Blood glucose levels early pregnancy

Blood glucose levels early pregnancy

answers questions about

pregnancy and diabetes

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1. For women with type 1 and type 2 diabetes, how do insulin needs change during menstruation?

Insulin and Menstruation with Diabetes:

Pre-menstrual hormones tend to make a woman’s blood glucose higher at breakfast than it normally would be. Pre-menstrual hormones also make a woman’s typical blood glucose fluctuations during the day even greater than usual.

The only way to manage changing insulin requirements right before your period is to measure your blood glucose often. Your doctor can help you to figure out what insulin dose adjustments you should make each month before your period.

Usually, a woman’s insulin requirement goes up 10 to 15% during the last 3 to 5 days of the menstrual cycle due to the hormone progesterone. This is the hormone that prepares the uterus to be full of extra tissue and blood to receive the egg, if it is fertilized. Rising levels of progesterone counteract that action of insulin. During these days, bedtime insulin doses may need to be increased, and possibly morning insulin doses as well.

2. For women with type 1 or type 2 diabetes, how do insulin requirements change during pregnancy?

Insulin and Pregnancy:

Pregnancy, type I diabetes, and insulin

If you have type 1 diabetes, your insulin requirements go up and down throughout the pregnancy. Every pregnancy involving diabetes is unique, so you and your doctor will work closely together to adjust your insulin regimen in a way that meets your specific needs.

When the egg first implants in your uterus, it secretes a hormone that tells the ovary to make more progesterone. This is the hormone that prepares the uterus to be full of extra tissue and blood to receive the egg, if it is fertilized. Progesterone counters the action of insulin. So when your progesterone levels rise, you may need to take more insulin.

With type 1 diabetes, by the time your pregnancy test turns positive, your progesterone levels are two to three times higher than the levels in a non-pregnant woman. Your insulin requirement is generally 20% higher 5 to 6 weeks after your last menstrual period. Your insulin requirement continues to rise slowly until 9 to 11 weeks, when the ovaries stop making progesterone and the placenta takes over progesterone production. This switch may be associated with a temporary drop in progesterone levels.

If you are thin and very insulin sensitive, when this drop in progesterone happens, your insulin requirement may drop suddenly. At this time, you have a higher risk of nighttime low blood sugar (hypoglycemia). If this happens while you sleep, you may not feel your blood glucose levels drop.

Your doctor will probably tell you to carefully increase your insulin doses to maintain normal blood glucose levels throughout the early part of the pregnancy. Every night, you will need to test your blood glucose at around 3:00 am. When the 3:00 am test readings fall to less than 70 mg/dl, your doctor may reduce your bedtime insulin dose substantially. This insulin dose reduction may last for approximately 8 to 10 days. Then your insulin requirements will begin to rise again. From that point on, there is a smooth rise in insulin requirement during each trimester of your pregnancy.

When you reach term and contractions begin, your insulin requirement will drop again. The contracting uterus is exercising and using up glucose for energy. Therefore, at 37 weeks’ gestation, you will need to wake up in the middle of the night again to measure your blood glucose. If the 3:00 am readings are less than 70 mg/dl, your bedtime insulin dose will need to be reduced. After the baby is born, your insulin requirements may drop again.

All of these insulin dose adjustments are essential to your developing baby’s health. This means that you will need to check your blood glucose often and let your doctor know the results, so that your insulin doses can be quickly and safely adjusted.

If you have type 1 diabetes and you are overweight when you become pregnant, your insulin sensitivity and insulin dose requirements may be different from those of a thinner pregnant woman. Your doctor will set up an insulin plan that is right for your specific needs.

Your doctor will tell you how often to check your blood glucose. Typically, you will check 8 to 10 times a day: before each meal, one hour after each meal, at bedtime and at 3:00 am. Keep good records of your blood glucose readings. these will help the doctor to fine-tune your insulin doses throughout the pregnancy. The health of your baby depends on these frequent dose adjustments.

