birth (congenital) defects and miscarriage. These are more likely to occur in women who had diabetes before pregnancy.

• High blood sugar

• Low oxygen levels

• Low blood iron levels

• High blood pressure

• Enlarged heart

• Poor nervous system development

• Poor lung development

• Stillbirth

The following problems may happen to your baby after they are born:

• Large size (macrosomia). Big babies are more likely to get hurt during delivery. These include shoulder injuries.

• Low blood sugar (hypoglycemia)

• Low blood calcium

• Low blood iron

• High levels of red blood cells and thickened blood

• High levels of bilirubin from the breakdown of red blood cells

• Birth defects. Most affect the heart, blood vessels, brain, and spinal cord.

• Premature birth

• Enlarged heart

• Breathing problems

• Long-term problems. Babies born to mothers with diabetes are more likely to have diabetes and be obese later in life.

How is diabetes during pregnancy diagnosed?

Your healthcare provider will check you for diabetes during pregnancy.

If you have risk factors for type 2 diabetes, such as being overweight, your provider will check you early in pregnancy. Your provider may test you during your first checkup.  

Your healthcare provider will screen you for gestational diabetes between 24 and 28 weeks of pregnancy. This screening is done using an oral glucose tolerance test (OGTT). An OGTT checks a woman's blood sugar levels after she has sugar (glucose). You may have one of these tests:

• One-step test. After not eating (fasting), you’ll have 75 grams of glucose. Your healthcare provider will check your blood sugar after a set amount of time.

• Two-step test. You’ll have 50 grams of glucose (you don’t need to fast). Your healthcare provider will check your blood sugar after a set amount of time. If your blood sugar is high, you’ll do another OGTT with 100 grams of glucose.

How are pregnant women with diabetes and their babies treated?

During pregnancy, your healthcare provider will watch you and your baby closely. You may be treated by a specialist who cares for pregnant women with diabetes.

Controlling your blood sugar levels is a must. This is the best way to reduce your baby’s risks. You’ll likely need to do the following to care for your diabetes:

• Watch your blood sugar levels closely. Your healthcare provider may ask you to test your blood sugar at home.

• Take insulin as prescribed. Your dose of insulin may change during pregnancy.

• Watch your weight. Your healthcare provider may tell you to gain less weight if you’re overweight or obese.

Your baby’s treatment depends on how well you controlled your blood sugar during your pregnancy and during labor and delivery. Treatment will also depend on your child’s symptoms, age, and general health. It will also depend on how severe the condition is.

Can complications from gestational diabetes be prevented?

Caring for your diabetes well can lower your baby’s risks. Eating a healthy diet, testing your blood sugar, and taking insulin can help you care for your condition.

Having gestational diabetes raises your risk for diabetes later in life. If you had gestational diabetes, your healthcare provider will test you for diabetes after you give birth. This is often done 6 to 12 weeks after your baby is born. Your provider will continue to check you for diabetes because of your risk.

After birth, your child’s healthcare provider should also regularly check the baby for diabetes. An early diagnosis and treatment can lower their risk for problems.

Key points about diabetes during pregnancy: risks to the baby

• Two types of diabetes can happen in pregnancy. One is gestational diabetes and the other is pregestational diabetes.

• All women are screened for gestational diabetes. This is done between weeks 24 and 28 of pregnancy.  

• Having diabetes during pregnancy can harm your baby.

• Your baby’s treatment depends on how well you control your blood sugar in the last part of pregnancy and during labor and delivery.

• Controlling your blood sugar is the best way to reduce your baby’s risks.

Next steps

Tips to help you get the most from a visit to your child’s healthcare provider:

• Know the reason for the visit and what you want to happen.

• Before your visit, write down questions you want answered.

• At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you for your child.

• Know why a new medicine or treatment is prescribed and how it will help your child. Also know what the side effects are.

• Ask if your child’s condition can be treated in other ways.

• Know why a test or procedure is recommended and what the results could mean.

• Know what to expect if your child does not take the medicine or have the test or procedure.

• If your child has a follow-up appointment, write down the date, time, and purpose for that visit.

• Know how you can contact your child’s provider after office hours. This is important if your child becomes ill and you have questions or need advice.