Preconception care should start from adolescence. It is important to use some form of contraception until you decide you want to become pregnant. If you have diabetes and are thinking of getting pregnant it is vital that you ask your diabetes care team for pregnancy planning advice.
You can also find lots of really useful preconception information at the Queen's University Belfast 'Women with Diabetes' page.
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 which is usually run by the diabetes midwife and the diabetes specialist nurse.
Keep your blood glucose on target
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.
Have your eyes checked
Pregnancy can place extra pressure on the small vessels in your eyes, so if you have retinopathy that has not been treated, make sure it's treated before you become pregnant.
Check your medications
Some medicines used in the treatment of 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 find out that you are pregnant, as these may damage your baby’s development.
Some tablets for Type 2 diabetes should not be taken in pregnancy because they may harm your baby. You may need to switch to insulin injections to control your blood glucose, but you can usually return to tablets after pregnancy. Your doctor will tell you whether or not you need to change your medicine.
Start taking 5mg folic acid until the end of the twelfth week of your pregnancy to help prevent neural tube defects. This will need to be prescribed by your doctor
Avoid alcohol whilst trying to conceive.
During your pregnancy
You will be offered extra monitoring appointments and scans during your pregnancy to help you keep good control of your blood glucose and check your baby’s growth and development. You should have contact with your diabetes team every one or two weeks.
Your diabetes team will encourage you to do extra blood glucose tests and agree personal target levels. Generally, pregnant women are advised to aim below the following target levels:
- 1 hour after meals: 7.8mmol/l or
- 2 hours after meals: 6.4mmol/l
Depending on how your diabetes is treated, you may find you are more at risk of hypos due to tighter control. If you have Type 1 diabetes, you should be given a ketone testing kit and a glucagon kit. Ensure that family/friends understand how to use the glucagon kit if you are unable to treat a hypo yourself.
It is extremely important to contact your diabetes team if your blood glucose levels remain high or you feel unwell. Your blood will be tested for ketones in order to rule out diabetic ketoacidosis (DKA).
As part of your delivery plan, you may be offered an induction of labour or caesarean section if this is the best option for you.
After the birth
Generally, your experience should be the same as anyone’s. But because you have diabetes, doctors will take some extra steps to make sure you and your baby are off to a healthy start.
- Your baby: All babies' blood glucose levels drop after separation from the mother. Breastfeeding soon after delivery and at regular intervals usually resolves this.
- Your baby’s blood glucose will be regularly checked after birth and xtra feeds may be given if needed.Your baby should stay with you unless ther is a medical reason why he or she needs admitting to a neonatal unit for extra care.
- After delivery your insulin needs will significantly drop. You may need an intravenous insulin/glucose drip for a few hours after delivery and your insulin dose will be adjusted as needed.
- Your blood glucose 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 for gestational diabetes, the insulin 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 per cent. Breast milk contains sugar called lactose. Every time you feed your baby, you will lose that sugar and your blood glucose will drop, which may cause a hypo. To help avoid hypos, you may need to eat 40–50g more starchy foods per day while you are breastfeeding.
- Even though you will be eating more, breastfeeding will not make you gain weight. In fact, it may help you lose weight.
- If you take metformin or glibenclamide for Type 2 diabetes, you can usually resume or continue taking these while breastfeeding, if your doctor is in agreement.
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 other women, GDM may be found during the first trimester of pregnancy. In these women, 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 before breakfast, then again two hours after a glucose drink.
Find out more about gestational diabetes.