Many changes occur
after birth including loss of weight and a return to normal physical
activities. Many mothers also experience emotional "ups and downs"
as their hormone levels return to pre-pregnancy levels. Insulin needs
will be lower than they were during pregnancy and within a few weeks
after delivery, insulin doses should return to pre-pregnancy levels.
Patients who have
diabetes before becoming pregnant sometimes
have difficulty returning to their normal dietary routine after delivery.
It is often not easy to adhere to a rigorous schedule for meals and
snacks when caring for a new baby. It is critical that good monitoring
and eating habits be maintained for optimal control.
If gestational
diabetes requiring insulin developed during pregnancy, the physician
will probably discontinue insulin treatment after delivery and monitor
a few blood sugars before releasing you from the hospital.
Most of the time
(>90%) gestational diabetes
will resolve after pregnancy, however, some women have persistently
high blood sugars and require postpartum treatment. Fasting blood sugars
should be drawn at the 6 to 8 weeks postpartum visits.
If the fasting
sugar is > 125 mg/dl or a random sugar is > 200 mg/dl (on two
occasions), overt diabetes needing treatment is present.
If the fasting
sugar is 111 - 125 mg/dl, a 2-hour oral glucose tolerance test should
be administered with a 75-gram glucose load for further evaluation.
If the fasting
sugar is < 111 mg/dl, the diabetes has resolved but a screening
test should be performed every year particularly if insulin was required
during the pregnancy since up to 60% of women will develop overt diabetes
later in life.
Breast
feeding
Mothers
with diabetes can breast feed their children
and, like for all nursing mothers, caloric needs must be carefully adjusted.
Approximately 500 calories per day should be added to the pre-pregnancy
diet, which covers the extra energy needed for milk production. If breast
feeding continues for longer than 3 months, a further increase in calories
may be needed.
A record of glucose
levels must be kept because breast feeding moms who have pre-gestational
diabetes will be more prone to hypoglycemia, particularly in the nighttime
hours between the bedtime snack and breakfast. A snack may be needed
before nighttime breast feeding
If an oral medication
was prescribed to control blood sugars before pregnancy and the doctor
switched to insulin during pregnancy, insulin may still be needed while
breast feeding Oral medications should not be taken while breast feeding
without approval of the doctor.
Birth Control
Birth control choices
should be discussed with the doctor or nurse before discharge from the
hospital. Choosing the safest and best time to have a child is one of
the keys to planning a successful pregnancy for the woman with diabetes.
Ideally, a physician will be seen in the preconception period (prior
to conception of the baby).
No form of contraception
is specifically contraindicated in women with diabetes, however the
usual indications and contraindications for each form should be considered.
Contraceptives containing only progesterone (e.g. the minipill, Norplant,
Depo-Provera) may make sugar control more difficult or have a negative
effect on the cholesterol and lipids. In addition, there is some evidence
that in women who had gestational diabetes, using a contraceptive with
only progesterone may increase the chance of developing overt diabetes
later in life.
Remember, pregnancy
is possible soon after giving birth. Even if there has been no menstrual
period, ovulation may still occur. Some people believe that breast feeding
a baby will prevent pregnancy…. Beware, this is not true!
This
information is not intended to substitute or replace the professional
medical advice you receive from your physician. The content provided
on this page is for informational purposes only, and was not designed
to diagnose or treat a health problem or disease. Please consult your
physician with any questions or concerns you may have regarding a medical
condition.
Mothers
with 
