Obstetrical Diabetes Management

Frequently Asked Questions

1. What is diabetes and how does it affect pregnancy?
2. What is the difference between pre-gestational and gestational diabetes?
3. At one point should a woman be tested for diabetes during her pregnancy?
4. What is the recommended monitoring for diabetes during pregnancy?
5. What are the potential complications from diabetes during pregnancy?
6. What types of educational follow-up are available at home for patients with pre-gestational or gestational diabetes?

1. What is diabetes and how does it affect pregnancy?

Diabetes occurs when the pancreas does not manufacture enough insulin to convert glucose from foods eaten into energy. A high level of glucose (sugar) in the blood results in vascular and eventually heart diseases, among other chronic disorders.

During pregnancy, women need even more insulin because hormones prevent the body from using insulin properly. As a result, women with either pre-gestational or gestational diabetes need to be closely monitored throughout their pregnancies. High blood sugar levels can be toxic to infants and lead to serious medical complications for the mother and child during pregnancy and after birth.

2. What is the difference between pre-gestational and gestational diabetes?

Diabetes that develops in the mother before pregnancy is referred to as pre-gestational diabetes. Most of these women have Type 1 (insulin-dependent) diabetes, which means the mother’s body cannot produce any insulin. However, some may also have Type 2 (non-insulin dependent) diabetes, particularly if they are obese, which means their body does not produce enough insulin. Gestational diabetes occurs during pregnancy when a woman’s hormones fail to function properly and keep her body from producing enough insulin.

3. At one point should a woman be tested for diabetes during her pregnancy?

The American College of Obstetrics and Gynecology (ACOG) and the American Diabetes Association (ADA) recommend screening all pregnant women between 24 to 28 weeks of gestation. Early screening is recommended by 18 weeks of gestation for patients who show the following risk factors:

• Previous diabetes
• History of unexplained stillborn or miscarriage
• Family history of Type 2 diabetes
• Neonatal course complicated by hypoglycemia (low blood sugar)
• Classic signs and symptoms of diabetes
• Obesity
• Unusually large infants with blood sugar and respiratory medical problems

4. What is the recommended monitoring for diabetes during pregnancy?

• Blood glucose testing at least four times a day, including once in the morning and once after each meal
• Hemoglobin A1C tests as prescribed by physicians to review the long-term average of blood sugar over a period of time
• Urine testing for ketones, which are toxins produced when cells start converting fat instead of glucose because of an insulin shortage

5. What are the potential complications from diabetes during pregnancy?

Elevated blood glucose levels during the first trimester can lead to birth defects. Also, elevated levels in the second and third trimesters are more likely to result in babies born much too large (up to 14 pounds) from ingesting too much sugar from the mother. As a result, they experience their own blood sugar and respiratory problems after birth. They also can produce too much insulin after birth, which leads to a myriad of respiratory, blood sugar management and other complications.

6. What types of educational follow-up are available at home for patients with a diagnosis of pre-gestational or gestational diabetes?

There are three service levels offered by Matria:

• Standard Level
• Daily Insulin Injection Level
• Continuous Subcutaneous Insulin Infusion Level