By:  Yvonne Moloney

Having diabetes can affect a pregnancy and a pregnancy can have an impact on you particularly if you have any complications associated with the condition.

This means that prior to becoming pregnant you should:

  • Tell your Diabetes team & General Practitioner that you intend to try to become pregnant.
  • Avoid pregnancy until your diabetes is well controlled.
  • Use a reliable form of contraception until it is safe for you to conceive.
  • Have a general diabetes review including eye screening, cholesterol, blood pressure and weight.

 It is recommended

  • that women with diabetes who are planning a pregnancy take 5 mg Folic Acid per day for 3 months prior to conception and for the first 3 months of their pregnancy (you will need a prescription for this strength of tablet).
  • that you avoid alcohol whilst planning and during your pregnancy.
  • You and your partner should avoid smoking and recreational drugs whilst planning and during pregnancy.
  • It is important that you are up to date with your cervical screening and your immunity for Rubella / Chickenpox and other conditions that all women are advised to be screened for before pregnancy.
  • Have your teeth checked.
  • When buying medications over the counter, always check with the pharmacist that they are suitable for pregnancy.

Why is good diabetes control important?

Before your pregnancy test is positive, your baby may have been developing for a number of weeks. During the first 8 weeks of your pregnancy, your baby’s major organs are developing. If blood glucose levels are high during this time, there is a risk that you may miscarry or that your baby may not develop normally.

  • Good control of your diabetes is important throughout all of your pregnancy.
  • Once pregnant, you will be required to attend the hospital frequently.
  • It is important that you attend all your scheduled appointments.

What is good blood glucose control?

Your diabetes team will help you to achieve and maintain normal blood glucose levels.

diabetes-2

You will need to test 7 times per day

 Before meals

  • 1 hour after meals
  •  At bedtime

Blood glucose targets:

  • Before meals less than 5.0 mmol/L
  • 1 hour post meal less than 7.0 mmol/L

Your HbA1c levels should be as low as possible

(Ideally 53 mmol/mol or lower)

before you try to conceive

Do I need to change my diabetes treatment for pregnancy?

Certain medicines cannot be used when you are pregnant. You will need to discuss this with your diabetes team and you will need time to make any changes required. Ideally this is done prior to becoming pregnant.

If you control your diabetes with:

Diet & Exercise

This may not be enough to achieve good blood glucose control when planning pregnancy. Insulin therapy may be required.

Tablets

Your tablets may be changed and you may require insulin therapy.

Insulin

Your type of insulin may be changed or adjusted and you may need more injections to improve your blood glucose control.

During pregnancy, your hypoglycaemia warning signs may change.

  • Hypoglycaemia may occur more frequently and often without warning signs.
  • You are advised to always carry sufficient treatment for hypoglycaemia with you (e.g. glucose tablets).
  • Ensure your glucagon hypokit is in date and your partner or family members know how to inject glucagon in an emergency.
  • Ensure you follow all the advice you received about insulin and your meal plan.
  • Ideally talk to a dietitian for specific information on the best plan for you and your baby.

Driving

Always check your blood glucose before you drive. If your blood glucose is less than 5.0 mmol/L, you should eat a snack and do not drive until your blood glucose has been sustained for a period of 45 minutes as advised by your diabetes team.

Checklists re-pregnancy checklist

  • Attend pre pregnancy diabetes clinic.
  • Avoid pregnancy until your HbA1c is 53 mmol /mol or lower.
  • Test your blood glucose pre and one hour post meals and at bedtime.
  • Blood glucose targets

-Pre meal less than-5.0 mmol/L

-1 hour post meal less than-7.0 mmol/L

  • Take 5 mg Folic Acid daily (prescription required)
  • Your diabetes treatment, insulin or any oral medicine may need to be changed.
  • When buying medications over the counter, always check with the pharmacist that they are suitable for pregnancy.
  • Be aware of your menstrual cycle and do a pregnancy test if your period is delayed.

Once your pregnancy test is positive, it is important that you attend the diabetes and obstetric clinic as soon as possible after your pregnancy is confirmed.

  • Contact the maternity service you wish to attend and speak with the diabetes midwife/nurse who will arrange for you to attend the next clinic.
  • Inform your diabetes team, pre pregnancy clinic and your GP of your transfer to the maternity hospital.

 

Bio:

Yvonne Moloney, Registered Advanced Midwife Practitioner RAMP Diabetes, UL Hospitals ,University Maternity Hospital Limerick .