Are There Diabetes Medications That Should be Avoided During Pregnancy?
Women with type 2 diabetes who take oral medications for blood sugar control should switch to using insulin before becoming pregnant and throughout pregnancy. While some oral antidiabetic medications have been studied and were found to be safe in pregnancy, insulin is the best and safest method for controlling blood sugar throughout pregnancy.Many blood pressure medications can be dangerous for the fetus; therefore, usually these medications should be stopped before pregnancy if blood pressure can be maintained below 130/80 mmHg with dietary salt control alone. If blood pressure medications are absolutely necessary, women may have to be switched to a new medication prior to pregnancy. In particular, angiotensin-converting enzyme inhibitors and angiotensin receptor blockers are excellent for blood pressure control in nonpregnant women with diabetes; however, these are not safe when used by a woman who is diabetic and pregnant. Similarly, cholesterol-lowering medications should also be stopped during pregnancy.
How are Diet and Exercise Managed for Pregnant Women With Diabetes?
Nutrition is vitally important for pregnant women with type 1 and type 2 diabetes. In general, pregnant and nursing women with diabetes should ingest 15 to 17 calories per pound of body weight daily, although this may vary from person to person and should be discussed with the diabetes care team before, during, and after pregnancy and nursing.Important nutritional concerns in type 1 diabetes include consistent day-to-day food intake and consumption of a bedtime snack, and adjusting insulin according to activity and food content to prevent high or low blood sugar levels to carefully treat hyperglycemia and hypoglycemia, respectively.
Nutrition is the most important means of blood glucose control in type 2 diabetes. Pregnant women with type 2 diabetes should talk with their diabetes care providers, and ideally a diabetes nutritionist, to determine their goals for daily calories, carbohydrates, nutritional balance in foods, and timing of eating throughout the day.
Exercise is beneficial for pregnant women with type 2 diabetes, as it helps improve the body’s response to insulin. Women with type 1 diabetes who exercised prior to pregnancy can probably continue to exercise during pregnancy. However, women with type 1 diabetes who are not accustomed to exercise are more prone to hypoglycemia with exercise during pregnancy; for this reason, these women are not advised to begin an exercise regimen when pregnant.
Sources:
Delahanty, Linda M. and David K. McCulloch. "Nutritional Considerations in Type 1 Diabetes Mellitus." UpToDate.com 2007. UpToDate. 18 Sept. 2007 (subscription) <http://patients.uptodate.com/topic.asp?file=diabetes/15284>.
Delahanty, Linda M. and David K. McCulloch. "Nutritional Considerations in Type 2 Diabetes Mellitus." UpToDate.com 2007. UpToDate. 18 Sept. 2007 (subscription) <http://patients.uptodate.com/topic.asp?file=diabetes/15820>.
Greene, M.F., J.W. Hare, J.P. Cloherty, B.R. Benacerraf, and J.S. Soeldner. "First Trimester Hemoglobin A1 and Risk for Major Malformation and Spontaneous Abortion in Diabetic Pregnancy." Teratology 39(1989): 225-31.
Jovanovic, Lois. "Glycemic Control in Women with Type 1 and Type 2 Diabetes Mellitus During Pregnancy." UpToDate.com 2007. UpToDate. 18 Sept. 2007 (subscription) <http://patients.uptodate.com/topic.asp?file=maternal/6670>.
Jovanovic, Lois. "Prepregnancy Counseling and Evaluation of Women with Diabetes Mellitus." UpToDate.com 2007. UpToDate. 16 Sept. 2007 (subscription) <http://patients.uptodate.com/topic.asp?file=maternal/4940>.
"Preconception Care of Women with Diabetes." Diabetes Care 27(Suppl 1)(2004): 76 S. 18 Sept. 2007 <http://care.diabetesjournals.org/>.
