Pregnancy and Diabetes

Women who develop diabetes during pregnancy (gestational diabetes) and women who have type 1 or type 2 diabetes prior to pregnancy (pregestational diabetes) face unique challenges. Diabetes in pregnancy can have serious health consequences for the mother and the baby during pregnancy and after delivery, but managing the disease can help prevent these complications.

At Brigham and Women’s Hospital (BWH), we provide highly specialized care for women with diabetes before, during, and after pregnancy. Our multidisciplinary team of experts, including maternal-fetal medicine (high-risk pregnancy) specialists, endocrinologists, nurse practitioners, nutritionists, and social workers is dedicated to delivering the highest level of care and achieving healthy outcomes for pregnant women and their babies.

How can I manage my diabetes during pregnancy?

The Pregnancy in Diabetes Program manages patients with gestational diabetes and pre-gestational type 1 and type 2 diabetes. The goal of the Program is to provide comprehensive care to meet the full range of women's needs before, during, and after pregnancy. In addition to care during pregnancy, preconception consultation is available with specialists in maternal-fetal medicine and endocrinology to better ensure that women enter pregnancy with type 1 or type 2 diabetes well-informed and as healthy as possible.

What is diabetes? What is insulin? How does diabetes affect the body? Marie McDonnell, M.D., Chief of the Diabetes Section of the Division of Endocrinology, Diabetes, and Hypertension at Brigham and Women's Hospital, answers patients' most commonly searched questions about diabetes.

If I have diabetes, what should I do to prepare for pregnancy?

If you have type 1 or type 2 diabetes and are considering becoming pregnant, we recommend you make an appointment with your primary care physician, a maternal-fetal medicine specialist and your endocrinologist to put the steps in place to ensure a healthy pregnancy. These steps include bringing your blood sugar control into a good range for pregnancy, making sure your medication regimen is safe for pregnancy, addressing any complications or co-morbidities you may have (for example hypothyroidism or high blood pressure), and working on diabetes self care, exercise and diet.

If you do not have an endocrinologist, our maternal-fetal medicine specialists and endocrinologists can provide preconception counseling, regardless of where you will be receiving your obstetrical care. Once it is confirmed you are pregnant, you will be evaluated by our endocrinology team as soon as possible to ensure good control of blood sugar in the critical early weeks of pregnancy. You also will meet with maternal-fetal medicine specialists during your first trimester to discuss symptoms, evaluate any concerns you have, and ensure your pregnancy is developing healthily.

What prenatal, delivery and postpartum care will I receive if I have diabetes?

Gestational Diabetes

Gestational diabetes is diabetes that a woman develops during pregnancy. It generally occurs in the second half of pregnancy, when an increase in placental hormones leads to increased insulin resistance, which can cause high glucose levels in the blood. Approximately five to eight percent of pregnant women develop gestational diabetes.

In the Pregnancy in Diabetes Program, women diagnosed with gestational diabetes receive education from our nurse practitioner on basic diabetes care including how to check their blood sugars. They also see a nutritionist during their first visit. Women with gestational diabetes who need more intensive treatment will be seen by an endocrinologist if they require diabetes medication or have other medical conditions that complicate their gestational diabetes. Women are generally seen every two to four weeks depending on their blood sugar levels or need for continued education, nutrition, or social work support.

Prior to delivery our team works with women to develop a plan for diabetes screening after they deliver, strategies for preventing diabetes, and transition to primary care postpartum.

If you have been diagnosed with gestational diabetes, you probably have many questions about what this means for you and your baby. Our experts in maternal-fetal medicine and endocrinology have answered the most frequently asked questions about gestational diabetes.

Pre Gestational Diabetes - Type 1 and Type 2

Women with type 1 and type 2 diabetes have appointments with our endocrinologists relatively frequently in the first trimester of pregnancy to maintain good control of blood sugar, provide guidance on diet and exercise, and manage diabetes or endocrine related co-morbidities as needed. You will also see our maternal-fetal medicine (MFM) specialists every two to four weeks to follow your pregnancy during the first and second trimester.

In the third trimester, you will see specialists in maternal-fetal medicine and endocrinology on the same day. The MFM and endocrinology teams work very closely together with you and your family to manage your diabetes leading up to your delivery and will continue to communicate with you during your hospital stay following delivery.

At the final appointment before delivery, our team will review pre-delivery diabetes management and postpartum diabetes screening and prevention. Our team will communicate with your primary care physician or OB/GYN so they are aware of your gestational diabetes and can recommend follow-up visits with an endocrinologist if needed.

At two and six weeks post-delivery, you will have appointments with our maternal-fetal medicine and endocrinology specialists. During this time, we will provide postpartum care including family planning (contraception) counseling. After this time you will be transitioned back to your primary care physician, OB/GYN and pre-pregnancy endocrinologist for care. If ongoing endocrine care is needed, the endocrinology team in the Pregnancy and Diabetes Program is available for continued postpartum care and for preconception care for women who are planning to become pregnant again.

Who will I work with to manage my diabetes during pregnancy?

In the Pregnancy in Diabetes program, our specialists in maternal-fetal medicine, endocrinology, and nutrition, work together to ensure that women with type 1, type 2 and gestational diabetes achieve healthy pregnancies. Our specialists are also available to provide both preconception consultation and postpartum management.

Emphasis is placed on achieving blood sugar control during pregnancy through a combination of lifestyle changes such as diet, exercise and medication, if needed. The team works closely with primary care providers to facilitate a successful transition to long-term care, ensuring focus on each patient’s individual needs. The Diabetes in Pregnancy Program provides easy access for women requiring appointments with multiple specialists. Learn more about our Pregnancy in Diabetes Program.

How do I request an appointment or find directions?

To schedule an appointment or to learn more about our services, please contact us at (617) 732-4840.

Our program is located at:

Brigham and Women’s Hospital
75 Francis Street
Boston, MA 02115

Our endocrinologists, diabetes educators and nutritionists are also available to see patients at the following locations:

Brigham and Women's Faulkner Hospital
1153 Centre Street
Jamaica Plain, MA 02130

Brigham and Women’s Health Care Center
850 Boylston Street, Suite 402
Chestnut Hill, MA 02467

Brigham and Women’s/Mass General Health Care Center
20 Patriot Place
Foxborough, MA 02035

Pregnancy and Diabetes Program Leaders

Marie E. McDonnell, MD
Division of Endocrinology, Hypertension and Diabetes

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