First trimester with type 1 or 2 diabetes

If you have type 1 or 2 diabetes visit your GP or your antenatal diabetes team as soon as you suspect you may be pregnant. 

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 (5mg per day). This higher dose can only be prescribed by your doctor because it isn't available over the counter.

Taking folic acid at least 2 months before conception can reduce the risk of birth defects by more than 70%.

Once pregnant you should continue taking folic acid until you are 12 weeks into your pregnancy.

You can expect to be referred to the joint diabetes and antenatal clinic immediately, or by ten weeks at latest. Your first scan should take place at 7-9 weeks.

If you had not been seeing the preconception team, the team should give you the full range of information and advice and take a clinical history to check your risk of diabetes-related complications. You will also have your HbA1c tested. This may be checked later in your pregnancy too, to assess your level of risk.

The team will check your medication to see if you need to switch to a different type now you are pregnant.

If you have not had your eyes and kidneys checked in the past year, you will need to be assessed at this stage. This is because you are at higher risk of eye and kidney problems during pregnancy.

'I’d been told that it would be a bad idea to get pregnant because I’d had early-stage retinopathy, but then I fell pregnant by accident. I had some laser treatment, but it came back towards the end of my second pregnancy.' Sara, mum of two

Appointment schedule

From this point onwards, you will have appointments every 1-2 weeks. You will have regular ultrasound scans to check how your baby is growing, and will also have regular Hb1Ac tests, blood pressure and urine samples. 

Throughout your pregnancy you are at increased risk of hypos if you are treated with insulin, but you may be less sensitive to hypos than usual (hypo unawareness), so you need to make sure you are always prepared with handy hypo treatments such as glucose-containing drinks. You may be prescribed dextrose tablets to help you manage any hypos.

If you have type 1 diabetes you may also be given a glucagon kit which can be used by someone else if you’re unconscious during a hypo.

'My diabetes nurse gave me a little paper diary so I could write down my blood glucose test results, so I'd go along with that every two weeks and she'd look at it, and between us we'd decide what adjustments to make to my insulin.' Prisha, mum of two

Morning sickness and diabetes

If you get morning sickness and actually throw up, be aware that this can affect your blood glucose levels, so you will need advice about how to time your insulin injections. So if you are getting sick, talk to your team. For many women, morning sickness passes after the first few weeks of pregnancy.