Pregnancy, type II diabetes, and insulin

If you have type 2 diabetes, your insulin plan during pregnancy will depend on your insulin resistance, your weight and the carbohydrate content of your meals.

Just like the type 1 woman, your insulin requirements will rise a little bit during each trimester of your pregnancy. Unlike the type 1 woman, because of your type 2 insulin resistance, your insulin requirements may not drop during early pregnancy.

Your doctor may advise you to limit the carbohydrates in your diet. The doctor will also continually adjust your insulin doses before and during the pregnancy. If you eat more than 30% to 40% of your total calories as carbohydrate, you may need much larger doses of insulin than if you limit the carbohydrate content of your meals. This is because of the carbohydrate intolerance associated with type 2 diabetes.

3. For women with type 1 or type 2 diabetes, how do insulin needs change after pregnancy?

Insulin After Pregnancy:

No matter what type of diabetes you have, once the placenta is removed, progesterone – the main source of anti-insulin hormone – is gone. Your pituitary gland will go through some changes that also help to lower progesterone levels, and your body will release any leftover insulin that had built up.

After delivery, hormone changes cause your insulin requirements to drop significantly. In fact, for 24 to 48 hours after delivery, even a woman with type 1 diabetes may need little or no insulin.

While your body is going through many post-delivery adjustments, your insulin doses will also be fine-tuned. Eventually, your insulin doses will return to pre-pregnancy levels, unless you decide to breast-feed.

Breast-feeding typically reduces your need for long-acting insulin, because some of your blood glucose is siphoned into the breast to produce milk that contains milk sugar (lactose). However, the lactation hormones you produce at this time counteract the action of insulin. So, you may need more short-acting mealtime insulin to cover your carbohydrates than you would need if you were not breast-feeding.

4. I have gestational diabetes. How will my insulin requirements change during and after pregnancy?

Gestational diabetes and insulin:

Gestational diabetes develops near the end of the second trimester of pregnancy, when the pancreas can’t make enough insulin to meet the extra demands of pregnancy.

In most cases, a low-carbohydrate meal plan and exercise are enough to treat the gestational diabetes. However, if diet alone cannot keep blood glucose levels within a range of 90 mg/dL to 120 mg/dL, then insulin must be taken.

If you need to take insulin, the doctor may suggest that you use a long-acting insulin to cover your low-level insulin needs throughout the day, and a separate, fast-acting insulin to cover the carbohydrates you eat at mealtimes.

With gestational diabetes, once the pregnancy ends the diabetes goes away in 90% of cases. Insulin doses may be stopped when a woman with gestational diabetes goes into labor. However, gestational diabetes is a window into the future. If you have had gestational diabetes and you are overweight, now is the time to take action.

If you do not become lean and fit after pregnancy, your risk of developing type 2 diabetes is around 10% per year, cumulative. This means that in 5 years, your risk of type 2 diabetes will be up to 50%. If you reach the 5-year mark without having diabetes, then your lifetime risk caps at 60%. If, however, you are able to become lean and fit after the baby is born, then your lifetime risk is only 25%.

5. For women with type 1 and type 2 diabetes, how do insulin needs change during menopause?

Insulin and Menopause:

The biological changes that take place in the seven to eight years prior to menopause are called peri-menopause. During these years you transition from normal menstrual periods to no periods at all.

During peri-menopause, the levels of estrogen and progesterone hormones can fluctuate, resulting in wide swings in blood glucose levels. With lower estrogen levels you may have increased insulin resistance and higher blood sugar. However, an early sign of dropping progesterone in the peri-menopausal period is a reduced insulin requirement. If you have type 1 or type 2 diabetes and are approaching menopause, you will need to check your blood glucose several times a day, including a 3:00 am reading. This will help your doctor to make the necessary adjustments to your insulin doses.

6. For women with type 1 and type 2 diabetes, how do insulin needs change during stress or illness?

Insulin and Stress or Illness:

Stress comes in three forms: emotional, physical, and hormonal.

