Tommy's PregnancyHub

Treatment of type 1 or 2 diabetes in pregnancy

If you have type 1 or 2 diabetes in pregnancy you will get extra care.

Your antenatal appointments

You should be seen in a joint diabetes and antenatal clinic as soon as you get pregnant. You’ll have extra care throughout pregnancy because of your condition, as well as the routine antenatal care everyone gets during pregnancy. 

This includes extra tests and ultrasound scans to check your health and your baby’s health. Your first scan should take place at 7-9 weeks. From early on in pregnancy, you will need to check your glucose levels more regularly and may need to make changes to your diet. 

You will have regular contact with your healthcare team to review your glucose levels. This could be as often as every 1 to 2 weeks. The team can support you with any lifestyle changes you may need to make.  

Try to go to any appointments you have so your healthcare team can monitor you and your baby.

Every pregnancy is different. Your care may be slightly different from other women with diabetes. Don’t be afraid to ask your healthcare team If there is anything about managing your diabetes that you are unsure about.

Your healthcare team

The specialists you see will depend on what services are available in your local area. But your team might include some of the following:

  • a specialist midwife – there may be a diabetes midwife or clinic lead midwife, who will give you specialist support while you are pregnant, during the birth and after the birth
  • an endocrinologist or diabetologist – a doctor who specialises in diabetes
  • an obstetrician – a doctor who specialises in pregnancy and birth
  • a diabetes nurse specialist – a nurse specialising in caring for people with diabetes
  • a dietitian – a healthcare professional who can provide advice on your diet
  • kidney or eye specialists (nephrologist or ophthalmologist).

These professionals will work alongside the other members of your healthcare team, such as your GP and your community midwife.

Managing your diabetes

Your diabetes team may recommend changes to your treatment regimen and lifestyle (such as diet or exercise) during pregnancy. Find out more about diet and exercise with type 1 or 2 diabetes

You will need to monitor your glucose levels more often during your pregnancy. Remember that morning sickness can affect your glucose levels. Your healthcare team will be able to give you more information about this.

Keeping your glucose levels in range may mean you have more low-glucose-sugar (hypoglycaemic) events (hypos). These do not harm your baby, but they could put you at risk. It’s important that you and anyone you spend the most time with know how to manage with them. Talk to your diabetes team about this. 

Find out more about using insulin in pregnancy with type 1 and type 2 diabetes.

Your blood pressure and urine will also be checked at each visit.

Find out more about managing your glucose levels

 

Your booking appointment

Your first antenatal appointment is called a booking appointment. Ideally, you should have this before you’re 10 weeks pregnant. 

If this wasn’t discussed before you got pregnant, they will talk to you about:

  • how pregnancy may affect your diabetes
  • how diabetes may affect your pregnancy, including labour and birth
  • how your diabetes will be managed during pregnancy
  • what diabetes medication you are taking and if you need to make any changes
  • any other medication you’re taking and if you need to make any changes
  • how to keep your glucose levels within safe limits during pregnancy, including advice on diet and exercise.

HbA1c test

You should be offered an HbA1c test. This is a blood test that measures the level of sugar in your blood. You may have this test again as your pregnancy progresses. If you have type 1 diabetes, you should be offered other methods for measuring your glucose levels, such as intermittent (Libra) and continuous glucose monitoring. 

Hypoglycaemia

Pregnancy can make it harder for you to recognise hypoglycaemia, especially in the first trimester.  
It’s important that you and anyone you spend time with (for example, your partner, friends or work colleagues) can recognise hypoglycaemia and how they can help if you need it. 

Find out more about hypoglycaemia.

Folic acid

You will need to start taking a high dose (5mg) of folic acid every day, from as soon as possible (preferably 3 months before getting pregnant) until you are 12 weeks pregnant (second trimester).

You take folic acid as a tablet (supplement). It reduces the risk of having a baby with spina bifida or other problems affecting the baby's spine and neural tube. 

You’ll need to get a prescription for this from your GP because you can’t get a higher dose of folic over the counter.

Vitamin D

Anyone who is pregnant or breastfeeding should take 10 mcg of vitamin D every day. Vitamin D keeps your bones, teeth and muscles healthy. 

Find out more about taking supplements in pregnancy. 

Morning sickness and diabetes

If you get morning sickness and vomit, this can affect your glucose levels. You will need advice about how to time your insulin injections. If you are getting sick, talk to your healthcare team. 

For many women, morning sickness passes after the first trimester. 

Diabetic ketoacidosis (DKA)

Diabetic ketoacidosis (DKA) is a serious problem that can occur in people with diabetes if their body starts to run out of insulin. This causes harmful substances called ketones to build up in the body, which can be life-threatening if not spotted and treated quickly.

