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 the Queen'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
You can increase your chances of delivering a healthy baby by keeping your blood glucose in control before conception and throughout 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 pregnancy: ideally it should be below 48mmol/mol.
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 glucose (blood sugar) targets:
- on waking: 5–7mmol/l
- before meals at other times of the day: 4–7mmol/l
- 90 minutes after meals: 5–9mmol/l.
If you do not have blood sugar testing kits, ask your diabetes team if you are planning to get pregnant. 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 is 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 twelfth 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, your aim should be for:
- 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 of hypos. If you have Type 1 diabetes, you should be given a glucagon kit. Ensure that family/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 out diabetic 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 expecting
- 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.
- 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 the 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.
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 per cent. 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. Please check with your doctor.
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 about gestational diabetes.