Women often say that managing diabetes when they’re pregnant is like a full-time job.
There are so many appointments, tests and scans. And as your baby grows inside you, it takes a lot of effort to keep blood sugar levels in a safe range.
It’s a lot of work, but it’s worth it. This will reduce the risk of complications and mean you’re more likely to have a successful pregnancy and a healthy baby.
And while all the scans and appointments take time and effort, it also means that your doctor and diabetes team are closely monitoring the health of you and your baby.
Ideally, you will have already spoken to your healthcare team about all the things you need to do to plan for a pregnancy. If you haven’t, it’s really important you speak to your doctor or nurse straight away. They will talk to you about:
- keeping blood sugar at safe levels
- taking folic acid
- stopping certain medications
- getting your eyes and kidneys checked.
You should be taking 5mg of folic acid. If you’re less than 12 weeks pregnant, speak to your healthcare team about getting a prescription. You don’t need to take it if you’ve passed the 12-week point.
Some medications aren’t safe to take when you’re pregnant, so you should’ve stopped taking them before your pregnancy. If you haven’t spoken to your healthcare team about your medication, talk to them as soon as possible.
It’s really important you have your kidneys and eyes checked. Talk to your diabetes team about arranging this.
Keeping your blood sugar at target levels
Your diabetes team will arrange regular appointments with you, to check your blood sugar and to help you keep it at a safe level. They will also check how your baby is growing.
You’ll have weekly or fortnightly contact with a joint diabetes and antenatal team throughout your pregnancy. It’s really important to keep in contact this often – the team are there to support you.
It’s vital you keep your blood sugar at the target levels agreed with your team, so you’ll need to check them more regularly. Your individual targets may be different, but you’re generally aiming for these:
- When you haven’t eaten – below 5.3mmol/l.
- One hour after eating a meal – below 7.8mmol/l, or two hours after meals – below 6.4mmol/l.
If you treat your diabetes with insulin, keeping tight control of your blood sugar levels means you’re more likely to have hypos. So try to plan ahead and make sure you always have something with you to prevent or treat a hypo.
If your blood sugar levels are too high or you feel unwell, see a doctor straight away.
Using diabetes tech
If you have Type 1 diabetes and are pregnant, you should be offered continuous glucose monitoring (CGM) free on the NHS – this is being rolled out during 2020 and 2021. CGM enables you to check your sugar levels at any time, shows you patterns in your levels and sends you an alert if your sugar levels are too high or low. Research shows that using CGM leads to improvements in blood sugars at target levels and fewer complications for your baby. And your baby is less likely to be admitted to a neonatal intensive care unit, and if they are, their stay should be shorter. We also know that being in your target range for longer will have benefits for you and your baby – this is called time-in-range. The Association of British Clinical Diabetologists has made some videos of people living with type 1 diabetes who are using continuous glucose monitoring in pregnancy.
If you have problems getting this tech or have more questions, give our helpline advisors a call.
You should also be given a glucagon kit if you have Type 1, for treating severe hypos. Make sure your friends and family know how to use it too, in case they need to do it for you. You’ll also need a meter to test for ketones. If the ketone test result is high, your blood sugar levels are too high or you feel unwell, see a doctor straight away.
Eat a healthy diet
It’s important for you and your baby that you follow a healthy, balanced diet. This also means not cutting out any important food groups, as this may not be safe for either of you. We know eating healthily isn’t always easy, and things like morning sickness can often get in the way.
Being sick can cause problems with your blood sugar levels. If you use insulin, this means you’re more likely to have hypos. It’s important to remember to keep taking your insulin.
If you’re struggling to keep food down, contact your diabetes team for advice. They may be able to prescribe medication to help with sickness.
Here are some things you can try too:
- Eat small, regular, carbohydrate-containing snacks – try soup and crackers or plain biscuits.
- Sip drinks like water little and often, rather than large amounts all in one go.
- If you don’t feel like eating, drink a sugary drink – this can help you avoid a hypo if you take insulin.
- Get plenty of rest.
If you’re being sick repeatedly or have a high level of ketones in your blood, speak to a doctor straight away. This is to stop the ketones from harming your baby.
In the same way that you need to eat the right things, you can also help keep you and your baby healthy by being more active. Regular physical activity can help you keep to a healthy weight, improve your blood sugar levels and reduce stress.
There’s lots of support out there to help you get active. Ask your healthcare team for information about activities in your area. This could be walking, swimming, or you could even give pregnancy yoga a try.
Doing something active can lower blood sugar levels. If you’re at risk of hypos because you take insulin, check your blood sugar regularly and have a hypo treatment close to hand.
Don’t drink alcohol
It’s safer not to drink any alcohol while you’re pregnant. Drinking during pregnancy can lead to long-term harm to your baby. The more you drink, the bigger the risk.
And if you treat your diabetes with insulin, alcohol can make hypos more likely.
If you smoke, being pregnant may be the incentive you need to stop smoking. Smoking can harm your unborn baby and make it harder for them to get their oxygen supply.
Don’t forget, if you live with someone who smokes, their smoke can also affect you and your baby before and after the birth. So you may want to talk about these risks with them.
For help to quit smoking, ask for support from your diabetes healthcare team. You can also get extra help from NHS Smokefree.
What to expect at the delivery
Most women want to know what to expect at the delivery. Knowing what can happen may help you feel more prepared and in control.
Your antenatal and diabetes team will be keeping a close eye on you and will check your blood sugar levels regularly. They’ll try to keep them between 4 and 7mmol/l.
If you have Type 1 diabetes, this means you’ll be started on an insulin and glucose drip. If you have Type 2 diabetes, you might also need to have a drip if your blood sugar levels don’t stay in this safe range.
Where to give birth
Your doctor and diabetes team will strongly suggest you choose a hospital birth, so you’re supported by a consultant and maternity team if you need urgent, specialist attention during delivery. This is to reduce the risks to you and your baby.
When and how to give birth
During your antenatal appointments, your healthcare team will talk to you about the best time and way to deliver your baby.
You can still have a natural birth, but it’s more common to have your labour induced (when labour is started artificially) or have a caesarean (C-section). This is because of the risks involved, such as your baby becoming too large. Your team will talk to you about this and why they think it’s the best thing to do for you and your baby.
If you haven’t had any health complications during your pregnancy, your doctor will recommend you’re induced or have a caesarean between 37 weeks and up to a day before week 39. If you’ve had some complications, you may be offered an even earlier delivery.
Your healthcare team will explain all the options to you and the risks involved. If you don’t understand anything or are worried about something, ask them questions and talk it all through before deciding anything. You may want someone with you, like a partner, friend or family member, so they can ask questions too.
We have more information to help you find out what to expect after delivery and how to take care of yourself and your baby.