Diabetes and Pregnancy: What You Need to Know

Introduction

Diabetes is a chronic disease that can affect women and men of childbearing age. If not well controlled, diabetes can affect fertility and reduce the chances of conceiving a child. Fortunately, you can improve your fertility and reduce the risk of pregnancy complications by taking simple steps before trying to conceive and following healthcare professionals' recommendations throughout your pregnancy.

Diabetes and fertility

Many people with diabetes have no difficulty conceiving. However, diabetes can affect fertility when it is not well controlled or when accompanied by another health problem. Here are a few examples:

• Menstrual disorders, such as irregular or absent periods, are more common in women with high blood sugar levels (hyperglycemia). These disorders are more prevalent in women who are very thin, which is more common with type 1 diabetes, and in women living with obesity, which is more common with type 2 diabetes. Better diabetes management or achieving a healthy weight can help regulate the menstrual cycle.
• Polycystic ovary syndrome (PCOS) is a hormonal disorder that affects how the ovaries mature and release eggs. Women living with obesity who have type 2 diabetes are more likely to have this condition. Treating PCOS and improving fertility may require weight loss and medication.
• Women with type 1 diabetes, as well as those diagnosed with type 2 diabetes at a younger age, are more likely to experience early menopause (before age 40), though this is uncommon. Early menopause can reduce the period of fertility by several years.

Men with diabetes may also have fertility problems.

• Poorly controlled diabetes can damage the blood vessels or nerves in the penis, which can lead to problems with erections or ejaculation.
• Men with diabetes are also at a higher risk for sperm abnormalities, such as a low sperm count, reduced motility, or an abnormal shape of the sperm.

Despite these potential issues, with proper care, many women and men with diabetes are able to conceive and have healthy children.

Planning is essential

It is always best to plan a pregnancy to ensure the right conditions are in place from conception. This is especially important for women with chronic conditions, such as diabetes, because the condition or its treatment can sometimes reduce the chances of conceiving or pose a risk to the fetus or mother.

For instance, women with diabetes who do not have their condition under control are at a higher risk of miscarriage, preeclampsia, and difficult or premature delivery. Their babies are at greater risk of birth defects, high birth weight, premature birth, jaundice, and stillbirth. However, improvements in diabetes treatment over the past few decades have greatly reduced these risks, and most women with diabetes have normal pregnancies and healthy babies.

Since pregnancy can occur earlier than expected, and fetal malformations are most likely to occur during the first few months of pregnancy, you should consult a healthcare professional at least three months before stopping contraception. This will give you time to undergo certain tests and take appropriate measures, if necessary.

For example, the following should be discussed before pregnancy occurs:

• Ensuring that diabetes and any other chronic health problems are well controlled.
• Ensuring that all medications used are safe during pregnancy.
• Screening for diabetes-related complications and diseases, such as hypertension, retinopathy, and nephropathy, as these can worsen rapidly during pregnancy.
• Weight gain during pregnancy and measures to limit it if necessary. For women living with obesity, weight loss before pregnancy is sometimes recommended. Any weight loss will have a positive impact on fertility and the risk of complications, although the ideal goal is to achieve a healthy weight.
• Use of alcohol, tobacco, cannabis, or illicit drugs.

Although this step may delay your plans to become pregnant, it is important not to overlook it, as it plays a key role in reducing the risk of pregnancy complications for both mother and baby.

Diabetes treatment during pregnancy

Blood sugar levels must be kept within a narrower range before and during pregnancy because hyperglycemia (high blood sugar) can be harmful to fetal development. The target is a glycated hemoglobin (HbA1c) level of 7.0% or less (6.5% or less when possible).

It is crucial to closely monitor blood sugar levels daily so treatment can be promptly adjusted if levels become too high or low. Insulin is the preferred treatment during pregnancy, even for women with type 2 diabetes who did not take it before becoming pregnant. Insulin is safe for the baby and can be quickly and easily adjusted to respond to changes in blood sugar levels.

Using a continuous glucose monitor makes daily blood sugar monitoring and treatment adjustments easier. This option is beneficial for pregnant women with both type 1 and type 2 diabetes. For women with type 1 diabetes, using an insulin pump to simplify insulin administration may also be considered.

Diabetes and pregnancy

Gestational diabetes is a condition in which a woman develops diabetes during pregnancy if she did not have it previously. It affects up to 20% of pregnant women. It typically appears late in pregnancy, around the end of the sixth month, after the baby's organs have formed. Therefore, it does not increase the risk of birth defects. However, babies born to women with gestational diabetes are sometimes larger, which can make delivery more difficult.

All pregnant women should be screened for gestational diabetes between the 24th and 28th weeks of pregnancy. During the screening, the woman drinks a sugar-rich liquid (glucose). Then, her blood sugar level is measured to see if her body can produce enough insulin naturally.

Proper management of diet (especially carbohydrates) and healthy lifestyle habits (sleep and physical activity) may be enough to manage gestational diabetes if it is diagnosed. However, some women will need insulin.

This type of diabetes usually disappears after childbirth. However, women who have had gestational diabetes are at greater risk of developing type 2 diabetes later in life. To reduce this risk, they should maintain healthy eating and lifestyle habits in the long term. Breastfeeding may also help.

Breastfeeding and the postpartum period

Although diabetes does not negatively impact the ability to breastfeed, it can cause blood sugar levels to become more unstable, particularly at night. Therefore, it is important to closely monitor blood sugar levels so that treatment can be adjusted as needed. For women with type 1 diabetes, it may take longer to establish milk production, though this usually has no further consequences.

During the weeks following childbirth, hormones gradually return to normal. For women with type 2 diabetes, it is usually possible to stop taking insulin and resume medications that were discontinued before pregnancy.

Caring for a newborn baby requires a lot of energy. However, it is important to maintain the healthy eating and lifestyle habits established during pregnancy because they help prevent or delay certain diabetes-related complications, such as eye, nerve, or kidney damage. New mothers should not hesitate to ask their partners, families, or friends for help so they can take the time they need to care for themselves.

Pharmacists: your allies before, during, and after pregnancy

Your pharmacist can provide valuable assistance before, during, and after pregnancy to help you manage your diabetes effectively.

Before

• They can conduct a comprehensive review of all your medications and other products you use, such as natural health products, vitamins, and supplements, to identify which ones you must avoid during pregnancy and breastfeeding. They can also recommend alternatives when necessary.
• They can verify whether you are meeting your treatment targets for diabetes and other chronic health conditions (e.g., hypertension) and create a plan to help you achieve them.
• They can recommend a folic acid supplement (or a multivitamin designed for pregnant women) to reduce the risk of brain and spine abnormalities (e.g., spina bifida) in the baby.
• They can teach you how to use a continuous glucose monitor, ensuring the results are reliable, and how to use them to correctly adjust your insulin dose.

During

• They can teach women who did not take insulin before pregnancy how to administer and adjust their insulin doses.
• They can verify that your basic vaccinations, particularly for pertussis, are up to date and recommend appropriate vaccines (e.g., flu, respiratory syncytial virus).
• They can also recommend treatments for common pregnancy symptoms, such as nausea, heartburn, and constipation.

After

• They can offer advice and support to women who wish to breastfeed (e.g., breast pumps).
• If you have stopped taking medication during your pregnancy, they can determine when it is appropriate to resume taking it.

Throughout pregnancy, pharmacists can also offer their professional advice on weight management, smoking cessation, and healthy lifestyle habits to support you during this period of physiological and emotional change.

Are you living with diabetes and hoping to conceive? Make an appointment with your pharmacist today! They will advise and support you in this important endeavour.