Women who already have diabetes should consult with their healthcare team and take special precautions before, during and after pregnancy. Other women may be diagnosed with gestational diabetes while pregnant and should take special precautions during pregnancy.
Click here if you already have diabetes and are planning a pregnancy.
Click here to read about gestational diabetes.
Pre-pregnancy advice
Will I have a healthy baby?
Most women with diabetes can have healthy babies if their diabetes is well controlled and if they are in good general health.
Although diabetes does increase the chances of you or your baby having complications during pregnancy, it should not always be a problem. The key to a healthy pregnancy is getting yourself in good shape before becoming pregnant, and thinking and planning ahead.
If you are thinking about having a baby, follow these simple steps:
- visit your GP for blood tests, contraception advice and rubella screening. Contracting rubella when you are pregnant may lead to blindness and abnormalities in your baby. This is relevant to all women so if you are not immune, you should be vaccinated before becoming pregnant.
- meet your diabetes care team for:
- pre-conception advice. Contraception helps you plan the timing of your pregnancy around your general health, blood glucose control and social circumstances.
- advice on possible treatment changes e.g. from tablets to insulin or to a different regimen of insulin.
- take folic acid (5 mg daily is recommended by Diabetes UK for both Type 1 and Type 2 diabetes) before you become pregnant, and for 12 weeks after you conceive
- stop smoking. Smoking damages your own health, affects the growth of your unborn baby and leads to many other complications, as well as heart disease and lung cancer
- if you drink alcohol or use recreational drugs, you should stop. These increase the risk of miscarriage and can damage your baby
- watch your weight. Being overweight can result in difficulties conceiving, and can also increase the risk of problems during pregnancy. Follow a healthy balanced diet and take regular exercise. Being underweight can also affect fertility. Advice on weight is available from your diabetes care team
Blood glucose
Keeping your blood glucose within the normal, healthy range (3.5 and 5.9 mmol/L and HbA1c less than 6.1% or 43mmol/mol) can help to reduce your chances of miscarriage, and of your baby developing abnormalities.
It is important to test your blood glucose regularly to make sure you are within this range for at least 3 months prior to becoming pregnant, and throughout your pregnancy. Make sure you are using a meter suitable for the changing levels of haematocrit you may experience during pregnancy. You should also choose a No Coding meter to ensure your blood glucose results are as accurate as possible.
Blood pressure
If you have high blood pressure, talk to your diabetes care team before you become pregnant about what effect this might have, especially if you are taking medication. High blood pressure increases the chance of certain problems in pregnancy (for you and your baby) and needs special attention.
Consider other medication
Every medication that you are taking (including tablets to help lower your cholesterol and blood pressure) must be reviewed before pregnancy. There are many drugs that need to be adjusted before you become pregnant.
Talk to your diabetes care team if you are planning a pregnancy. It may take time to make sure that any necessary treatment changes are effective and working well.
Pre-pregnancy summary (3 months)
- Meet with your diabetes care team
- Take the appropriate amount of folic acid
- Seek advice before discontinuing contraception
- HbA1c less than 6.1% or 43mmol/mol (measure of blood glucose over previous 3 months)
- Discuss tests and screening e.g. rubella screening, renal and retinal assessments, risk factors for gestational diabetes
- Medication review
- Review of diet and lifestyle
Your first source of pre-conception care is generally your GP or practice nurse.
Advice for during pregnancy
Tell your diabetes care team as soon as you find out you are pregnant. If your usual diabetes care is with your doctor, you will need an immediate referral to the diabetes care team and antenatal services.
If you are already pregnant, don’t panic! Now is the time to get your body on track. Tell your diabetes care team as soon as possible.
Hypoglycaemia during pregnancy
Insulin requirements change in early pregnancy and this can lead to severe hypoglycaemia (“hypos”) and changes in the normal warning signs. This means that hypos often happen fast and without enough warning for you to treat the early symptoms.
It may be useful for your family or partner to know how to inject glucagon in an emergency.
Top tips:
- Create a ‘hypo kit’ to keep at home which includes glucagon and hypo food, like digestive biscuits or a sugary drink, so that your family know where to find it in an emergency.
- Make sure you carry a supply of hypo food (e.g. glucose tablets, biscuits or sweets) with you at all times
- Continue to check your glucagon is in date and ask your diabetes care team for a prescription if needed.
First trimester (12 weeks)
The first 8 weeks of your pregnancy are when your baby’s major organs develop. As your blood glucose during this time can affect the development process, it is important to achieve and maintain tight control of blood glucose throughout this period.
Making sure your blood glucose control is in the normal, healthy range at the time of conception and during the first 3 months of pregnancy is a major factor in preventing miscarriage and birth defects in your baby.
In general, women with established diabetes are seen every 1–2 weeks and have very regular contact with the diabetes specialist nurse / midwife. The care you can expect during pregnancy for women with diabetes is summarised in the table below. The table is only a guide to the tests and care that you should receive during your pregnancy; your diabetes care team will discuss your individual situation with you in more detail.
