Why it’s so important to plan my pregnancy?
If you have type 1 or 2 diabetes, you need to be as healthy as possible before you conceive, and while you are pregnant. All pregnancies come with risks, but if you have type 1 or 2 diabetes, your level of risk is higher, for the baby and for you. You can’t avoid these risks completely, but there are a lot of things you can do to reduce them.
"Right from when I was diagnosed, my diabetes team said to me ‘If you're ever thinking of having a family, you need to let us know because there are special things you have to do." Maria, mum of one
Preparing for pregnancy with type 1 or 2 diabetes…
If you are not yet pregnant, talk to your GP or diabetes team. They may have enough expertise themselves, or they may refer you to a specialist pre-conception care team. There are a number of steps you can take before conception that will give you the best possible chance of having a healthy pregnancy. They will explain these steps to you and your partner or family member.
Step 1: Get your HbA1C to the recommended level
Your HbA1C gives your average blood glucose level for the previous 2-3 months. It is thought that the closer it is to your ideal level (your healthcare team will be able to tell you what this is), the lower the risk of miscarriage or stillbirth. If your levels are too far above the ideal level, your team will encourage you to manage your blood glucose more tightly and then re-test every month until you reach the recommended levels before you actually try to conceive.
If your HbA1C is very high (above 86 mmol/mol) you are strongly recommended to avoid getting pregnant until you can reduce the levels, as this will reduce the risk of miscarriage, and of your baby dying before, during or after the time of birth.
Step 2: Check your blood glucose levels
While you are getting your body ready to conceive, you need to get into the habit of controlling your blood glucose much more tightly. It can help if you start to check your blood much more often than usual so that you really understand how your diabetes affects you. This includes testing your fasting levels (after an eight-hour sleep), before meals and after meals. Your healthcare team should give you a meter for testing your levels if you don’t already have one. They will also discuss your personal blood glucose targets.
Step 3: Take folic acid
All women planning to become pregnant are recommended to take folic acid to help prevent birth defects, such as spina bifida. If you have diabetes you are at higher risk of having babies with these disorders, so you should take a higher dose of folic acid at 5mg per day. This can be prescribed by your doctor because 5mg tablets aren’t available over the counter in supermarkets or pharmacies. Start taking folic acid as soon as you consider pregnancy, and up until you are 12 weeks pregnant. If you have become pregnant without planning or taking folic acid to this extent you should not worry if you’re reading this information too late. Many women have been in this situation and their babies have been healthy.
"I got my blood sugar to a good level, I had laser treatment on my eyes, I lost some weight – also to make me more fertile – and I had to stop some of my medication because I was on statins."Megan, mum of one
Step 4: Check your medication
Check with your team that your medication is suitable to continue through pregnancy. Metformin is safe, but you need to stop any other glucose-lowering tablets before you conceive or as soon as you realise you are pregnant, and don’t forget to check other medications – such as statins and certain blood pressure tablets. You will also need to stop taking other injected medications often used for type 2 diabetes, such as Victoza (liraglutide) and Byetta (exenatide), which are unsafe in pregnancy.
As your needs change through pregnancy, your treatment may need to change too: if you have Type 2 diabetes and are on tablets, you may move to insulin injections; if you are on injections but you are still struggling to control your levels, you may be offered pump therapy. Your team will advise you what is right for you.
Step 5: Have an overall health check
Get an overall health check from your GP or diabetes team – especially your eyes and kidneys – to make sure there aren’t any concerns. If there are concerns, you may be referred to a specialist team for follow up. Pregnancy puts extra pressure on the blood vessels in these areas, which are already at risk if you have diabetes so your checks would be repeated through pregnancy.
Step 6: Look at your lifestyle
Take a look at your general lifestyle – for example, quit smoking, eat a healthy diet, do the right amount of exercise for you, and lose weight if you need to. If you have a body mass index (BMI) above 27, your healthcare team should give you advice on how to lose weight. If you are already pregnant, you shouldn’t be aiming to lose weight as this may be unsafe for you and your baby. However, if you were overweight before pregnancy, small changes to your diet and lifestyle will help to reduce the amount of weight you gain during pregnancy.
Step 7: Check that you're vaccinated
Like everyone, you need to check that you have had your rubella injection if you have never had German measles. If you aren’t sure, ask your GP who may have a record of previous vaccinations.
More key things to be aware of
Equipment for testing
If you have Type 1 diabetes, you should be given blood ketone testing strips and a meter. You can use these to test for ketones if your blood glucose levels are too high or you become unwell. If your ketone readings are high get medical advice immediately.
"I have always known I wanted children and I have always had this ideal in my head, so of course for me I was going to do this right. I wasn’t going to put my baby at any risk." Laura, mum of one
The first eight weeks of pregnancy are especially important for your baby’s development, which is why it’s important to get glucose levels in control before conception. You are unlikely to know that you’re pregnant for the first few weeks.
Even though the patient information leaflet for Metformin advises that Metformin shouldn’t be used when planning to become pregnant and during pregnancy, be assured that there is strong evidence for its effectiveness and safety. Metformin is commonly used in the UK for managing diabetes during pregnancy and breastfeeding.
Before changing your blood glucose levels
If you are planning to make a rapid change to your blood glucose levels before you get pregnant, wait until you have had your eye examination and any resulting treatment. Rapid improvement in blood glucose control can sometimes make diabetes eye problems (retinopathy) worse. Don’t stop using contraception until you have received your renal (kidney) assessment and any treatment that you need.
- NICE (2015) Diabetes in pregnancy: management of diabetes and its complications from preconception to the postnatal period, NICE guideline, National Institute for Health and Care Excellence, http://www.nice.org.uk/guidance/ng3/resources/diabetes-in-pregnancy-management-of-diabetes-and-its-complications-from-preconception-to-the-postnatal-period-51038446021
- Diabetes UK. Pregnancy and diabetes, www.diabetes.org.uk/Guide-to-diabetes/Living_with_diabetes/Pregnancy
- NHS Choices. Vitamins and nutrition in pregnancyhttp://www.nhs.uk/conditions/pregnancy-and-baby/pages/vitamins-minerals-supplements-pregnant.aspx#close.
- Capel I, Corcoy R (2007). ‘What dose of folic acid should be used for pregnant diabetic women?’. Diabetes Care. vol 30, no 7, e63 available at http://care.diabetesjournals.org/content/30/7/e63.full
- NHS Choices. Victoza, Overview, http://www.nhs.uk/medicine-guides/pages/MedicineOverview.aspx?condition=Diabetes&medicine=Victoza&preparationVictoza%206mg/ml%20solution%20for%20injection%203ml%20pre-filled%20pen.
- NHS Choices. Byetta, Overview, http://www.nhs.uk/medicine-guides/pages/MedicineOverview.aspx?condition=Diabetes&medicine=Victoza&preparationVictoza%206mg/ml%20solution%20for%20injection%203ml%20pre-filled%20pen.
- NHS Choices. Rubellahttp://www.nhs.uk/Conditions/Rubella/Pages/Introduction.aspx
If you have type 1 or 2 diabetes in pregnancy you will get extra care.
Women with type 1 or 2 diabetes are at higher risk of some complications but the majority have normal pregnancies and healthy babies. There is much you can do to reduce the risks, for you and baby.
Many women with type 1 or 2 diabetes go on to have a healthy birth. But you are at higher risk of complications so your healthcare team will have recommendations for the birth of your baby.
ℹLast reviewed on September 1st, 2015. Next review date September 1st, 2017.