Women with diabetes who get pregnant face special challenges. Planning your pregnant is vitally important. It is also important to have good management of your diabetes throughout the nine months period of your pregnancy.
Pregnant women who have diabetes are at a higher risk of experiencing problems during pregnancy and when they are in labour, including the incident of stillbirth and heart defects. In addition, they also have increased risk of premature birth, and having a baby weighing above 4kg, which is relatively large.
There are things you can do to ensure you and your baby are healthy. The first thing you should do If you’re thinking of having a baby is to seek medical advise on how your diabetes would affect your pregnancy.
Before you get pregnant
Bear in mind that planning is the key to a good pregnancy when you have diabetes. Preferably, you should ensure that you monitor and control your blood glucose (sugar) levels before you become pregnant. Inadequate blood glucose control during the first eight weeks of your pregnancy can increase the risk of your baby having serious health problems.
While it is essential that you achieve best possible control of your blood glucose level before becoming pregnant, you should also get your eyes checked for diabetic retinopathy. This is because pregnancy does put extra pressure on the small blood vessels in the eyes, which can make an existing problem quickly get worse.
In addition, you should tell your diabetes care team or specialist pre-conception diabetes clinic about any medicines you’re taking. This is important because there are certain medicines, including oral medicines, you should not be taking during pregnancy.
Furthermore you should stop drinking and smoking. Alcohol can increase your risk of hypoglycaemic attacks and harm your baby when you’re pregnant. Similarly, smoking cigarettes during pregnancy can harm your baby.
If it is not prescribed for you, ask your doctor about folic acid, which you ought to be taking. You will need to take 5mg instead of the standard 0.4mg because women with diabetes should take higher doses of folic acid.
While it is the case that not all pregnancies are planned, if you have diabetes and you’re pregnant, you need to address the consequences of your diabetes on your pregnancy as a matter of urgency. The advantage of seeing your doctor immediately is that you have less chance of having diabetics related complications for you and your baby.
Once you’re pregnant
Pregnancy can be a particularly challenging time for women with diabetes. In order to keep you and your baby healthy throughout your pregnancy you need extra planning, patience and careful management of your diabetes.
Ask your doctor to refer you to a specialist antenatal clinic for women with diabetes, if your doctor practice does not have the facility. Specialist antenatal clinic can give you detailed advice on how to manage each stage of your pregnancy. You should expect your blood glucose levels to change in new ways as your pregnancy progresses. Experience have shown that many women find that their blood glucose levels fall lower than usual during the first three months of pregnancy.
Our advice is that it is important to check your blood glucose levels no less than four times a day. You should test your blood sugar after you have not eaten for at least eight hours. You can do this by testing your blood sugar first thing in the morning and then test one hour after every meal. Also learn about the signs and treatment for hypoglycaemia, hypos, which is when your blood glucose falls too low.
In addition, learn about the signs and treatment for hyperglycaemia, which is when your blood glucose becomes too high. It is essential you manage your diet and/or insulin regime carefully around your blood glucose levels.Then follow the nutritional advice given to you care team. You must not fail to attend all your antenatal appointments, and ask your diabetes care team questions or concerns you may have.
Hypos (low blood glucose)
Some women find that close control of their blood glucose levels makes them more susceptible to hypoglycaemic attacks in which blood glucose falls dangerously low.
You can be prepared by carrying a hypo treatment (glucose tablets, glucose gel or fruit juice) with you everywhere. Keeping a glucagon kit with you at all times. If you don’t have one, ask your doctor or diabetes care team. The kit allows you to give yourself a simple injection that will bring you out of a hypo. Make sure that you, and people around you at work and home, know how to use it.
Hypers (high blood glucose)
Some women find that during certain stages in pregnancy – often in the last months when they’re eating more – their blood glucose rises higher than usual.
Know how to test your urine or blood for ketones. These are acids that your body produces when it burns its own fat. They’re a sign that your blood glucose is too high and that you need to adjust the way you’re managing your condition.
Call for emergency help if you are unwell and suspect you may be developing diabetic ketoacidosis (DKA).
Diabetes that develops in pregnancy
Diabetes that starts in pregnancy is called gestational diabetes, and only lasts as long as the pregnancy lasts. Close to the start of pregnancy, every woman should be assessed for the risk factors for gestational diabetes. These include being overweight or obese; having a close family history of diabetes; if you’ve previously given birth to a very large baby (over 4.5kg); having gestational diabetes in a previous pregnancy; and being of south Asian, black Caribbean or Middle Eastern descent.
If you’ve been diagnosed with gestational diabetes, diet and lifestyle changes are often enough to control the condition.
With the advice of your diabetes care team, you should increase your levels of physical activity. You should also be referred to a registered dietitian who will advise you about adopting a healthy balanced diet. If blood sugar levels are not controlled by these measures, then tablets or insulin therapy will be considered.
Women with gestational diabetes need to be as careful as those with type 1 or type 2 diabetes about blood glucose control and keeping healthy.
If you’ve had gestational diabetes your risk of developing type 2 diabetes at some point in your life rises to 30%. You’re also at increased risk of developing gestational diabetes during subsequent pregnancies.
This means that even after pregnancy you should stay aware of the other risk factors of diabetes and visit your doctor if you are experiencing any symptoms. Your doctor should arrange for you to be tested each year for type 2 diabetes.
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- The causes of miscarriage
- Treatment for miscarriage
- The ‘what’ and ‘why’ of miscarriage in early pregnancy.
- What makes a woman prone to recurrent pregnancy miscarriage?
- Can I get pregnant just after my period has finished?
- Working and having a baby
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