Some of the important stages and issues to be covered during pregnancy for women with diabetes
| Gestation Period |
Important stages and issues |
| First appointment |
- Confirmation of pregnancy
- Assesment of conditions conducive to a healthy pregnancy
- How to acheive the best possible glycaemic control
- Diabetes-related complications
- Review of diabetes medications
- Possible retinal and/or renal assessment (if these have not been undertaken in the previous 12 months)
|
| 16 weeks |
- An opportunity for retinal assessment if retinal diabetic retinopathy was detected at the first antenatal appointment
|
| 20 weeks |
- An ultrasound scan of your baby's head, heart, spine, limbs and internal organs, position of the placenta and volume of fluid surrounding your baby in the womb
|
| 28 weeks |
- An ultrasound to monitor your baby's growth and the volume of fluid surrounding it in the womb
- An opportunity for retinal assessment if no diabetic retinopathy was detected at your first antenatal clinic visit
|
| 32 weeks |
- An opportunity for further ultrasound monitoring of your baby's growth and volume of fluid surrounding it in the womb
- Other investigations typically carried out at 31 weeks in women without diabetes
|
| 36 weeks |
- An opportunity for further ultrasound monitoring of your baby's growth and volume of fluid surrounding it in the womb
- Information and advice given about:
- Timing and management of birth
- Pain relief
- Changes to hypo therapy during and after birth
- Management of the baby after birth
- Breastfeeding and its effects on glycaemic control
- Contraception and follow-up
|
| 38 weeks |
- An opportunity to induce labour (or perform C-section if indicated)
- Tests to check your baby's wellbeing if continuing to wait for a natural start to labour
|
Based on NICE (2008) Clinical Guidance 63 - Diabetes in Pregnancy
What is gestational diabetes?
Gestational diabetes is a form of diabetes that can occur in some expectant mothers after week 24 of their pregnancy.
When you eat, your body slowly breaks down starchy foods (carbohydrates) into glucose, which then enters the blood stream. Insulin produced by your body allows this glucose to enter your cells where it can be used as energy.
Without insulin, the cells in your body cannot get the energy they need to work efficiently. This means that excess glucose remains in the blood stream causing high blood glucose, a condition known as “hyperglycaemia”.
Hormones produced in pregnancy can cause insulin not to be used properly by the body, resulting in high blood glucose. Left untreated, high blood glucose can affect your own health and that of your baby, so it is important to monitor your blood glucose and take appropriate treatment if it is too high.
How can gestational diabetes affect my baby?
There are some conditions that are more common in gestational diabetes:
- Macrosomia (large baby): if your blood glucose is higher than normal, your baby also receives higher amounts of glucose. Storing this extra energy causes your baby to grow larger
- Hypoglycaemia: just after birth, your baby may have low blood glucose (called hypoglycaemia). This can happen if your baby has been making extra insulin to cope with the excess glucose it has been getting from you while in the womb. After your baby has been born, its blood glucose will be checked and will only be treated if it is low.
How can gestational diabetes affect me?
With the right treatment and good blood glucose control, most women suffer no ill effects from their diabetes. However, having gestational diabetes does increase your chance of experiencing problems during pregnancy. These problems can include increased risk of:
- Premature birth
- Induced labour
- Caesarean section (also known as C-section)
- Diabetic ketoacidosis (this can occur due to illnesses, infections, insufficient insulin or increased insulin resistance, and may be harmful for you and your baby)
- Type 2 diabetes in later life
- Gestational diabetes in the future.
If diagnosed with gestational diabetes, you may be given a meter and shown how to test your blood glucose to help minimise the associated risks.
The risks that gestational diabetes poses to you and your baby can be reduced with proper treatment and good control of your condition.
How is gestational diabetes treated?
You will be referred to a specialist clinic during your pregnancy. You will have regular appointments during your pregnancy at which you will be given advice on how best to manage your condition.
Gestational diabetes tends to be treated through diet and exercise, but a few women require tablets or insulin treatment.
You will need to check your blood glucose closely every day. This will help you and your diabetes care team know what is happening and what is the best treatment for you. Your diabetes care team will tell you what your ideal blood glucose should be, and will advise you when and how often you need to test.
Common questions
What happens after the birth?
Most womens’ blood glucose tends to return to normal as soon as their babies are born. Talk to your diabetes care team about having your blood glucose checked after your baby is born. This typically happens 6 weeks after the birth.
Will I get diabetes later in life?
Having had gestational diabetes does put you at a higher risk of developing Type 2 diabetes later in life. You should aim to stay as healthy as possible and to have a diabetes check-up every year. You will also be at increased risk of developing gestational diabetes in future pregnancies.
Will my baby have diabetes?
Your baby will be at no greater risk of developing diabetes in childhood than any other baby. However, if you have had gestational diabetes, your baby may have a higher risk of developing type 2 diabetes later in life.
Who is at risk of developing gestational diabetes?
Some of the risk factors for gestational diabetes include:
- Excess weight
- A family history of diabetes
- Ethnicity, particularly South Asian, Black Caribbean or Middle Eastern
- Having had a large baby previously (over 4.5 kg)
- Polycystic ovary syndrome (PCOS)
- A history of gestational diabetes.