Having children is a big decision for anyone. If you are a woman who has diabetes, it is a decision that requires much more thought and careful planning.
Planning for a successful pregnancy
Diabetes UK’sHelplineoften gets asked ‘Can I have a baby if I have diabetes?’ The answer is yes, many women who have diabetes (Type 1, Type 2 or gestational diabetes) have perfectly healthy pregnancies and wonderfully healthy babies. But this isn't to say that it's an easy experience – it requires a lot of work and dedication on your part. If you are planning to have a baby, or think you are pregnant, then it is vital that you speak to your diabetes care team.
Success stories - pregnancy with Type 1 diabetes
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Check out our video Rebel Rebel, to help understand the importance of planning your pregnancy.
Preconception care should start from adolescence and it is important to use effective contraception until you want to become pregnant. If you have Type 1 diabetes or Type 2 diabetes and are thinking of having a baby, it is a good idea for you to know what tests and treatment to expect, and what you can do to get your pregnancy off to a healthy start. Ask to be referred to a pre-conception clinic that is usually run by the diabetes midwife and the diabetes specialist nurse. Avoid alcohol while you are trying to conceive as well as during pregnancy.
You can also find lots of really useful preconception information on theQueen's University Belfast's Women with Diabetes page.
Reducing the risks for you and your baby
For you, risks can include an increased risk of miscarriage, problems with your eyes and your kidneys, and having a large baby, which can make labour more difficult.
For your baby, risks can include health problems after birth requiring special or intensive care, as well as the possibility of heart problems, spina bifida and other birth defects. There is also an increased risk of stillbirth or your baby dying shortly after birth.
By planning ahead, you can really improve your chances of having a healthy pregnancy and a healthy baby.
Check your medications
Some medicines used in managing diabetes should not be taken by pregnant women. If you are on a statin, ACE inhibitor or similar blood pressure tablets you must tell your doctor if you plan to become pregnant or immediately you find out that you are pregnant, as these may harm your baby.
Many medicines used for blood glucose (also called blood sugar) control in Type 2 diabetes should not be taken in pregnancy so you may need to switch to insulin injections to control your blood sugar before or as soon as you find out you are pregnant. After the birth, you can usually return to your pre-pregnancy medications. Your doctor will tell you whether or not you need to change your medications.
Keeping control of your blood sugar levels
Before you stop contraception, it is really important that you get your HbA1c checked. You can increase your chances of delivering a healthy baby by keeping your blood sugar levels in control before conception and throughout your pregnancy.
The first eight weeks are particularly important for the physical development of your baby. If your HbA1c is more than 86mmol/mol, you should avoid getting pregnant. Ideally you should aim to keep your HbA1c below 48mmol/mol if you are planning to become pregnant. Your diabetes team will discuss your individual target and any reduction towards the target of 48mmol/mol is likely to reduce risks to your baby.
You’ll also be encouraged, and supported, to safely aim for the following blood sugar targets:
- when you wake up: 5–7mmol/l
- before meals at other times of the day: 4–7mmol/l
- 90 minutes after meals: 5–9mmol/l.
If you're planning to get pregnant and don't have a blood sugar testing kit, ask your diabetes team. If you have Type 1 diabetes, make sure your meter can test ketones too.
Checking for diabetes complications: eye and kidney checks
Pregnancy can make certain diabetes complications worse, so it's important to have a retinal screening of your eyes and specific test for your kidneys before you stop contraception. Your team will discuss your results with you and give you specific advice. In some cases, they may refer you to a specialist team for extra support.
Start taking 5mg folic acid until the end of the 12th week of your pregnancy, to help prevent neural tube defects. This is a high-dose folic acid and will need to be prescribed by your doctor or nurse.
During your pregnancy
You will be offered extra monitoring appointments and scans during your pregnancy to help you keep good control of your blood sugar and check your baby’s growth and development. You should have contact with a joint diabetes and antenatal team weekly or fortnightly throughout your pregnancy.
Your diabetes team will encourage you to do more blood glucose tests and agree personal target levels. As a general guideline, you should aim for:
- when fasting: below 5.3mmol/l
- 1 hour after meals: below 7.8mmol/l
- 2 hours after meals: below 6.4mmol/l.
