Pregnancy and Diabetes
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As a diabetic woman, what do I need to know before considering pregnancy?
- Over 95% of babies born to diabetic mothers are healthy and well
- Both mums and infants need very intensive input before, during and after
pregnancy. Good glucose control is especially important before and throughout
- To increase the chances of a good outcome, you need to plan your pregnancy.
This means you (and your partner) should discuss pregnancy management
with a specialised diabetes and obstetric team (your General Practitioner
can refer you for this).
What will happen at a pre-pregnancy assessment ?
- You will be given the opportunity to discuss any questions you have about
- A series of blood tests will be checked for anaemia, rubella (German Measles)
immunity, thyroid and kidney function. Another important investigation
is the HbA1C test, which measures the average glucose over the previous
two to three months. Efforts will be made to keep your HbA1C level as
close to the non-diabetic range as possible. If your diabetes is controlled
by tablets, the diabetes team may recommend switching to insulin.
- You will be advised to begin taking folic acid (5mg daily) in the months
before you become pregnant right through until the end of the first trimester
of your pregnancy (12 weeks). The 5mg dose of folic acid can only be obtained
- Certain medications need to be avoided in pregnancy. It may be advised some
tablets are discontinued and alternatives suggested.
What about glucose control?
- It is important to maintain blood sugar levels within the normal range
(fasting around 4-5mmol/l and after a meal less than 7.8mmol/l) for as
much of the day as possible both before you become pregnant and throughout
- You should be aware that this involves very regular blood testing (often
over 4 times a day), adherence to dietary recommendations and regular
insulin administration (usually 4 times a day).
What about hypos in pregnancy?
Hypoglycaemia is common in pregnancy. It can happen more often and be
more severe. Family members should be warned of this and they should be
instructed on how to treat hypoglycaemia.
What if my tests are high?
- If your glucose levels are raised (over 10mmol/l) it is important to monitor
urinary or plasma ketones.
- Ketones can increase quickly during pregnancy, they can harm your baby
as well as making you ill.
- You should contact your telephone helpline or General Practitioner for
advice if ketones develop.
Will my delivery be normal?
- In Scotland, one third of diabetic women have a vaginal delivery and two
thirds have caesarean sections. No matter what type of delivery you have,
blood sugar will be closely monitored and maintained throughout labour.
- All women with diabetes are delivered in hospital with access to a Neonatal
Unit since the baby needs to have regular blood sugar measurements to
ensure these are not in the low range.
- You will be expected to deliver in hospital, no later than 40 weeks. Labour
may be induced at this point if it shows no sign of beginning by itself.
Arrangements with your midwife for tour of Labour Ward and Neonatal Unit
will be arranged.
Will the health of my baby be affected?
- As mentioned above the vast majority of pregnancies in women with diabetes
have a very good outcome. In comparison with the population as a whole
however, there is a slightly increased risk of neonatal death and malformations
in the infant. By ensuring blood sugar control is optimal before and
throughout pregnancy, you can reduce these risks to levels approaching
that of the non-diabetic population.
- Babies of mothers with diabetes tend to be bigger than other babies. This
is sometimes called macro-somia. The blood sugar level of the mother
is one of the major factors affecting this growth and this is why we emphasise
the importance of keeping blood sugar as near the normal range as possible.
Will my baby be diabetic?
- No, not at birth. In fact, babies of mothers with diabetes tend to have
low blood sugar and for this reason the glucose will be monitored around
the time of delivery.
- Compared to non-diabetic women, there is only a very slightly increased
risk of your child developing diabetes in later life.
What should I expect during pregnancy?
- In most hospitals there is a dedicated multi-disciplinary team comprising
obstetricians, physicians, midwives, nurse specialists and dieticians
involved in the care of women with diabetes who are pregnant.
- You will be encouraged to attend clinic assessment as soon as pregnancy
is confirmed. In the survey, most women attend before 8 weeks gestation.
In addition, women with diabetes attend hospital more frequently than
- You will have several ultrasound scans to check fetal growth and development.
- As with almost all other pregnant women you are likely to be offered serum
screening (a test to check for Downs' Syndrome and Spina Bifida) at around
16 weeks of gestation.
- You will have more frequent checks of your eyes and kidney function during
pregnancy (it is recommended that the eyes are checked around 3 times
during the course of pregnancy). This is because occasionally the eye
appearances can change during pregnancy and referral for a specialist
opinion is recommended.
- Any changes generally revert back to normal after delivery.
Is breast feeding possible for those with diabetes?
- Yes it is. Breast milk of mothers with diabetes is the same as those without
- In fact, just like for all other women, breast-feeding is recommended
for those with diabetes. You should be aware however, that it can reduce
your blood sugar level and that diet may need adjusted to cope with
Advantages for baby
Advantages for mum
- Reduces risk of gastro intestinal infections
- Reduces risk of chest, urine and ear infections
- Reduces risk of asthma, eczema and childhood diabetes
- A faster return to pre pregnancy weight
- Reduces risk of osteoporosis
- Reduces risk of ovarian and breast cancer
- Bonding immediately after birth
Post natally expect
- Your insulin requirements to go back to pre-pregnancy levels, you may have required up to twice as much during pregnancy.
- To continue frequent blood tests
- A change in blood sugar profile
- An increase in carbohydrate intake
- If you were not treated with insulin pre-pregnancy this may be discontinued post natally,
although you may need to go back onto pre-pregnancy tablets. Your diabetes team will discuss this with you if appropriate.
Things to think about
- Recognise the stress of a crying baby and the effect this has on blood
- Crucial to avoid hypoglycaemia. Hypoglycaemia is much more of an issue
for the safety of mother and child
- Be aware of increased exercise, day and night
- Continue insulin injection technique as pre natally
- Drink 3 litres of water a day to remain well hydrated
- Practice careful hand washing - use non-perfumed cream
- Keep blood sugar profile in single figures pre meal 5-10 mmols. This
seems high in comparison to the tight control in pregnancy but is acceptable
post natally when breast feeding
- Adjusting insulin dose - as an approximate guide 1 unit of insulin will
reduce blood sugar by 2-3 mmol/l
- Breast-feeding is not a contraceptive
- Try to eat before or while breast-feeding or expressing milk
- Have easily available quick acting carbohydrate or your usual hypo remedy. Consume
approximately 500Kcals/50g carbohydrate extra daily. Ideally as complex
carbohydrate (see below for some ideas).
Snacks containing approximately 500Kcals/50g carbohydrate
- Large sandwich + glass of milk (200ml) + fresh fruit
- Cereal bar + yoghurt+ fruit
- Standard size pitta bread + filling + 200ml fresh fruit juice
- 4 oatcakes + cheese + crisps + fruit
- Large bowl cereal + 200ml milk
- 2 slices toast + large banana Latte café + blueberry muffin
- Scone + spread + jam + cappuccino
Foods to avoid
- Don't eat more than one tuna steak a week (approximately - 140g cooked or 170g
raw) or two medium sized cans of tuna. This means about six rounds of
tuna sandwiches or three tuna salads. Avoid swordfish, marlin and shark.
- This is because of the levels of mercury in these fish which can pass
into breast milk and can harm a very young baby's developing nervous system.
- If a close relative has a peanut allergy it would be sensible to avoid
eating peanuts and peanut products while breastfeeding.
- Otherwise continue with usual healthy diet.