Pregnancy and Diabetes

Planning a pregnancy

Pregnant womanIf you have Type 1 or Type 2 diabetes, it is very important to talk to your diabetes team before you start to try to become pregnant. This is because your blood sugars should be stable and as near normal as possible to ensure that you remain healthy and that your baby grows and develops normally. In order to achieve this, you may need some help adjusting your diet or diabetes treatment.

Before becoming pregnant, there are a number of things to think about:-

  • Try to keep blood sugars as near to normal for at least 3 months before trying to become pregnant. We recommend 4-6mmol/l before meals and no higher than 8mmol/l 2 hours after meals. The HbA1c test looks at your long-term blood sugar control – you should aim to have this below 7% before a pregnancy.
  • Start taking folic acid supplements for at least 3 months before pregnancy – when you have diabetes there is a higher risk of the baby developing spina bifida. Folic acid helps to lower this risk and we would recommend that you take the higher dose of 5mg daily until you are 12 weeks pregnant. This dose of folic acid is available from your GP.
  • You may need to change your diabetes medication before considering pregnancy:
    • If you are on diet only for your diabetes then it is likely that you will need to start on insulin at some stage either before or during pregnancy
    • If your diabetes is treated with tablets – then is advisable to change to insulin before pregnancy
    • If your diabetes is treated with insulin – you may need to change your doses or increase the number of times a day you take injections to help improve your blood sugar control.
    • If you are taking blood pressure or cholesterol medication these may need to stop or be changed before becoming pregnant.
  • It is a good idea to have your rubella (german measles) status checked by a blood test – if you are not immune to this, you will need an injection as contracting rubella in the early stages of pregnancy can put the baby at significant risk of abnormalities.
  • If you smoke – please stop. Stopping smoking will help protect your baby’s health as well as your own. We can provide you with support to help stop now if you would like (??tel no for smoking cessation)
  • It is also important to stop or cut down on alcohol before becoming pregnant.
  • It is important to eat a healthy balanced diet before embarking on pregnancy – if you have any concerns, it would be a good idea to speak with your dietitian and have your diet reviewed
  • You should consider having your eyes checked before pregnancy – your diabetes team can organise this for you.

It is important that you continue with your usual contraception until your diabetes team are happy that it is safe for you to become pregnant and give you the ‘go-ahead’.

Once there is a gap of 5 weeks since the start of your last period, check a pregnancy test. As soon as you know you are pregnant – tell your GP and diabetes specialist nurse who will arrange for you to have an early visit to the hospital antenatal clinic.

Pregnancy and Diabetes

Managing Diabetes during Pregnancy

Now that you are pregnant, the hard work really starts!

Good control of your diabetes during pregnancy combined with good antenatal care is known to reduce the risk for babies born to diabetic mothers. It is important to keep your blood sugars as near to normal as possible for the whole of pregnancy because

  • High blood sugars before and in early pregnancy could prevent your baby from developing normally
  • High blood sugars during pregnancy may cause the baby to grow quickly and become overweight, especially in the last 3 months. This can lead to problems for you during delivery (higher chance of caesarian section or forceps delivery) and could also mean that your baby may be born prematurely or have problems controlling his/her blood sugars immediately after birth (known as hypoglycaemia).

At the Antenatal Clinic

You will be asked to attend our diabetes antenatal clinic at the Ulster Maternity unit as early as possible in pregnancy. We like to see you every 2 weeks throughout pregnancy. Our team consists of:

  • Dr R Harper - Physician
  • Dr P Hill, Dr C McElhenny - Obstetricians
  • Michelle Burke / Nicky Fuller - Diabetes Specialist Nurses
  • Lynne Thomas - Dietitian

We all work closely together to support you through your pregnancy.