Physical stress can be caused by trauma or illnesses that cause inflammation or infection. Hormonal stress occurs during childhood growth and development, puberty, the menstrual cycle, pregnancy and menopause. The body reacts the same way to all three types of stress: it produces stress hormones.

During times of stress, your insulin requirements rise in direct proportion to the amount of stress you experience:

  • Mild stress usually raises insulin requirements about 10-15 %
  • Moderate stress raises insulin requirements about 20 to 30%.
  • Severe stress can increase your insulin requirements by as much as 100% over your usual dose.

During a stressful time, the only way to tell if your insulin doses are appropriate is to monitor your blood glucose often. Your doctor will tell you what adjustments to make to your insulin regimen.

7. Why do doctors prefer insulin over oral medications during pregnancy?

Pregnancy and Diabetes – Oral Medications or Insulin:

First generation oral agents cross the placenta and may affect the baby. They can cause the fetus to secrete too much insulin and suffer severe hypoglycemia (low blood glucose). Oral agents are also not strong enough to meet the rising insulin requirements of pregnancy.

Insulin does not cross the placenta. Because the outcome of pregnancy is directly related to blood glucose control, insulin is the preferred diabetes regimen for pregnancy.

8. Is it a good idea to ask your doctor to start on insulin if you have type 2 diabetes, don’t take insulin and are trying to conceive? Why would this help?

Trying to Conceive with Type 2 Diabetes:

If you plan to become pregnant and your fasting plasma blood glucose is greater than 90 mg/dL or your post-meal blood glucose is greater than 120 mg/dL one hour after eating, then your doctor may recommend that you take insulin. The best pregnancy outcomes are associated with blood glucose levels below these limits.

Researchers do not know the exact blood glucose level that increases the risk of spontaneous abortion and birth defects. They do know that if the A1c test level is above normal, then the risk of pregnancy-related complications goes up.

If you have type 2 diabetes and are managed with diet or diet plus oral agents, monitor your blood glucose often. If the readings are higher than 90 mg/dL before meals, and higher than 120 mg/dL one hour after meals, then your doctor may discontinue the oral agents and start you on insulin before conception occurs.

Preconception counseling is best given by the team of healthcare professionals who will care for you during the pregnancy, too. This team may include a nurse educator, dietician, endocrinologist, and obstetrician. Most major university medical centers have a diabetes and pregnancy team.

9. Can birth control pills affect glucose levels?

Diabetes and Birth Control Pills:

Current low-dose birth control pills will not affect your blood glucose levels, so they should not affect your insulin doses. Some women with type 1 diabetes actually take birth control pills to counteract menstrual hormone swings, so that they do not have to change their insulin doses.

10. How can I avoid bruising when I inject?

Insulin Injections and Bruises:

Bruising is a common occurrence. Some places in the body have more tiny blood vessels than other places, so if a particular injection site tends to bruise, then avoid that spot for future injections. To minimize bruising, put pressure on the injection site after the syringe is removed, and also remain still for a few minutes after the insulin injection. If you are using an insulin pen, a 5mm pen needle might reduce bruising.

11. Does the baby get extra insulin from the mother?

Fetus and Insulin:

Insulin does not cross the placenta, so your insulin will not appear in the baby’s blood. Only your blood glucose can cross the placenta. High blood glucose can harm your developing baby, and that’s why your doctor may want you to take insulin during your pregnancy.

12. Is the baby already making his own insulin? Does the mother get insulin from the baby?

Fetus and Insulin:

Fetal insulin does not cross the placenta. Even though the baby makes insulin by the 10th gestational week, the fetal insulin does not transfer into the mother’s blood.

13. After the baby comes, it is very hard to take care of ourselves. Injections, testing, and record keeping become harder to do. What tips do you have for busy mothers?

Diabetes Control for Diabetic Mothers:

A newborn does take up most of your waking attention! However, you need to devote as much time as possible to good blood glucose control.

If you are breast-feeding, it is mandatory to keep your blood glucose levels as near normal as possible. If you have high blood glucose levels it will sweeten your milk, which may cause problems for your baby.

