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Blood Glucose
Control
You will need to monitor your
blood glucose levels frequently—before each meal, one and a half to two hours after a meal, at bedtime, and at
2 A . M . Additional
checks may be necessary if you are driving. Poor glucose control at conception increases the risk of spontaneous
abortion and of congenital malformations of the heart, kidney, nervous system, or skeleton. Controlling the
diabetes so that the HbA1c is normal before and early during pregnancy reduces the risk of these congenital
malformations.
Good blood glucose control
remains important even later in the pregnancy. High glucose levels can cause a number of problems:
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Polyhydramnios, a term used to
describe too much amniotic fl uid, which can lead to premature labor
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Stillbirth
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A large fetus due to high fetal
insulin in response to the high maternal glucose. This condition is referred to as
macrosomia. Labor can be complicated with such a
large fetus, and a cesarean section may be necessary. Babies with macrosomia are likely to have
low blood glucose reactions after birth, they may not feed well, and they may have breathing
problems, low calcium levels, and jaundice.
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Ketoacidosis is very serious during
pregnancy and can lead to fetal death.
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It is also important not to be
overaggressive in controlling the glucose levels—if postmeal glucose levels are not allowed to rise at
all, there may be insufficient fetal growth, leading to a “small for dates”
infant.
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