What You Should Know About Pregestational Diabetes

Medically reviewed by Debra Sullivan, PhD, MSN, CNE, COI on May 3, 2016Written by Ann Pietrangelo on May 3, 2016

Understanding pregestational diabetes

Pregestational diabetes occurs when you have insulin-dependent diabetes before becoming pregnant. Pregestational diabetes has seven classes that depend on your age at diagnosis and certain complications of the disease.

For example, your diabetes is class C if you developed it between the ages of 10 and 19. Your diabetes is also class C if you’ve had the disease for 10 to 19 years and you have no vascular complications.

Having diabetes when you’re pregnant increases some risks for both you and your baby. The class of diabetes that you have tells your doctor about the severity of your diabetes. If you have diabetes, your pregnancy will need extra monitoring.

Symptoms of diabetes

The symptoms of diabetes include:

  • excessive thirst and hunger
  • frequent urination
  • changes in weight
  • blurry vision
  • extreme fatigue

Pregnancy can also cause symptoms such as frequent urination and fatigue. It’s important to monitor your glucose levels closely to help you and your doctor determine the reason for these symptoms.

Your symptoms will have a lot to do with how well-controlled your diabetes is and how your pregnancy is progressing.

Causes and risk factors for diabetes

The pancreas produces insulin. Insulin helps your body:

  • use glucose, or sugar, and other nutrients from food
  • store fat
  • build up protein

If your body doesn’t produce insulin or produces it inefficiently, then your blood glucose levels will be higher than normal and affect how your body functions.

Type 1 diabetes occurs when your pancreas is unable to produce insulin. It can happen when your immune system mistakenly attacks your pancreas. It can also happen for unknown reasons. Researchers aren’t sure why people develop type 1 diabetes. You’re more likely to develop type 1 diabetes if you have a family history of the disease. People who have type 1 diabetes usually receive the diagnosis during childhood.

Type 2 diabetes is more common than type 1 diabetes. It begins with insulin resistance. It means your body doesn’t use insulin properly or it no longer produces enough insulin. Being overweight or having a family history of the disease increases your risk of getting type 2 diabetes. Having a poor diet and being physically inactive may also increase your risk of getting type 2 diabetes.

Diagnosing diabetes

Your doctor will perform a series of random and fasting blood tests to help them make a diagnosis. Some women only develop diabetes during pregnancy. This is called gestational diabetes. Doctors screen most pregnant women for diabetes as part of their prenatal care.

Other classes of diabetes

Classes of pregestational diabetes

The following are classes of pregestational diabetes:

  • You can control class A diabetes by diet alone. The onset may occur at any age.
  • Class B diabetes occurs if you developed diabetes after age 20, have had diabetes for less than 10 years, and you have no vascular complications.
  • Class C diabetes occurs if you developed it between the ages of 10 and 19. Your diabetes is also class C if you’ve had the disease for 10 to 19 years and you have no vascular complications.
  • Class D diabetes occurs if you develop diabetes before age 10, have had diabetes for more than 20 years, and you have vascular complications.
  • Class F diabetes occurs with nephropathy, which is a kidney disease.
  • Class R diabetes occurs with retinopathy, which is an eye disease.
  • Class T diabetes occurs in a woman who has had a kidney transplant.
  • Class H diabetes occurs with coronary artery disease or another heart disease.

Classes of gestational diabetes

If you didn’t have diabetes until you became pregnant, you have gestational diabetes. Gestational diabetes has two classes. You can control class A1 diabetes through your diet. If you have class A2 diabetes, you need insulin or oral medications to control it. Gestational diabetes is usually temporary, but it increases your risk of developing diabetes later in life.

Monitoring and treating pregestational diabetes

During your pregnancy, you’ll need extra monitoring for diabetes. It’s likely you’ll see your OB-GYN, endocrinologist, and perhaps a perinatologist. A perinatologist is a maternal-fetal medicine specialist.

A variety of methods are available to monitor and treat pregestational diabetes:

  • The first thing you should do when you become pregnant is go over your medication list with your doctor. Some medications may not be safe to take during pregnancy.
  • You’ll still take insulin, but you may have to adjust the dose during pregnancy.
  • Monitoring your blood glucose levels is a priority. This means taking frequent blood and urine tests.
  • Your doctor will let you know how to adjust your diet and what exercises are best for you and your baby.
  • Your doctor can use ultrasound imaging to assess your baby’s heart rate, movements, and the amount of amniotic fluid.
  • Diabetes can slow down the development of your baby’s lungs. Your doctor can perform an amniocentesis to check your baby’s lung maturity.
  • Your health, your baby’s health, and your baby’s weight will help your doctor determine if you can deliver vaginally or if a cesarean delivery is necessary.
  • Your doctor will continue to monitor your blood glucose levels closely during labor and delivery. Your insulin needs will likely change again after delivery.

Complications associated with diabetes during pregnancy

Many women with diabetes carry and deliver healthy babies without serious complications. If you have diabetes, you and your baby are at an increased risk of complications.

If you have diabetes, you’re at increased risk for the following during pregnancy:

  • urinary, bladder, and vaginal infections
  • high blood pressure, or preeclampsia, which can cause kidney and liver dysfunction
  • a worsening of diabetes-related eye problems
  • a worsening of diabetes-related kidney problems
  • a difficult delivery
  • a need for a cesarean delivery

High glucose levels, especially in the first trimester, can increase the risk of birth defects. Potential risks for your baby include:

  • a miscarriage
  • premature birth
  • high birth weight
  • low blood glucose, or hypoglycemia, at birth
  • prolonged yellowing of the skin, or jaundice
  • respiratory distress
  • birth defects, including defects of the heart, blood vessels, brain, spine, kidneys, and digestive tract
  • stillbirth

Tips for a healthy pregnancy if you have diabetes

If you have diabetes, monitoring your health will become even more important when you decide to have a baby. The sooner you start planning, the better. Follow these tips for a healthy pregnancy:

  • See your endocrinologist and your OB-GYN to make sure you’re in good health and your diabetes is under control. Keeping diabetes well-controlled for several months before you get pregnant can decrease risks for you and your baby.
  • Tell your doctor about all of the medications and supplements you’re currently taking. If you’re pregnant, tell them about all of the medications and supplements you’ve taken since becoming pregnant.
  • Folic acid helps fuel healthy growth and development. Ask your doctor if you should take folic acid or other special vitamins.
  • Take prenatal vitamins if your doctor recommends it.
  • Ask your doctor what your specific blood glucose goals should be.
  • See your doctor again right away when you think you’re pregnant. Make sure your doctors communicate with each other.
  • Keep all prenatal appointments.
  • Tell your doctor about any unusual symptoms right away.
  • Maintain a healthy diet that includes a variety of vegetables, whole grains, fruits, nonfat dairy products, beans, fish, and lean meats. Portion control is also important.
  • Get some exercise every day.
  • Make sure you’re getting the right amount of sleep each night.
  • Consider wearing a medical identification bracelet that indicates you have diabetes.
  • Make sure your spouse, partner, or someone close to you knows what to do if you have a medical emergency.
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