Diabetes in Pregnancy: Managing Sugar Levels for Safe Outcomes

A coordinated treatment program for women with preexisting or pregnancy-related diabetes is giving moms peace of mind and babies a healthy start in life. Managing diabetes during pregnancy can be overwhelming but having the right support matters. Lehigh Valley Health Network, part of Jefferson Health, offers the Diabetes in Pregnancy Program (DIPP) which provides care for women with gestational diabetes and the Comprehensive Diabetes in Pregnancy Program (CDIPP), giving women the specialty care needed to manage pregnancy complicated by type 1 or type 2 diabetes.

“Women with type 1 or type 2 diabetes mellitus [pregestational diabetes] who become pregnant, or who are diagnosed with diabetes mellitus during pregnancy, have a higher risk for certain complications, both for themselves and their babies,” says endocrinologist Sharmila Koshy, MD. “The good news is that many of these risks can be lowered with good blood sugar (blood glucose) control and routine medical care.” 

Gestational diabetes mellitus is a type of diabetes that develops during pregnancy. The risk factors for gestational diabetes mellitus include obesity, a family history of type 2 diabetes, conditions such as polycystic ovary syndrome or prediabetes and a history of diabetes in a previous pregnancy. 

According to the World Health Organization, gestational diabetes mellitus occurs in 21 million women annually – and that's about one for every six births. High-risk women are screened in the first trimester, while others will be screened between 24-28 weeks. Some women don’t realize they have diabetes until they are diagnosed while pregnant.

Women who have had diabetes for many years before their pregnancy, or who have other health concerns – like high blood pressure, kidney or eye problems – may require closer monitoring during pregnancy.

Planning ahead is important. Preconception counseling helps women with pregestational diabetes understand their glucose goals before becoming pregnant. Good blood sugar control before and during pregnancy improves outcomes for both mom and baby.

Without careful management, diabetes in pregnancy can increase the risk of high blood pressure in pregnancy (preeclampsia), delivery complications, birth injuries, larger than average babies, early delivery and Cesarean delivery. 

Babies may also experience short-term challenges such as low blood glucose, difficulty maintaining temperature, feeding difficulty, jaundice and respiratory distress requiring care in the neonatal intensive care unit (NICU).

Christine Dennis is a certified registered nurse practitioner with LVPG–Maternal Fetal Medicine. “If their diabetes is well managed, moms with diabetes can absolutely have a healthy pregnancy,” she says. “Technology that was made available in the last few years has made glucose monitoring simpler and improves communication between patients and their clinicians.” 

Continuous glucose monitors and remote patient monitoring tools allow the care team to track blood glucose trends closely and make timely medication adjustments. 

Caring for pregnant women with diabetes involves a flexible team approach that may consist of a maternal fetal medicine (MFM) clinician, an endocrinologist, a dietitian, a diabetes educator, an obstetrician, specially trained nurses and counselors. 

Telehealth has now become an important part of diabetes care in pregnancy, and when combined with in-person care has been shown to improve outcomes. Specialists used to work all in one location, but today team members in different locations can work together with video visit technology.

If you have type 1 or type 2 diabetes before becoming pregnant, also known as pregestational diabetes, the team will coordinate your care to help ensure you and your baby stay healthy. 

Here’s what you need to know about preexisting diabetes in pregnancy:

• MFM specialists, an endocrinologist and other members of the care team will coordinate your care jointly through the (CDIPP).
• You will receive diabetes education and nutritional counseling from a registered dietitian who specializes in pregnancy nutrition.
• Pre-pregnancy counseling is available and can help you understand the risks and treatment requirements before you become pregnant.
• Some diabetes medications aren’t safe during pregnancy. You may need to transition to insulin or have your medication adjusted to maintain tight control.
• You may need increased insulin as your pregnancy progresses.
• Continuous blood glucose monitors make it easier to monitor blood sugars.
• Insulin pumps may be used in appropriate patients.
• Consistent control of blood sugar before and during pregnancy can help lower the risks of health complications in mom and baby.

If you develop diabetes during pregnancy, also known as gestational diabetes mellitus, your care team will work with you to help you learn about this new condition and how you can manage it while having a healthy pregnancy.

• MFM specialists, specially educated nurse practitioners and dietitians will work with you to control gestational diabetes through the Diabetes in Pregnancy Program (DIPP).
• You will receive diabetes education, a glucose monitoring device and nutritional counseling from a registered dietitian who specializes in pregnancy nutrition.
• A nurse practitioner will review your food logs and blood sugar results weekly to see how well your blood sugar is controlled and adjust the treatment plan as needed.
• About 50 percent of women will be able to manage gestational diabetes through diet management. The other half may need medication.

Consistent control of blood sugar before and during pregnancy can help lower the risks of health complications in mom and baby.

MFM has many subspecialty programs, including the DIPP and CDIPP programs. DIPP is available at all MFM locations and at Valley Health Partners (VHP) Center for Women’s Medicine. 

Women in CDIPP are seen by both MFM and endocrinology and have access to other MFM services such as ultrasound, dietary counseling by our registered dietitian, genetic counseling and fetal monitoring. CDIPP is available at LVPG Maternal Fetal Medicine–3900 Hamilton Blvd. in Allentown, Women’s Health Center at Tower Place and VHP Center for Women’s Medicine. And it can be offered virtually to women receiving care in other areas of the network.