What Is Pregestational Diabetes?
Pregestational diabetes is diabetes in a pregnant person that is diagnosed before pregnancy. This can be type 1 or type 2 diabetes. It is not the same as gestational diabetes, which develops during pregnancy.
A diagnosis of pregestational diabetes can be a challenge for a maternity healthcare provider, as it requires frequent monitoring and adjusting medications to ensure blood glucose is in the proper range. It also means a higher risk of potential maternal-fetal complications.
This post will review the types of pregestational diabetes, its symptoms, treatments, complications, and how to cope with the condition.
Types of Pregestational Diabetes
The types of diabetes you can have before getting pregnant include type 1 diabetes and type 2 diabetes. Other types of diabetes are less common.
Type 1 diabetes is when your body doesn’t make insulin or enough insulin, a hormone that allows your cells to take in blood glucose (sugar) for energy. You then need to take insulin daily.
Type 2 diabetes is the most common type of diabetes. It occurs when the body doesn’t use insulin well, causing blood sugar levels to become high.
Pregestational Diabetes Symptoms
Type 1 diabetes can take months or years to develop noticeable symptoms, but once they are noticeable, they can become severe very quickly. Type 1 diabetes usually starts in childhood, adolescence, or young adulthood.
Type 2 diabetes take years to develop, and some people never notice their symptoms. This kind of diabetes often begins in adulthood, though more children and teens are showing symptoms.
Symptoms of either kind of diabetes can include:
- Frequent urination, especially at night
- Increased thirst and hunger
- Blurry vision
- Numb or tingling hands or feet
- Slow healing of cuts or sores
- Increased infections
Type 1 diabetes can also include symptoms like nausea, stomach pain, or vomiting.
Causes of Pregestational Diabetes
Type 1 diabetes is thought to be caused by an autoimmune reaction. The body destroys its own pancreas cells that make insulin. Sometimes the link is genetic, although triggers in the environment may interact with heredity in some people to cause type 1 diabetes to occur.1 Type 1 diabetes develops independently of diet, lifestyle, or weight.
Type 2 diabetes causes and risk factors include:
- Being overweight
- Sedentary lifestyle
- Insulin resistance
- Genetics
Diagnosis
A blood test to measure blood glucose levels can determine whether you have pregestational diabetes. This, together with symptoms, medical history, family history, and other factors, help your healthcare provider make a diabetes diagnosis.
Common blood tests to diagnose diabetes include:
- Fasting plasma glucose test (FPG): Measures your blood glucose at a single time in the morning, after fasting for at least eight hours
- A1C test: Provides average blood glucose levels over the last three months
- Random plasma glucose test: Taken when you have diabetes symptoms and your healthcare provider doesn’t want to wait until you’ve fasted eight hours
While the blood test can let your healthcare provider know if you have diabetes or not, it does not tell them what type you have. Certain autoantibodies will be in your blood if you have type 1 diabetes.
Treatment
Treatment for type 1 diabetes involves daily insulin shots or wearing an insulin pump, as well as regular blood sugar checks. Your healthcare provider will discuss with you when to check your sugars, how often, and what your target levels should be.
Regular exercise, stress reduction techniques, healthy lifestyle behaviors, and controlling blood pressure and cholesterol are also essential.
Treatment for type 2 diabetes is a combination of things, including possible medications as well as lifestyle changes. In addition, it’s important to manage blood glucose levels, cholesterol, and blood pressure if you have type 2 diabetes, as these can all be connected.
Other types of treatment and management techniques include:
- Quitting smoking
- Eating a healthy diet
- Losing weight if necessary
- Incorporating physical activity
- Diabetes medications like insulin or other drugs
During pregnancy, your treatment methods may need to be altered or changed to better control your type 1 or type 2 diabetes. Talk with the healthcare provider managing your diabetes and your prenatal healthcare provider, and have them work together to help keep your diabetes under control during pregnancy.
Complications
Uncontrolled diabetes can increase risks during pregnancy, including:
- Preterm labor
- Preeclampsia (high blood pressure and protein in the urine)
- Low blood sugar (hypoglycemia)
- Increased chance of a cesarean section (surgical delivery)
- Injury from delivering a large baby
- Miscarriage or stillbirth
- Health complications for the baby, including structural or functional changes present at birth that can affect the brain, spine, heart, and other organs
Coping
Pregnancy can be stressful. Pregestational diabetes may add to your stress with worries about your health and the health of your fetus.
When you’re stressed, the body makes stress hormones. These can impact your blood sugar and increase it, causing difficulty in managing blood glucose levels.
Stress can also cause fluctuations in eating habits, interfere with exercise, and impair self-care behaviors. If you have pregestational diabetes and are pregnant, managing your stress and using healthy coping skills is vital.
Ways to cope with pregestational diabetes both before and during/after pregnancy can include:
- Talk to someone you trust.
- Practice meditation, mindfulness exercises, or yoga.
- Ask for help with things if you’re overwhelmed
- Adhere to an exercise routine.
- Do something you love—enjoy a hobby, see a favorite movie, or meet up with a friend.
- Join a support group.
If you’re feeling overwhelmed and it’s interfering with the self-management of your diabetes, tell your healthcare providers. They can suggest resources for you and help get you back on track so you can stay as healthy as possible for you and your baby. Remember you got this mama!