Diabetes in Pregnancy
Women with diabetes, (type 1, type 2 and gestational diabetes) have healthy pregnancies and healthy babies and for most women is a very positive experience. If you are planning to have a baby or you think you are pregnant then it is really important to discuss this with your GP or diabetes team. If you have type 1 or type 2 diabetes it's very important to plan your pregnancy, and with the support of your diabetes team you can ensure you get that positive outcome.
Pre conception care for women with pre existing diabetes
Pre conception care should start from adolescence, it is recommended to use some form of contraception until you decide you want to become pregnant and your diabetes control is under excellent control.
York Teaching Hospitals Foundation Trust offer a pre conception service run by the specialist diabetes team. Tel : 01904 726510
Things to consider prior to pregnancy
Keep your blood glucose levels as near normal as possible. NICE recommend a target Hba1c of 43 mmol/mol (6.1%) prior to conception and for at least 3 months before. If your blood glucose control isn't controlled before and during pregnancy, the risk of miscarriage and stillbirth is increased. Your baby's development may also be affected.
Discuss your current medications with your diabetes team - some medications including anti hypertensive (blood pressure medication) some injectables for treatment in type 2 diabetes and statins (cholesterol lowering medication) are not recommended during pregnancy and may need to be changed or stopped.
Have your retinal screening (eyes photographed)
Start taking folic acid (5mgs dose) once daily until the end of the twelfth week of your pregnancy to help prevent neural tube defects- this will be prescribed by your GP or diabetes team.
Eat a healthy balanced diet
Ensure your annual blood and urine tests are up to date.
Once you become pregnant you will be seen in joint diabetes, obstetric clinic regularly for monitoring and scans to support you in keeping good control of your blood glucose levels and to check your baby's growth and development.
The target levels for your blood glucose levels will be discussed, generally aiming for 4 - 6 mmol/l before meals and no more than 7.8 mmo/l one hour after meals.
As you may be more at risk of hypoglycaemia especially early in your pregnancy then you will be given advice on treatment of severe hypoglyceamia. You will also be given specific advice of management of hyperglycaemia and when to test for ketones.
As your pregnancy progresses, you will probably find that the amount of insulin / medication you take will need to be increased. This is perfectly normal and due to the changes in your hormone levels.
Women with diabetes sometimes have larger than average babies, and you may need to be induced. Most ladies with pre existing diabetes will deliver their baby at between 38 - 40 weeks gestation. This will be discussed with you by the Obstetric / Diabetes Team.
During labour, your blood glucose levels will be monitored closely by the midwives. You may need to have an insulin infusion during labour (a continuous amount of insulin is fed into your blood stream through a tube)
After the birth
All babies' blood glucose levels drop after separation from the mother, breastfeeding or feeding your baby soon after delivery is encouraged to resolve this. Your baby's blood glucose levels will be checked regularly after birth and extra feeds may be given if needed. Your baby should stay with you unless there is a medical reason why he/she needs admitting to neonatal care for extra care/ monitoring.
After delivery insulin requirements will drop significantly, blood glucose levels will be monitored closely and insulin requirement often return to pre pregnancy doses.
You will be followed up in the joint diabetes obstetric clinic 6 weeks after the birth of your baby then your diabetes care will continue as before your pregnancy.
There is no reason why women with diabetes cannot breastfeed. Breastfeeding is generally thought to be best for babies. You will be given advice and support on this from your midwife / breast feeding advisor.
Breastfeeding can lower your insulin requirements by up to 25%, but can increase your risk of hypoglycaemia so eating more or adjusting your insulin may be needed. Breastfeeding can even help you lose weight.