Diabetes

The best thing for a healthy pregnancy and baby is planning. This usually means putting in some extra work before you are pregnant.

Discuss with your diabetes team your pregnancy plans ideally at least three months before trying to conceive.

However, if like many women, you get pregnant without planning, don’t panic!

Make an appointment with your diabetes team as soon as possible to review your diabetes and general health and put a plan in place from there.

Planning your pregnancy

It is ideal to start working on the following about three months before conception:          

• Try to achieve an HbA1c below 53 mmol/mol (7%), or ideally below 48 mmol/mol (6.5%) if this can be achieved without increased episodes of hypoglycaemia. The first 8 to 12 weeks are when a baby’s major organs develop, so it is important to gain tight blood glucose control before you get pregnant. Persistently high blood glucose levels increase the risk of abnormal development of your baby. Work with your diabetes team to achieve the best blood glucose level you can.
• Blood glucose targets, glucose monitoring, medicines for treating diabetes (including insulin regimens) and medicines for complications of diabetes will need to be reviewed before and during pregnancy. Some medication you take may need to be changed prior to conception e.g. some blood pressure medication or statins for cholesterol reduction. If you have Type 2 diabetes and take certain oral medications, you may need to change over to insulin prior to pregnancy.
• It is important if you have Type 1 diabetes to be able to check for ketones preferably with a blood ketone meter. It is advisable to check if your blood glucose levels are high or if you are unwell at any point even if your blood glucose levels are normal.
• All pregnant women with Type 1 diabetes are now offered continuous glucose monitoring (CGM) during their pregnancy. Use of CGM is linked to a reduction in rates of pre-eclampsia for pregnant women with Type 1 diabetes, and a reduction in adverse neonatal outcomes (large for gestational age, neonatal hypoglycaemia and neonatal intensive care admission) for their babies.
• It is recommended to have check-ups with your doctor prior to and during your pregnancy. They will check your blood pressure and your kidneys along with making sure you are up to date with eye screening.
• Start taking a folic acid supplement and daily multivitamin. Discuss an appropriate dose with your doctor and get a prescription. High dose folic acid (5mg daily) is recommended for all women planning pregnancy who have diabetes. Ideally you should take it at least three months before conception and continue taking it until 12 weeks into pregnancy.
• Speak to your dietitian. They can advise you on any foods that it is advisable to avoid during your pregnancy.
• If you smoke or drink alcohol, it is recommended you stop prior to conception.

More information on planning for pregnancy when you have diabetes is available on the Diabetes UK website here.