One of the best kept secrets about pregnancy is that it is a sneak preview into your future health. Conditions that come on during pregnancy, such as diabetes and high blood pressure, often show up again later in life. Learning to manage these conditions when they first appear can help safeguard you and your baby during pregnancy and allow you stay healthy as you age.
In Mendocino County, one common condition, especially among people of color, is diabetes. Diabetes occurs when the body is unable to control the sugar in food properly and the sugar in the bloodstream becomes too high. This can be due to the body producing no insulin (type 1) or because the insulin it is making is inadequate (type 2). Both types are treatable. Type 1 diabetics take insulin. Type 2 diabetics can control their blood sugar with good nutrition and physical activity, but sometimes medications are also needed.
Diabetes is a condition that can lurk in the shadows for years, causing damage without obvious symptoms. Because we know this, as soon as we see a patient who is planning to get pregnant or who is newly pregnant, we do a blood-sugar test to see if she may have diabetes or pre-diabetes. If she does, we create a nutritional plan that balances protein, carbohydrates, and fats in her diet to ensure that the fetus has a healthy environment in which to develop. We also test blood-sugar levels during the third trimester, because pregnancy can bring on gestational diabetes.
Uncontrolled diabetes is never healthy, but during pregnancy it can be devastating. During the first trimester, uncontrolled diabetes can lead to birth defects, especially with the heart, as well as cause miscarriages. Later in the pregnancy, uncontrolled diabetes can lead to preeclampsia (high blood pressure), pre-term birth, babies that are so large they get stuck during vaginal deliveries, increase need for cesarean sections, or even cause fetal demise (death).
When a woman has diabetes during pregnancy, babies have to work harder to control their blood sugar in the womb. Although the baby does not have diabetes, once born their blood sugar can drop below safe levels and may require treatments like IVs, multiple blood draws, and a longer hospital stay for monitoring. It’s a very difficult way for babies to come into the world. When sugars are well controlled in pregnancy babies often do not have these problems after delivery.
People familiar with diabetes may think they know how to treat gestational diabetes, but the rules change when there’s a developing fetus involved. A popular diet for non-pregnant people with diabetes is the keto diet, which increases ketones, but ketones are dangerous to developing babies and not recommended with pregnancy.
Prenatal care is important for preventing or catching health problems with the mother and baby. If you are thinking of getting pregnant, make an appointment with your medical provider to discuss ways to become as healthy as you can. If you’re already pregnant, schedule an appointment with a medical provider as soon as possible. If you discover you have high blood sugar, small lifestyle changes can have enormous benefits. You do not need to cut all the yummy carbohydrates out of your diet and become an exercise zealot. Little things like adding a 15-minute walk to your day can improve not only your blood-sugar levels, but also your mood.
At Care for Her, we work with women who face many challenges, whether they be financial, social, or medical—and diabetes can make everything harder. There is a proven connection between diabetes and depression, so we also have counselors on staff who can work with patients who need extra support. We have nutritional counselors and financial counselors available to assist you.
As certified nurse midwives, we want every pregnant woman to have a safe and healthy experience. Starting or expanding a family can be such a joyous time. By working with a medical team that respects your needs and collaborates with you on your treatment plan, you are more likely to have a happy, healthy pregnancy and birth.
Dana Estevo and Devery Montano are certified nurse midwives at Care for Her, a service of MCHC Health Centers—a community-based and patient-directed organization that serves Mendocino and Lake Counties, providing comprehensive primary healthcare services as well as supportive services such as education and translation that promote access to healthcare. Learn more at mchcinc.org.