Pregnancy and Diabetes

Careful planning and working with your diabetes team
from the start are key to having a successful pregnancy and a healthy baby.

When deciding to have a baby, some people plan carefully for parenthood, while others are happy to let nature take its course. Research shows one in six pregnancies in Britain are unplanned.1

But if you’re a woman with diabetes, you shouldn’t leave pregnancy to chance. That’s because if your diabetes isn’t carefully controlled before you conceive and while you’re pregnant, you and your baby run a higher risk of developing complications that can be very serious. These can include:2

  • Having a large baby and complications in labour
  • A higher risk of miscarriage and slightly higher risk of stillbirth than women without diabetes
  • A slightly higher risk of birth defects, such as spina bifida or heart problems
  • A higher risk of your baby needing special care shortly after birth

Being pregnant can also bring on, or make worse, long-term complications of diabetes such as diabetic retinopathy, which can affect your sight, or kidney problems. You may also be at higher risk of developing diabetic ketoacidosis.2

Pregnant woman scanning her glucose level

The good news is, most women who have diabetes have healthy pregnancies and safely deliver a healthy baby.2 Knowing the risks, careful planning and working with your diabetes team from the start are key to achieving the best possible outcome.

Having been diagnosed with Type 1 or Type 2 diabetes before you become pregnant is different from gestational diabetes, which only develops during pregnancy and disappears after the birth.

If you know you have diabetes and want to try for a baby, your first step (before planning those romantic nights in) should be to make an appointment with your diabetes care team, who may refer you to a specialist diabetic pre-conception clinic.2

What should my glucose level be before pregnancy?

Keeping tight control on your glucose levels is especially important pre-conception and during pregnancy.7 Before you start trying for a baby, your care team will advise you to use reliable contraception until your glucose level is in a safe range.3

Before getting pregnant it’s usually advised to keep your HbA1c level to 48mmol/mol or below. If your HbA1c is higher than 86mmol/mol, you should be advised not to get pregnant until it’s fallen to a safer level.3

What else should I do before trying for a baby?

All women are advised to take folic acid supplements before conceiving and in early pregnancy, to reduce the risk of the baby developing spina bifida. Women with diabetes should take a higher dose (5mg daily), which your GP can prescribe.2

You should also be offered a specialist eye test to screen for diabetic retinopathy and urine and blood tests to check your kidney function.6

If you take medications for high blood pressure or to control cholesterol, which many people with diabetes do, you may be advised to change your prescription or stop taking them when you’re pregnant.6

Preparing for pregnancy is also the ideal opportunity to get into healthy habits, such as stopping smoking, cutting out alcohol4, taking regular exercise and eating a healthy diet.

Will pregnancy change my diabetes treatment?

Your diabetes treatment during pregnancy will focus on:

  • Helping you to keep your glucose levels within a safe range3

During pregnancy the general recommendation for glucose levels is below 5.3mmol/L before meals, below 7.8mmol/L one hour after eating and no higher than 6.4mmol/L two hours after eating.8 Testing your glucose more often can help you keep track of your levels.

To make it easier to keep tight glucose control, you may be advised to adjust your insulin routine, if you have Type 1 diabetes, or to start having insulin injections if you have Type 2 diabetes managed with medication.2

Another risk with pregnancy is that your warning signs for a hypo may decrease, making it harder for you to notice a falling glucose level and treat it before the level goes too low. Hypos don’t harm your baby but are unpleasant and can be dangerous, for example when driving. Talk to your diabetes care team about how to spot and treat a hypo, and make sure those close to you know too.2

As well as the usual scans and tests that all pregnant women are offered, you may be advised to have:2

  • Regular specialist eye tests to screen for diabetic retinopathy, which can be treated if spotted early
  • Monthly HbA1c tests
  • Regular monitoring to check your baby is progressing well and you aren’t developing diabetes complications.

What if I have morning sickness?

Morning sickness is better described as nausea and vomiting in pregnancy (NVP) as it can happen at any time of day. Between 70% and 80% of pregnant women experience nausea or vomiting at times during their pregnancy.5

Controlling your glucose if you’ve no appetite or are vomiting can be difficult, so if you’re affected by NVP it’s important to take advice from your diabetes care team.

What can I expect when I give birth?

To reduce the risk of anything going wrong during labour and delivery you’ll be advised to give birth in hospital, under the care of a diabetes specialist team.6 Depending on how your pregnancy has progressed, you may be advised to have labour induced, or to have an elective Caesarean section if these are safer options for you and the baby.2 Throughout labour, your glucose and insulin levels will be constantly monitored to keep them as stable as possible until your baby has been safely delivered.6

 

References

1.Wellings, K et al 2013, The prevalence of unplanned pregnancy and associated factors in Britain: findings from the third National Survey of Sexual Attitudes and Lifestyles (Natsal-3), The Lancet, 382, 9907, 1757-1856, e26-e-32, accessed 29 March 2019, https://www.thelancet.com/journals/lancet/issue/vol382no9907/PIIS0140-6736(13)X6059-3/.

2.NHS 2019, Diabetes and pregnancy, accessed 29 March 2019, https://www.nhs.uk/conditions/pregnancy-and-baby/diabetes-pregnant/.

3.Diabetes UK 2019, Planning for a pregnancy when you have diabetes, accessed 29 March 2019, https://www.diabetes.org.uk/guide-to-diabetes/life-with-diabetes/pregnancy/.

4.NHS 2017, No change to alcohol guidelines in pregnancy, accessed 29 March 2019.

5.Pregnancy Sickness Support 2019, Nausea and Vomiting in Pregnancy, accessed 29 March 2019, https://www.pregnancysicknesssupport.org.uk/get-help/faq/.

6.NICE 2013, Guideline NG3: Diabetes in pregnancy: management from preconception to the postnatal period, https://www.nice.org.uk/guidance/ng3/ifp/chapter/checking-for-complications-of-diabetes-before-pregnancy.

7.Diabetes UK 2019, Pregnancy: know the risks, accessed 29 March 2019, https://www.diabetes.org.uk/guide-to-diabetes/life-with-diabetes/pregnancy#Know%20the%20risks%20of%20possible%20complications.

8.Diabetes UK 2019, Managing your diabetes during pregnancy, accessed 29 March 2019, https://diabetes.org.uk/guide-to-diabetes/life-with-diabetes/pregnancy/during-pregnancy?_ga=2.108271106.1615928332.1559026366-1494646317.1367014856/.

 

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