14. Can stomach injections increase stretch marks?

Insulin Injections and Stretch Marks:

No. Stomach injections cannot increase stretch marks.

15. What areas of the stomach are okay to inject into, especially late in pregnancy?

Insulin Injections During Pregnancy:

You can inject in any place where you can ‘pinch an inch’. The skin is tight over the area where the uterus is located, and it is impossible for an inch to be pinched in that location late in pregnancy.

Dr. Lois Jovanovic is Director of Research and Chief Scientific Officer of Sansum Diabetes Research Institute. Sansum has been on the forefront of the effort to guarantee women with diabetes the same opportunity for a healthy outcome of pregnancy as a non-diabetic woman.

How to Test Your Blood Sugar Levels in Pregnancy

Test Frequently

In order to build a healthy plan for controlling gestational diabetes, the goal must be to keep your blood sugar levels in the normal range throughout the day. This must be priority #1.

The first step in a healthy plan for controlling gestational diabetes is knowing what your blood sugar level is by testing at intervals throughout the day.

Recommended Glucose Monitoring Levels

The American College of Obstetricians and Gynecologists (ACOG) and the American Diabetes Association (ADA) both have similar recommendations for your target blood glucose levels in pregnancy. If the suggested blood glucose levels are met, this would mean that you have excellent control of your gestational diabetes and can avoid the complications associated with gestational diabetes.

  • Fasting blood glucose of less than 95 mg/dl

  • A blood glucose of less than 100 mg/dl before each meal

  • One hour after eating your glucose level should be less than 140 mg/dl

  • Two hours after eating your glucose level should be less than 120 mg/dl
  • How Do You Test Your Blood Sugar Level?

    Testing glucose levels is quick and simple. Most drug stores, medical supply stores and pharmacies carry testing supplies and many are covered under health insurance. Renting a glucose meter might be an option, as it may only be needed during pregnancy. Here are the basic steps in a nutshell:

    • Wash hands thoroughly with soap and water

  • Prick your finger with a lancet and squeeze a drop of blood.

  • Place the drop of blood on the paper strip that fits into the glucose meter

  • Wait a few seconds and the meter will give you a number for your blood sugar level, like 115 mg/dl
  • When to Test?

    According to the American Diabetes Association (ADA) self-monitoring blood glucose or SMBG in pregnant women with a prior history of diabetes should test as follows:

  • One or two hour after each meal

  • Occasional between 2 and 4 AM. (test when you have symptoms of low blood sugar at night)
  • Home glucose monitoring test kits

    There are many different glucose monitoring test kits on the market. Some are more accurate than others. You should check the accuracy of your meter by bringing it with you to your prenatal visits and use your home meter to check your blood sugar level at the same time that your physician draws your blood sample. There should not be a larger than 15% difference in the two glucose results. If there is a large difference the problem may be with your meter, blood strips or your technique for drawing the sample. Most home glucose meters are accurate, however use common sense if your readings do not fit with your symptoms. Example low blood sugar (a value less than 63 mg/dl) without symptoms of irritability, confusion and feeling faint could mean an inaccurate reading.

    Causes of early morning high blood glucose

    There are two main reasons that when you test your blood sugar in the morning that it is higher than your bedtime glucose level. The dawn phenomenon is an elevated blood glucose level that is seen around 3 to 5 am. It is due to the normal overnight secretion of hormones that inhibit insulin function resulting in high blood glucose levels in the morning. The second phenomenon is the Somogyi Effect and it refers to the rebound high blood glucose level 6 to 12 hours after a low blood sugar level before going to bed.

    How to Control Blood Sugar Level in Pregnancy

    Whether you have diabetes before you become pregnant or you develop gestational diabetes, it is important to control your blood sugar levels during pregnancy. Working closely with your medical team, you should use proper diet and moderate exercise to help keep your blood sugar levels in check. If diet and exercise can’t bring your blood glucose levels under control on their own, your doctor may prescribe medication such as metformin or insulin injections.