What to expect as pregnancy progresses

Weeks 0 – 16 (1st Trimester)

  • Baby’s development: major organs are formed; nervous system begins to develop; eyes; ears and nose take shape
  • Clinic visits: You will see the diabetes team every 2 weeks and attend the obstetricians every month
  • Tests: An HbA1C will be checked every 2 weeks to help you monitor your blood sugar control. We will carry out blood tests to check your kidney function and with your consent will check a number of blood tests related to pregnancy. We recommend an ultrasound to measure the baby’s growth and confirm an expected date of birth. We will recommend an eye test to check for retinopathy.
  • Insulin needs: Your insulin needs can change in the early stages of pregnancy and it is important for you to monitor your blood sugars more regularly to help avoid hypos. It is common to suffer hypos more frequently in early pregnancy and you may find that the warning symptoms that you normally have are different from usual. If you are having frequent hypos it may be a good idea to stop driving until you are around 16 weeks pregnant – your diabetes team can advise you if you are worried (links to hypos and contact nos)
  • Your Goals:
    • Check blood sugars at least 4 times a day before meals – keep a diary documenting all your readings
    • Follow diet and exercise guide(link); stop smoking and stop alcohol
    • Contact your dietitian or midwife if you have particular problems with nausea and vomiting
    • Make sure you have a glucagon kit and that someone at home knows how to use it
    • Attend all your antenatal visits – but also feel free to phone us if you have any concerns (link)
    • Keep taking folic acid 5mg every day until you are at least 12 weeks pregnant

Weeks 16-28 (2nd Trimester)

  • Baby’s development: Heartbeat becomes regular and the brain becomes more complex. Body growth begins to catch up with head growth. Cannot yet breathe on its own. Movements will become more noticeable (you will probably start to feel movement between 17-23 weeks)
  • Clinic Visits: Both the diabetic team and the obstetric team will see you every 2 weeks
  • Tests: Detailed ultrasound is carried out at 18-22weeks to check for any major malformations – you will also be referred to Dr Frank Casey at the Royal Victoria Hospital for a detailed ultrasound scan of the baby’s heart at around 24 weeks – this is because babies born to mothers with diabetes are at a higher risk of heart abnormalities. We will continue to check an HbA1c every 2 weeks to monitor your blood sugar levels and will check a urine sample at every visit. We can carry out a screening blood test called the Triple Test at approx 15 weeks, if you request, to assess the risk of Down’s syndrome and spina bifida. From around 24 weeks of pregnancy we will start to regularly measure the baby’s growth by ultrasound scan.
  • Insulin needs: As the baby grows, your insulin doses may increase
  • Your goals:
    • Check your blood sugars at least 4 times a day before meals
    • Follow diet and exercise guidelines (link)
    • Come to all your antenatal appointments but feel free to contact the diabetes team if you have any concerns with either your diabetes or the pregnancy (link)

Weeks 28-40 (3rd Trimester)

  • Baby’s development: Brain grows rapidly during this stage. As the baby grows it is putting more demand on your body.
  • Clinic visits: Both the diabetic team and the obstetric team will see you every 2 weeks until you are 36 weeks pregnant and then every week until you have the baby.
  • Tests: Ultrasound at every visit to ensure the baby is growing satisfactorily. More frequent scans may be necessary if there are problems such as the baby growing too large, too slowly or if your blood pressure is increased. We will continue to check your HbA1c every 2 weeks and will check a urine sample at every visit.
  • Insulin needs: These will continue to increase and you may need 2-3 times your pre-pregnancy dose. If your insulin requirements decrease – contact the diabetes team.
  • Your goals:
    • Check your blood sugars at least 4 times a day before meals
    • Follow diet and exercise guidelines (link)
    • Come to all your antenatal appointments but feel free to contact the diabetes team if you have any concerns with either your diabetes or the pregnancy (link)
    • Check that your baby moves at least 10 times each day – if you have less movements or are concerned – please contact the Day Obstetric Unit for an antenatal check (Tel no 028 90550403)
    • Rest as much as possible