Diabetes and pregnancy
Most women with type 1 or type 2 diabetes have healthy pregnancies and healthy babies, but the condition does require special management during pregnancy.
Pregnancy places extra demands on a woman's body meaning diabetes needs to be carefully monitored and blood sugar levels well managed.
Diabetes in pregnancy increases the risk of having a large baby, stillbirth, miscarriage, the need for a caesarean delivery and possible health problems for the child later in life.
If you have diabetes and would like to get pregnant, there are steps you can take with your diabetes care team take to lessen the risks to you and your baby.
As well as managing diabetes, the normal pre-pregnancy advice will be given to not smoke, avoid alcohol, have a healthy balanced diet, and to stay active.
Preparing for pregnancy when you have diabetes
If you have diabetes, discussing everything with your doctor before becoming pregnant is important.
A doctor will look at HbA1c blood glucose readings to see how well controlled the diabetes has been over the past 2 to 3 months against individual targets.
A woman with an HbA1c reading of more than 86mmol/mol will be advised to avoid pregnancy.
Readings below 43mmol/mol may be recommended before pregnancy and targets adjusted during the pregnancy.
Other diabetes tests before getting pregnant
Having other medical tests before you become pregnant can also help your doctor monitor your health and help prevent the development of diabetic complications during pregnancy. Some of the tests your doctor may recommend include:
- An assessment of kidney function to screen for diabetic kidney complications
- Cholesterol and triglyceride blood tests
- An eye examination, in the form of a retinal assessment, to screen for retinopathy
- Self-monitoring of blood glucose levels
In this pre-conceptual period, it is important to discuss with your doctor the safety of any medications that you take, since some may be unsafe in pregnancy.
Women with diabetes who are planning a pregnancy should also take 5mg folic acid daily whilst trying to become pregnant and for the first 12 weeks of pregnancy. This reduces the likelihood of having a baby with a neural tube defect (for example, spina bifida).
A pre-conception counselling appointment with your doctor is another important step in preparing for pregnancy. Pre-conception counselling helps educate women so they can be physically and emotionally prepared (and healthy) for pregnancy.
Blood sugar control before and during pregnancy
Good diabetic control both before and during pregnancy lessens the risk of complications during pregnancy. Good blood sugar control means keeping blood glucose levels within the ideal range, as well as balancing meals, exercise, and diabetes medications.
Good blood sugar control is important before becoming pregnant because many women do not even know they are pregnant until the baby has been growing for 2-4 weeks. If blood sugar levels are high early on in the pregnancy (before 13 weeks), this can be a cause of birth defects.
Good blood sugar control is just as important during pregnancy when women should be aiming for their recommended target blood glucose levels, because high blood sugar levels can increase the risk of miscarriage and of developing diabetes-related complications.