    Steps Edit

    Method One of Three:

    Eating a Nutritionally Balanced Diet Edit

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    If you have diabetes and plan to have a baby, you should try to get your blood glucose levels close to your target range before you get pregnant.

    Staying in your target range during pregnancy, which may be different than when you aren’t pregnant, is also important. High blood glucose, also called blood sugar, can harm your baby during the first weeks of pregnancy, even before you know you are pregnant. If you have diabetes and are already pregnant, see your doctor as soon as possible to make a plan to manage your diabetes. Working with your health care team and following your diabetes management plan can help you have a healthy pregnancy and a healthy baby.

    Plan to manage your blood glucose before you get pregnant.

    If you develop diabetes for the first time while you are pregnant, you have gestational diabetes.

    How can diabetes affect my baby?

    A baby’s organs, such as the brain, heart, kidneys, and lungs, start forming during the first 8 weeks of pregnancy. High blood glucose levels can be harmful during this early stage and can increase the chance that your baby will have birth defects, such as heart defects or defects of the brain or spine.

    High blood glucose levels during pregnancy can also increase the chance that your baby will be born too early, weigh too much, or have breathing problems or low blood glucose right after birth.

    High blood glucose also can increase the chance that you will have a miscarriage or a stillborn baby. 1 Stillborn means the baby dies in the womb during the second half of pregnancy.

    How can my diabetes affect me during pregnancy?

    Hormonal and other changes in your body during pregnancy affect your blood glucose levels, so you might need to change how you manage your diabetes. Even if you’ve had diabetes for years, you may need to change your meal plan, physical activity routine, and medicines. If you have been taking an oral diabetes medicine, you may need to switch to insulin. As you get closer to your due date, your management plan might change again.

    What health problems could I develop during pregnancy because of my diabetes?

    Pregnancy can worsen certain long-term diabetes problems, such as eye problems and kidney disease, especially if your blood glucose levels are too high.

    You also have a greater chance of developing preeclampsia, sometimes called toxemia, which is when you develop high blood pressure and too much protein in your urine during the second half of pregnancy. Preeclampsia can cause serious or life-threatening problems for you and your baby. The only cure for preeclampsia is to give birth. If you have preeclampsia and have reached 37 weeks of pregnancy, your doctor may want to deliver your baby early. Before 37 weeks, you and your doctor may consider other options to help your baby develop as much as possible before he or she is born.

    How can I prepare for pregnancy if I have diabetes?

    If you have diabetes, keeping your blood glucose as close to normal as possible before and during your pregnancy is important to stay healthy and have a healthy baby. Getting checkups before and during pregnancy, following your diabetes meal plan, being physically active as your health care team advises, and taking diabetes medicines if you need to will help you manage your diabetes. Stopping smoking and taking vitamins as your doctor advises also can help you and your baby stay healthy.

    Work with your health care team

    Regular visits with members of a health care team who are experts in diabetes and pregnancy will ensure that you and your baby get the best care. Your health care team may include

    • a medical doctor who specializes in diabetes care, such as an endocrinologist or a diabetologist
    • an obstetrician with experience treating women with diabetes
    • a diabetes educator who can help you manage your diabetes
    • a nurse practitioner who provides prenatal care during your pregnancy
    • a registered dietitian to help with meal planning
    • specialists who diagnose and treat diabetes-related problems, such as vision problems, kidney disease, and heart disease
    • a social worker or psychologist to help you cope with stress, worry, and the extra demands of pregnancy

    You are the most important member of the team. Your health care team can give you expert advice, but you are the one who must manage your diabetes every day.

    Talk with your health care team before you get pregnant.

    Get a checkup

    Have a complete checkup before you get pregnant or as soon as you know you are pregnant. Your doctor should check for

    • high blood pressure
    • eye disease
    • heart and blood vessel disease
    • nerve damage
    • kidney disease
    • thyroid disease

    Pregnancy can make some diabetes health problems worse. To help prevent this, your health care team may recommend adjusting your treatment before you get pregnant.

