Ensuring a Safe Pregnancy and Delivery

The Big Diabetes Lie

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Tight control in pregnancy means achieving a blood glucose level that is as close to normal as possible using insulin, diet, and exercise, just as in the person with T1DM who is not pregnant.

A study in Diabetes Care in August 2001 showed that a normal pregnant woman without diabetes will have a blood glucose of between 55 mg/dl and 105 mg/dl one hour after meals from the 28th to the 38th week. The study also measured the abdominal circumference of the fetus by ultrasound and found that the higher the one-hour glucose, the larger the abdominal circumference.

More recently, a study that has not yet been published was reported at the Scientific Meetings of the American Diabetes Association in June 2007. Called the Hyperglycemia and Adverse Pregnancy Outcome (HAPO) study, it showed that even pregnant women with no evidence of diabetes by glucose testing at the beginning of the study could develop complications similar to those in pregnant women with T1DM if their blood glucose rose above normal frequently during the pregnancy, even when they didn't reach the criteria for diabetes. High birth weights correlated with high blood glucose levels.

Tight control of type 1 diabetes in pregnancy means achieving a blood glucose level that's as close to normal as possible using insulin, diet, and exercise, just as in the person with T1DM who isn't pregnant. Pregnant women with no diabetes normally have blood glucose and hemoglobin A1c levels lower than non-pregnant women because the fetus takes so much of the glucose. The goal is to achieve these levels in the pregnant woman with diabetes.

Ideally, because macrosomia (see the earlier section "Risks to the baby" for more about this condition) is found when the one-hour blood glucose is consistently greater than 120 mg/dl, and normal pregnant women without diabetes have a hemoglobin A1c level up to 5 percent, the desirable levels are

1 Blood glucose less than 90 mg/dl before meals 1 Blood glucose less than 120 mg/dl at 1 hour 1 Hemoglobin A1c no greater than 5 percent

How do you achieve these goals? Read the following sections to find out.

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