Diabetes and Pregnancy: Expert Advice from Pregnancy Guru Dr. Lois Jovanovič
By Lynn Kennedy and Ava Runge
Dr. Lois Jovanovič has a long and storied career in diabetes treatment and research, and her tireless efforts have revolutionized many views on pregnancy and diabetes. Her work centers on a key point: women with any type of diabetes can deliver healthy babies as long as the appropriate measures are taken to tightly manage blood sugar during pregnancy.
Dr. Jovanovič’s trail-blazing research proved this point, starting early in her career with a small, first-of-its-kind study in ten pregnant women with diabetes. All ten delivered healthy babies, which 36 years ago was groundbreaking, given the accepted medical opinion that diabetes – and not high blood sugar – caused complications.
More recently, Dr. Jovanovič contributed to the CONCEPTT trial that examined whether babies born to mothers with diabetes had a higher risk of birth defects, malformation, congenital anomalies, or spontaneous abortions. Unsurprisingly to Dr. Jovanovič, it was high blood sugar that led to complications and not simply having diabetes. Even slightly elevated blood sugar was associated with an increased risk of complications, reinforcing the need to achieve very tight target glucose levels (the ADA suggests 95-140 mg/dl), both before and during pregnancy. [Technologies like CGM and automated insulin delivery may help pregnant women with diabetes meet this goal – see this recent publication in New England Journal of Medicine.]
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Throughout her work to improve pregnancy outcomes for women with diabetes, Dr. Jovanovič draws on her extensive experience as a physician, researcher, and mother with diabetes herself. Read on for seven expert tips from a diaTribe exclusive interview with Dr. Jovanovič!
[Editor’s Note: Always check with your doctor before making medical decisions.]
Seven Tips on Diabetes and Pregnancy from Dr. Lois Jovanovič:
1. Find a doctor with robust experience managing diabetes and pregnancy, including experience with a specific diabetes type, family background, and lifestyle factors. Dr. Jovanovič suggests, “When you choose your doctor, ask ‘How many women just like me with my type of diabetes have you delivered babies for in the last year?’ If the doctor says less than five, it’s not the right doctor for you.”
2. Educate family members about the need to restrict carbohydrate intake while pregnant with diabetes. According to Dr. Jovanovič, it is important to make sure family members understand the importance of reducing carb intake for blood sugar management during pregnancy. She said that grandmas in particular “often think a pregnant lady needs to eat all the time and not only eat all the time, but eat tortillas and rice and pasta. The grandma often cooks and thickens food with starch, puts a lot of noodles in it, etc. Then of course the young woman doesn’t want to disappoint her grandma, and it can be a difficult situation.” Clear communication can help a supportive family provide medically sound support, in line with the mutually desired outcome – a healthy mom and baby!
3. Avoid cigarette smoke and other environmental hazards. A particularly important point is that family members of any pregnant women should quit smoking or only smoke when they are not at home. “There has to be absolutely no smoking in the house,” warned Dr. Jovanovič, highlighting that smoke poses serious health risks to the developing fetus. The American Cancer Society offers resources for those looking to quit smoking.
4. Get support from loved ones. Dr. Jovanovič stressed the need for the pregnant woman’s partner to be helpful in reducing physical and mental stress, including that arising from management of family affairs. This is particularly critical if she is placed on bed rest, which is more common for women with diabetes than without (gestational diabetes itself increases the likelihood of requiring at least partial bed rest; women with type 1 or 2 diabetes are more likely to have high blood pressure – a leading predictor of requiring bed rest – than women of childbearing age without diabetes). Dr. Jovanovič will sometimes even suggest that pregnant women on bed rest “stay in a hospital away from the family so the nurses can take care of them. That's usually the biggest support.” [Editor’s Note: Everyone is different; consult a healthcare provider for advice on individual care.]
5. Use the gestational period as a time to develop lifelong health habits. After delivery, Dr. Jovanovič said the mother should maintain pregnancy-appropriate eating habits (limited simple carbs, lots of fruits and vegetables). “The idea is for the whole family to take the behaviors formed during pregnancy and continue with them,” she said. “Pregnancy is an opportunity to learn habits and to keep them going all the time. Let that be the legacy that goes on to the next generation. The best thing is to teach children healthy habits early on.”
6. Stay active, but choose exercise type carefully. While staying active is a critical component of managing diabetes, exercise type could adversely impact the fetus’ health. According to Dr. Jovanovič, strenuous running early in pregnancy causes the uterine wall to contract and could potentially lead to a spontaneous abortion. As an alternative, Dr. Jovanovič suggests, “A great option is to sit in a chair and lift arm weights. That would get a cardiovascular workout, burn sugar, and won't bother the uterus. Weight-bearing exercise really is a contraindication during pregnancy.”
7. Gestational diabetes may have been undiagnosed type 2 diabetes – be vigilant of blood sugar after pregnancy. Dr. Jovanovič detailed how hormone levels change drastically after birth. This is especially true for women with a diagnosis of gestational diabetes: “For 36 hours, the diabetes appears to go away because the hormones are being cleared, but after 36 hours, that's the time to test to see whether or not there was undiagnosed type 2 diabetes. Don’t wait for another blood test weeks later. If you’re breastfeeding, it’s not fair to the baby to wait to get tested later because the sugar gets into the milk, and it isn't healthy for a baby to be sucking on sweet milk.” As Dr. Jovanovič explained, “gestational diabetes” can be a bit of a misnomer because what’s really diagnosed is better classified as hyperglycemia (high blood sugar) during pregnancy. It may go away after giving birth (embodying the more classic definition of gestational diabetes, but also imposing a great likelihood of developing type 2 diabetes later in life), but it may have been type 2 diabetes undiagnosed until pregnancy, requiring more immediate treatment.
[Photo Credit: Diabetes in Control]