    Don’t smoke

    Smoking can increase your chance of having a stillborn baby or a baby born too early. 2 Smoking is especially harmful for people with diabetes. Smoking can increase diabetes-related health problems such as eye disease, heart disease, and kidney disease.

    If you smoke or use other tobacco products, stop. Ask for help so you don’t have to do it alone. You can start by calling the national quitline at 1-800-QUITNOW or 1-800-784-8669. For tips on quitting, go to Smokefree.gov.

    See a registered dietitian nutritionist

    If you don’t already see a dietitian, you should start seeing one before you get pregnant. Your dietitian can help you learn what to eat, how much to eat, and when to eat to reach or stay at a healthy weight before you get pregnant. Together, you and your dietitian will create a meal plan to fit your needs, schedule, food preferences, medical conditions, medicines, and physical activity routine.

    During pregnancy, some women need to make changes in their meal plan, such as adding extra calories, protein, and other nutrients. You will need to see your dietitian every few months during pregnancy as your dietary needs change.

    Be physically active

    Physical activity can help you reach your target blood glucose numbers. Being physically active can also help keep your blood pressure and cholesterol levels in a healthy range, relieve stress, strengthen your heart and bones, improve muscle strength, and keep your joints flexible.

    Before getting pregnant, make physical activity a regular part of your life. Aim for 30 minutes of activity 5 days of the week.

    Talk with your health care team about what activities are best for you during your pregnancy.

    Physical activity can help you reach your target blood glucose numbers.

    Avoid alcohol

    You should avoid drinking alcoholic beverages while you’re trying to get pregnant and throughout pregnancy. When you drink, the alcohol also affects your baby. Alcohol can lead to serious, lifelong health problems for your baby.

    Adjust your medicines

    Some medicines are not safe during pregnancy and you should stop taking them before you get pregnant. Tell your doctor about all the medicines you take, such as those for high cholesterol and high blood pressure. Your doctor can tell you which medicines to stop taking, and may prescribe a different medicine that is safe to use during pregnancy.

    Doctors most often prescribe insulin for both type 1 and type 2 diabetes during pregnancy. 3 If you’re already taking insulin, you might need to change the kind, the amount, or how and when you take it. You may need less insulin during your first trimester but probably will need more as you go through pregnancy. Your insulin needs may double or even triple as you get closer to your due date. Your health care team will work with you to create an insulin routine to meet your changing needs.

    Take vitamin and mineral supplements

    Folic acid is an important vitamin for you to take before and during pregnancy to protect your baby’s health. You’ll need to start taking folic acid at least 1 month before you get pregnant. You should take a multivitamin or supplement that contains at least 400 micrograms (mcg) of folic acid. Once you become pregnant, you should take 600 mcg daily. 4 Ask your doctor if you should take other vitamins or minerals, such as iron or calcium supplements, or a multivitamin.

    What do I need to know about blood glucose testing before and during pregnancy?

    How often you check your blood glucose levels may change during pregnancy. You may need to check them more often than you do now. If you didn’t need to check your blood glucose before pregnancy, you will probably need to start. Ask your health care team how often and at what times you should check your blood glucose levels. Your blood glucose targets will change during pregnancy. Your health care team also may want you to check your ketone levels if your blood glucose is too high.

    During your pregnancy, you may need to check your blood glucose levels more often.

    Target blood glucose levels before pregnancy

    When you’re planning to become pregnant, your daily blood glucose targets may be different than your previous targets. Ask your health care team which targets are right for you.

    You can keep track of your blood glucose levels using My Daily Blood Glucose Record (PDF, 44 KB) . You can also use an electronic blood glucose tracking system on your computer or mobile device. Record the results every time you check your blood glucose. Your blood glucose records can help you and your health care team decide whether your diabetes care plan is working. You also can make notes about your insulin and ketones. Take your tracker with you when you visit your health care team.

    Target blood glucose levels during pregnancy

    Recommended daily target blood glucose numbers for most pregnant women with diabetes are

    • Before meals, at bedtime, and overnight: 90 or less
    • 1 hour after eating: 130 to 140 or less
    • 2 hours after eating: 120 or less 3

    Ask your doctor what targets are right for you. If you have type 1 diabetes, your targets may be higher so you don’t develop low blood glucose, also called hypoglycemia.

