Diabetes During Pregnancy

Diabetes and thyroid disease are the two major endocrine issues women face during pregnancy. Froedtert & the Medical College of Wisconsin endocrinologists are experts at diagnosing and treating hormonal problems before, during and after pregnancy to optimize the health of mother and baby.

The Endocrine Disorders in Pregnancy Clinic, based at Froedtert Hospital, provides high-level consultation for pregnant women with type 1, type 2 and gestational diabetes as well as other endocrine disorders such as pituitary tumors, thyroid disease and congenital adrenal hyperplasia.

Pregnant women with endocrine disorders receive a treatment plan aimed at balancing blood sugars, nutrition, exercise and hormone levels. Froedtert & the Medical College of Wisconsin endocrinologists work with patients' perinatologists and obstetrician/gynecologists to manage the health of the woman and her baby.

Pre-gestational Diabetes (Type 1 or Type 2 Diabetes)

Keeping blood glucose levels as close to normal as possible before getting pregnant, as well as during pregnancy, is very important for the health of a woman and her baby.

Poorly controlled diabetes can cause malformations to a developing fetus. These typically occur before the seventh week of gestation. Research has shown that when women with diabetes keep blood glucose levels under control before and during pregnancy, the risk of birth defects is about the same as in babies born to women who don’t have diabetes.

It’s important for a diabetic woman to plan her pregnancy, with care beginning before she conceives. All of our female patients receive extensive pregnancy counseling, starting at age 18, even if a woman may not be considering having children for many years. Counseling is provided by physicians, nurses and dietitians who are certified diabetes educators. They work closely with each woman’s obstetrician/gynecologist.

Women are screened for possible complications of diabetes, such as retinopathy, nerve damage and kidney damage that can make pregnancy more risky for the woman and baby. Their blood glucose is strictly monitored during biweekly visits to the Endocrine Disorders in Pregnancy Clinic. When at home, they check their blood sugar a minimum of seven times a day to ensure it falls within determined limits.

Women’s spouses or partners are encouraged to join them during clinic visits. They play an important role in supporting and encouraging women during pregnancy and understanding what they need to manage their diabetes. A woman may be at risk for hypoglycemia during pregnancy, and her spouse/partner needs to recognize the signs and know how to treat them.

There are predictable changes in insulin needs throughout pregnancy. Immediately after giving birth, a woman’s insulin need drops. Clinic staff teach women about reducing their insulin doses during this time, and monitor each woman’s diabetes control for several months after giving birth. There are also special considerations for breastfeeding, which requires an adjustment in the mother’s diet and possibly an adjustment in insulin dosages. Frequent monitoring of blood sugar levels is necessary during the time a woman is breastfeeding.

Gestational Diabetes

About 4 percent of pregnant women develop gestational diabetes, which may be diagnosed at any time during pregnancy.

During weeks 23 to 28 of pregnancy, a screening test is done to check for the presence of gestational diabetes. This is usually performed at a routine obstetric office visit and measures a woman’s blood glucose one hour after she drinks a sweet-tasting liquid containing glucose. If the woman’s blood glucose is higher than 140 mg/dL, she is asked to return on another day soon after for a formal three-hour oral glucose tolerance test (OGTT). This test involves drinking more glucose solution and checking blood glucose levels at intervals of one, two, and three hours later.

The OGTT is performed in the endocrinology clinic at Froedtert Hospital. A nurse checks the blood glucose levels immediately. If at least two of the four glucose values are abnormal, this indicates gestational diabetes. The patient will meet that same day with a diabetes nurse educator and she will be provided with a blood glucose monitoring device. She will also meet with a dietitian for extensive counseling on medical nutritional therapy.

Nutrition and diet play an important role in helping people with diabetes manage their health. Proper diet and nutrition can help prevent and reduce complications for the mother and baby. This includes an initial assessment of nutrition and lifestyle, nutrition counseling (especially carbohydrate control), information on managing lifestyle factors that affect diet, and follow-up visits to monitor progress.

If a woman with gestational diabetes is unable to control her diabetes with diet, she will need insulin injections or, in some cases, oral medications that stimulate the pancreas to release more insulin. Daily blood glucose monitoring is needed, along with regular visits to the clinic for monitoring.

About six weeks after giving birth, another oral glucose tolerance test may be done to verify that the woman had true gestational diabetes, and not undiagnosed type 2 diabetes that requires ongoing treatment.