Editor

Pregnancy is a wondrous and exciting time. It’s a time of change, both physically and emotionally. With the proper attention and prenatal medical care, most women with diabetes can enjoy their pregnancies and welcome a healthy baby into their lives.

Why Tight Blood Sugar Control Is Critically Important

Blood sugar control is important from the first week of pregnancy all the way until delivery. Organogenesis takes place in the first trimester. Uncontrolled blood sugar during the early weeks of pregnancy increases the risk of miscarriage, and birth defects. (Women don’t develop gestational diabetes until later in pregnancy, which means they don’t share these early pregnancy risks.)

Later in the pregnancy, uncontrolled blood sugar levels can cause fetal macrosomia, which may lead to shoulder dystocia, fractures, and the need for Cesarean section deliveries. Very high blood sugar levels can increase the risk of stillbirth.

Self-monitoring of blood glucose (SMBG) with home blood glucose monitors is essential. The blood glucose (BG) results are used to assess the efficacy of therapy, and to provide data by which to make management decisions. Typically, patients who use insulin should be SMBG at least 3-4 times per day. Some type 1's check as much as 6-8 times per day.  Individuals with type 2 diabetes should SMBG, but if well controlled they may need somewhat less frequent checks. Patients on diet therapy without medications may only need to check BG a few times per week. Type 2's using oral agents should check at least 1-2 times daily, and vary the times. When BG control is sub-optimal, frequency of monitoring should be increased to provide data for therapy changes. To assure proper technique, patients should receive training on meter use.