Depending on how your diabetes is treated, you may find you are more at risk ofhypos. If you have Type 1 diabetes, you should be given a glucagon kit. Ensure that family or friends understand how to use the glucagon kit if you are unable to treat a hypo yourself. Your diabetes team will work with you very closely to manage your insulin needs.
If you have Type 1 diabetes, you should be given a meter that tests ketones so that you can test your blood ketones, and seek urgent medical advice if your blood sugar levels become too high or you become unwell. For women with Type 2 diabetes or gestational diabetes, it is extremely important to contact your diabetes team if your blood sugar levels remain high or you feel unwell. Your blood will be tested for ketones in order to rule outdiabetic ketoacidosis (DKA).
Lifestyle tips for a healthy pregnancy
- Stop smoking – smoking during pregnancy can harm your baby.
- Avoid alcohol – the safest approach is not to drink at all while you're pregnant.
- Eat a healthy, balanced diet – eat healthily for you and your baby.
- Keep active – staying fit in pregnancy helps you to adapt to changes in shape and weight.
Morning sickness can cause problems with your blood sugar control. Here's some advice on what to do:
- Contact your diabetes team if you struggle to keep food and drink down.
- Make sure you get plenty of rest.
- Try to eat small, regular, carbohydrate-containing snacks, such as soup and crackers or plain biscuits.
- Try sipping drinks such as water, little and often rather than large amounts all in one go.
- If you don’t feel like eating and you are treated with insulin, drink a sugary drink to avoid going hypo, but always take your insulin. If this doesn’t help, your doctor may be able to prescribe a safe medicine to control the vomiting.
- If you have repeated vomiting and/or a high level of ketones on testing, you should seek medical advice as soon as possible to prevent the ketones from harming your baby.
Labour and birth
Your team will discuss your birth plans with you, including timings and whether you need an induction or caesarean section.
During labour and birth, your team will monitor your blood sugar closely and try to keep your levels between 4–7mmol/l. In some cases, you may need an intravenous insulin and glucose drip to achieve this. If you have diabetes, it is advisable to give birth in a hospital so that you can have immediate attention in case of any medical emergency.
You and your baby
Generally, your experience should be similar to other new mothers. But if you have diabetes, doctors will take extra steps to make sure you and your baby get off to a healthy start. These will include the following:
- After delivery, your insulin needs will significantly drop so it is important to monitor your blood sugar levels closely so your insulin dose can be adjusted as needed.
- All babies' blood sugar levels drop after separation from the mother. Feeding them soon after delivery and at regular intervals usually resolves this.
- Your baby’s blood glucose will be regularly checked after birth and extra feeding may be required. Your baby should stay with you unless there is a medical reason why he or she needs admitting to a neonatal unit for extra care.
- Your blood sugar will be checked regularly, until your levels stabilise. When you resume your normal diet, you should also return to your pre-pregnancy insulin dose. If you were taking insulin or any other medication for gestational diabetes, these can usually be stopped immediately after delivery.
- Most women who deliver by caesarean section are given antibiotics after delivery in order to decrease the risk of infection at the wound site.
Breastfeeding and diabetes
There’s no reason why women with diabetes cannot breastfeed. You may have some early difficulties – for example if your baby needs extra feeds, or if you were initially separated from your baby due to caesarean section or your baby’s treatment in the neonatal unit – but with patience and practice you and your baby should be able to establish a good breastfeeding pattern.
- Breastfeeding may lower your insulin needs by up to 25%. Breast milk contains sugar called lactose. Every time you feed your baby, you lose that sugar and your blood sugar levels will drop. This can cause a hypo, especially if you treat you diabetes with insulin. To help avoid hypos, it is a good idea to have a snack handy before or during each feed.
- If you take metformin or glibenclamide for Type 2 diabetes, you can usually resume or continue taking these while breastfeeding.
- You should continue to avoid any medication that was stopped before or during pregnancy, for safety reasons if you are breastfeeding. Talk to your doctor about this.
Gestational diabetes mellitus (GDM) is a type of diabetes that arises during pregnancy (usually during the second or third trimester). In some women, GDM occurs because the body cannot produce enough insulin to meet the extra needs of pregnancy. In others, diabetes may be found during the first trimester of pregnancy. In these cases, the condition most likely existed before the pregnancy. A test called an oral glucose tolerance test (OGTT) is used to diagnose GDM. An OGTT involves a blood test.
Find out more aboutgestational diabetes.