Pregnancy and Diabetes

This leaflet provides information about pregnancy and diabetes. This leaflet is aimed at people who have diabetes before pregnancy. It covers what to consider pre-conception, what to expect during pregnancy, delivery, and what to expect postnatally. In addition, information is provided on how the baby will be affected. Finally, the leaflet provides useful information on breastfeeding including breastfeeding when the mother is taking insulin.

 

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 pregnancy.
  • 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 diabetic pregnancy.
  • 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 on prescription.
  • 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 pregnancy.
  • 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 11 mmol/l) or you feel unwell 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? 

  • At Musgrove Part Hospital, Somerset, one quarter of diabetic women have a vaginal delivery and three quarters 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 after birth 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 (problems with development of some of the key body organs) 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 macrosomia. 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 taking insulin 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 type 1 diabetes in later life. For type 2 diabetes there is a stronger genetic link but the overall risk is still relatively low particularly if a good lifestyle is maintained.

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 women without.
  • 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 11 to 13 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 in which case referral for a specialist opinion is recommended.
  • Any eye 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 diabetes.
  • 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 (if you are taking insulin) and that diet may need adjusted to cope with breast-feeding.

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
  • Convenience
  • Bonding immediately after birth

Postnatally (After the Baby is born): what to 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 after the baby is born for women taking insulin 

  • Recognise the stress of a crying baby and the effect this has on blood sugars
  • Avoid hypoglycaemia. Hypoglycaemia is much more of an issue for the safety of mother and child
  • Be aware of increased exercise, day and night which can lead to hypo 
  • 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
  • Remember 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 nearby
  • 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.

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