The decision to have a child is a major decision for a diabetic woman. The pregnancy will be a high risk situation, with respect to physical health, emotional responses, and financial concerns. It will require close cooperation between the patient, her obstetrician, her diabetologist, and a pediatrician. There are substantial risks involved in these pregnancies. There is a higher than average chance of miscarriage and of major abnormalities in the developing fetus. Fortunately, it is now possible for obstetricians to identify some of these abnormalities early in the pregnancy. This allows the parents to know about the problem and plan accordingly.

The best chance for a normal pregnancy will occur when the diabetes is brought under excellent control before the pregnancy begins. The young woman can begin to work to control her blood glucose levels months before the planned conception. The idea of "tight control" means aiming for normal glycohemoglobin values, probably increasing the number of daily insulin injections (or using an insulin pump), doing multiple blood sugar tests every day, and dealing with the possibility of occasional insulin reactions.

It's a lot of work. But, when the glycohemoglobin can be brought into the normal range before conception, and when tight control of the blood sugar is maintained throughout the pregnancy, it is clear that the chances of a successful pregnancy will improve considerably.

      Additional comment, February, 2001

What about women with type 2 diabetes, who are taking diabetes pills, or women who have had gestational diabetes in the past? Will they need insulin, or will diabetes pills be okay to use during pregnancy?

As of the moment of this writing (February, 2001), it is the opinion of the editors that it is inappropriate to use sulfonylureas (or other diabetes drugs) during pregnancy unless part of a fully-informed situation, such as a Phase 4 clinical trial protocol, where the risks as well as the benefits are fully discussed and understood. It is also recognized that in a carefully selected group of patients, that an oral agent could be a good alternative.

In the case of diabetes developing during pregnancy (gestational diabetes) insulin is needed only for a few months during the third trimester of the pregnancy, and has several relative advantages to offset the one minor disadvantage of the nuisance of giving injections: doses of insulin can be rapidly adjusted (on an hour-by-hour basis if needed), and the present study using pills has not been thoroughly replicated with sufficient power to watch for the possibility of rare side-effects.

-- WWQ

Also see

Planning a pregnancy. At the DiabetesMonitor
Pregnancy and Family Planning (a listing of other websites discussing pregnancy and diabetes) at the DiabetesMonitor
A comparison of glyburide and insulin in women with gestational diabetes mellitus New England Journal of Medicine, 343 (16):1134. Langer O, Conway DL, Berkus MD, Xenakis EMJ, Gonzales O.
A Comparison of Glyburide and Insulin in Women with Gestational Diabetes Mellitus. New England Journal of Medicine Oded Langer, Deborah L. Conway, Michael D. Berkus, Elly M.-J. Xenakis, Olga Gonzales. Volume 343 October 19, 2000 Number 16. "Women with gestational diabetes mellitus are rarely treated with a sulfonylurea drug, because of concern about teratogenicity and neonatal hypoglycemia. There is little information about the efficacy of these drugs in this group of women. METHODS: We studied 404 women with singleton pregnancies and gestational diabetes that required treatment. The women were randomly assigned between 11 and 33 weeks of gestation to receive glyburide or insulin according to an intensified treatment protocol. The primary end point was achievement of the desired level of glycemic control. Secondary end points included maternal and neonatal complications. RESULTS: The mean (+/-SD) pretreatment blood glucose concentration as measured at home for one week was 114+/-19 mg per deciliter (6.4+/-1.1 mmol per liter) in the glyburide group and 116+/-22 mg per deciliter (6.5+/-1.2 mmol per liter) in the insulin group (P=0.33). The mean concentrations during treatment were 105+/-16 mg per deciliter (5.9+/-0.9 mmol per liter) in the glyburide group and 105+/-18 mg per deciliter (5.9+/-1.0 mmol per liter) in the insulin group (P=0.99). Eight women in the glyburide group (4 percent) required insulin therapy. There were no significant differences between the glyburide and insulin groups in the percentage of infants who were large for gestational age (12 percent and 13 percent, respectively); who had macrosomia, defined as a birth weight of 4000 g or more (7 percent and 4 percent); who had lung complications (8 percent and 6 percent); who had hypoglycemia (9 percent and 6 percent); who were admitted to a neonatal intensive care unit (6 percent and 7 percent); or who had fetal anomalies (2 percent and 2 percent). The cord-serum insulin concentrations were similar in the two groups, and glyburide was not detected in the cord serum of any infant in the glyburide group. CONCLUSIONS: In women with gestational diabetes, glyburide is a clinically effective alternative to insulin therapy."