    A1C numbers

    Another way to see whether you’re meeting your targets is to have an A1C blood test. Results of the A1C test reflect your average blood glucose levels during the past 3 months. Most women with diabetes should aim for an A1C as close to normal as possible—ideally below 6.5 percent—before getting pregnant. 3 After the first 3 months of pregnancy, your target may be as low as 6 percent. 3 These targets may be different than A1C goals you’ve had in the past. Your doctor can help you set A1C targets that are best for you.

    Ketone levels

    When your blood glucose is too high or if you’re not eating enough, your body might make ketones. Ketones in your urine or blood mean your body is using fat for energy instead of glucose. Burning large amounts of fat instead of glucose can be harmful to your health and your baby’s health.

    You can prevent serious health problems by checking for ketones. Your doctor might recommend you test your urine or blood daily for ketones or when your blood glucose is above a certain level, such as 200. If you use an insulin pump, your doctor might advise you to test for ketones when your blood glucose level is higher than expected. Your health care team can teach you how and when to test your urine or blood for ketones.

    Talk with your doctor about what to do if you have ketones. Your doctor might suggest making changes in the amount of insulin you take or when you take it. Your doctor also may recommend a change in meals or snacks if you need to consume more carbohydrates.

    What tests will check my baby’s health during pregnancy?

    You will have tests throughout your pregnancy, such as blood tests and ultrasounds, to check your baby’s health. Talk with your health care team about what prenatal tests you’ll have and when you might have them.

    References

    [1] ACOG Committee on Practice Bulletins. ACOG Practice Bulletin. Clinical management guidelines for obstetrician-gynecologists. Number 60, March 2005. Pregestational diabetes mellitus. Obstetrics and Gynecology. 2005;105(3):675–685. Reaffirmed 2014: www.acog.org/Resources-And-Publications/Practice-Bulletins-List.

    [2] U.S. Department of Health and Human Services. The health consequences of smoking—50 years of progress. A report of the Surgeon General. www.surgeongeneral.gov/library/reports/50-years-of-progress/. Published 2014. Accessed July 7, 2016.

    [3] Standards of Medical Care in Diabetes—2016. Diabetes Care. 2016;39(1)(suppl):S94–S98.

    [4] Correa A, Gilboa SM, Botto LD, et al. Lack of periconceptional vitamins or supplements that contain folic acid and diabetes mellitus-associated birth defects. American Journal of Obstetrics and Gynecology. 2012;206(3):218.e1–e13.

    Clinical Trials

    The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and other components of the National Institutes of Health (NIH) conduct and support research into many diseases and conditions.

    What are clinical trials, and are they right for you?

    Clinical trials are part of clinical research and at the heart of all medical advances. Clinical trials look at new ways to prevent, detect, or treat disease. Researchers also use clinical trials to look at other aspects of care, such as improving the quality of life for people with chronic illnesses. Find out if clinical trials are right for you.

    What clinical trials are open?

    Clinical trials that are currently open and are recruiting can be viewed at www.ClinicalTrials.gov.

    This content is provided as a service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), part of the National Institutes of Health. The NIDDK translates and disseminates research findings through its clearinghouses and education programs to increase knowledge and understanding about health and disease among patients, health professionals, and the public. Content produced by the NIDDK is carefully reviewed by NIDDK scientists and other experts.

    The NIDDK would like to thank:

    Boyd E. Metzger, MD, Northwestern University Feinberg School of Medicine

    Contact Us

    The National Institute of Diabetes and Digestive and Kidney Diseases

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    http://www.diabeticmommy.com/sp-pregnancy-diabetes-bd-faq-answers.html

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    http://www.wikihow.com/Control-Blood-Sugar-Level-in-Pregnancy

    http://www.niddk.nih.gov/health-information/diabetes/diabetes-pregnancy

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