Diabetes in Pregnancy
Before Pregnancy
Many women with type 1 diabetes will have a healthy pregnancy and a healthy baby but to achieve this will require real commitment on your part.
Diabetes in pregnancy is automatically considered to be high risk but there are things you can do to mitigate this risk and pre pregnancy that’s about ensuring that your blood glucose levels are well under control for at least 3 months before conception.
You should be aiming to have HbA1c below 48mmol/mol (6.5%). If your HbA1c is raised you may be advised by your specialist diabetes team to delay your pregnancy so that you can try and achieve that ideal HbA1c. It is vital that you discuss your plans for pregnancy and give as much notice as possible to your specialist team. High blood glucose and ketones are able to pass through the placenta into the fetus and this can increase the chance of problems for your baby such as:
- Congenital malformations of the heart and brain
- Being born prematurely
- Weighing too much
- Having breathing problems
- Having prolonged jaundice
- Having low blood glucose at birth
There is also an increased risk of miscarriage - however research shows that women who control their blood sugars before and during pregnancy carry about the same risks as those women without diabetes.
During Pregnancy
Because pregnancy inevitably causes changes in the body you need to be more mindful of your own health too. It can put extra pressure on the small vessels of your eyes so if you have untreated retinopathy make sure you get this treated before you become pregnant.
The main things that require monitoring is any worsening of eye or kidney problems; bladder and vaginal infections and any signs of pre-eclampsia (high blood pressure in pregnancy) - because of this you should be offered extra monitoring appointments and scans to keep good control of your blood glucose and to monitor your baby’s development.
It’s likely that your doctor will recommend the checking of your blood glucose several times a day – the frequency of this may have to be increased during periods of morning sickness as this can cause your blood glucose levels to rapidly rise.
Your doctor might also suggest that you check for ketones on a daily basis or when your blood glucose is above a certain level.
You’ll need to review your medications and supplements with your GP to ensure it is safe to continue with them during pregnancy. Medicines like statins, ACE inhibitors, ARB’s and most non- insulin therapies should not be taken by pregnant women. You will need to be on high dose folic acid pre-conception.
Even if you’ve had diabetes for a prolonged period, diabetes in pregnancy can throw things out so you might need to change your activity routine and meal plan more than once as you get closer to the delivery.
Labour and post pregnancy
Since you are physically active during labour you may not need much insulin but hospital staff will check your blood glucose levels frequently and may even use an IV line for insulin and glucose to keep your levels under control
The blood glucose levels of all babies drops after they are born but breastfeeding soon after delivery and then at regular intervals will usually resolve this. They baby will be regularly checked and extra feeds will be given if necessary.
After delivery your own insulin needs will drop significantly and you may need an IV insulin/glucose drip for a while with your insulin dose adjusted as required. However, once you resume your normal diet you should be able to go back onto your pre-pregnancy insulin dose.
Although every effort is made to ensure that all health advice on this website is accurate and up to date it is for information purposes and should not replace a visit to your doctor or health care professional.
As the advice is general in nature rather than specific to individuals Dr Vanderpump cannot accept any liability for actions arising from its use nor can he be held responsible for the content of any pages referenced by an external link
