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Type 1 or Type 2 Diabetes and Pregnancy

Planning your pregnancy

If you have either type 1 or type 2 diabetes, it is very important to plan a pregnancy to keep you and your baby healthy. If your blood glucose is high at the time you become pregnant, and during the first 6-8 weeks, it can be harmful to your baby. The risks to you can include hypoglycaemia (hypo), poor hypo awareness (you don’t realise when your blood glucose is low), miscarriage and having a very large baby (which can cause problems during labour)

Checklist to planning a healthy pregnancy

Pre-Pregnancy Care

  • If you need to reduce your blood glucose levels to reach your pre-pregnancy target you may be at increased risk of hypoglycaemia. Do not delay in treating hypoglycaemia by making sure you take your hypo treatment as quickly as possible
  • Attend a diabetes pre-pregnancy clinic for at least 6 months before trying to become pregnant
  • Make sure you have had all your vaccinations and screening for pregnancy (rubella/chickenpox/cervical). You will be advised to avoid pregnancy for some time after certain vaccines
  • Check that any medications you take are safe in pregnancy - ask your pharmacist or your Diabetes care team

Gestational Diabetes

Gestational diabetes is a form of diabetes (raised level of glucose in the blood) that is diagnosed during pregnancy. In most cases there will be no symptoms. A pregnancy complicated by gestational diabetes is considered high risk and will require specialised care.

The insulin hormone may change during pregnancy. In addition, your body may not make as much insulin as it requires during pregnancy. Either of these issues can result in high blood glucose levels. If left untreated, high blood glucose levels may cause health problems for you and your baby.

Risk factors

Gestational diabetes is usually diagnosed with an oral glucose tolerant test (GTT). The following are risk factors that indicate a glucose tolerance test is necessary:

  • A history of diabetes in an immediate family member
  • Being living with overweight or obesity (Body Mass Index >30kg/m2)
  • Age greater than 40 years
  • A previous unexplained still-birth or neo-natal death
  • Presence of glucose in urine
  • Long term steroid treatment
  • Polycystic Ovarian Syndrome (PCOS)
  • Your baby is larger than expected for due date and/or there is too much fluid around your baby (current pregnancy)
  • Ethnic group associated with high prevalence of diabetes
  • Gestational diabetes in a previous pregnancy

Treatment & Monitoring

Each patient’s treatment plan will be individual and decided on by yourself and your specialist team. It will be necessary to monitor your blood glucose levels for the duration of your pregnancy. The standard treatment for gestational diabetes is diet and lifestyle changes, but many women also require medication such as insulin injections and/or tablets. If you do require treatment, it is generally only for the duration of your pregnancy.

Follow up

There is a high risk of gestational diabetes returning in a future pregnancy. There is also a high chance of developing type 2 diabetes in the future. Research shows that maintaining a healthy weight, keeping a healthy diet and taking regular exercise, may prevent or delay the development of type 2 diabetes.

Having gestational diabetes should not prevent you from breastfeeding your baby. Breast milk following gestational diabetes will be the same as the breastmilk of a woman who has not had gestational diabetes. For advice and support on breastfeeding please contact your local breastfeeding team.

It is recommended that you have a diabetes test at around 6 weeks after you give birth. It is also recommended you have an annual diabetes screening and you consider attending a diabetes prevention programme.

It is advised that if you are planning another pregnancy, you make sure that your diabetes screening is up-to-date, and your blood glucose is within normal limits. If not planning another pregnancy, please discuss a reliable method of contraception with your doctor or nurse/midwife. If you find yourself unexpectedly pregnant you should seek medical advice immediately.

 

Date of preparation: September 2022. IE22DI00123

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