People with type 1 diabetes are at higher risk of DKA (although anyone with diabetes can get it). If you have type 1 diabetes, you should be given ketone testing strips and a monitor at the beginning of your pregnancy. You should test the ketone levels in your blood if your glucose is above target (known as hyperglycaemia) or if you are unwell. 

If you have type 1 or type 2 diabetes, you should get urgent medical advice if you have hyperglycaemia that is not improving or you are feeling unwell.  

Eye examinations

People with diabetes are at risk of developing problems with their eyes. Pregnancy can increase your risk of developing these problems or make existing ones worse.

You’ll be advised to attend an eye examination (unless you have had one in the last 3 months). 

If eye screening shows that you have diabetic retinopathy (damage to the back of the eye), you may be referred to an eye specialist. 

Kidney tests

People with diabetes are at risk of developing problems with their kidneys (diabetic nephropathy). Pregnancy can increase your risk of developing these problems or make existing kidney problems worse.

You’ll be offered a kidney test at your booking appointment (unless you have had one in the last 3 months). If a kidney test shows that you have diabetic nephropathy, this may affect your blood pressure and might increase the risk of developing pre-eclampsia.  You should be offered treatment and you may be referred to a kidney specialist. 
 

By the second trimester (12-24 weeks), as your baby grows your insulin needs will increase. Your diet, medication and insulin doses will be regularly reviewed. Your blood pressure and urine will be checked at each visit.

“I had a real problem with my blood sugars being really high. I was told that I would need to keep my blood sugars well controlled, but I wasn't aware of how enormous the change was going to be in terms of insulin and how much more I'd have to take.” 

Megan

Reducing your risk of pre-eclampsia

Having diabetes increases your risk of pre-eclampsia.  From 12 weeks, you may be advised to take aspirin each day to reduce this risk. 

If your blood pressure gets high, you’ll be seen by a specialist team and given medication if needed. 
Ultrasound scans

You’ll have an ultrasound scan at 20 weeks to check that your baby is developing normally. This will include checks on your baby’s heart.  

You’ll have another ultrasound scan at 28 weeks to check your baby’s growth.

Many women with diabetes must take 2 or 3 times the normal dose of insulin at this point in the pregnancy.  

If your insulin needs start to drop significantly at this stage rather than increasing or staying stable, you should contact your diabetes team. This may be a sign that your placenta is not working as well it should be.

Eye examinations

Everyone will have another eye examination at 28 weeks

Ultrasound scans

You’ll have an ultrasound scan at 32 weeks and at 36 weeks. 

Colostrum harvesting

Colostrum is the first breast milk that your body makes. This is very thick and yellow, and it contains all the nutrients your baby needs in the first few days after birth. Because their stomach is so small, your baby will only need a small amount.

You can collect and freeze this milk during the last few weeks of your pregnancy. This is known as ‘colostrum harvesting’. 

“Expressing and storing colostrum in the weeks leading up to birth helped me feel empowered and proactive. My stored colostrum was invaluable when baby was mildly hypo for 24 hrs after birth.”

Zoe

Some women have difficulties establishing breastfeeding. If your baby needs extra feeds, you can use colostrum instead of formula milk.

If you want to harvest your colostrum, you can start hand expressing for a few minutes once a day when you are 36 to 37 weeks pregnant. Do not use a breast pump until after you have given birth. 

Ask your healthcare team for more information.

Planning your labour and birth

During your third trimester, your healthcare team will work with you to plan the birth. There are some risks associated with giving birth if you have diabetes, so your healthcare professionals should explain your options for giving birth before you make your birth plan.

You may talk about:

  • where to have your baby (you will be advised to give birth in hospital)
  • when to have your baby
  • how to have your baby – if your ultrasound scans have shown that your baby is large, you may be advised to have an early induction (starting labour artificially) or a planned caesarean section
  • if you want any pain relief (if you have a vaginal birth)
  • how your glucose levels will be managed during labour
  • what happens if your labour starts early
  • the effects of diabetes on you and your baby after birth. 

Read more about labour and birth with type 1 or 2 diabetes.

Your baby

You will have tests to check your baby’s wellbeing at 38 weeks (and every week after that) if they are not born yet. 
 

Your baby's movements

If you have diabetes, there is a higher risk of stillbirth. This can cause anxiety but try to remember that this is rare, and the risk goes down if your glucose levels are in range.  

It’s important for you to be aware of your baby’s movements. Feeling your baby move is a sign that they are well.
You may feel your baby move as early as 16 weeks of pregnancy, but most women usually feel something between 18 and 24 weeks.   

It is not true that babies move less towards the end of pregnancy. You should continue to feel your baby move right up to the time you go into labour and during labour.

Get to know your baby’s normal pattern of movements. If you think your baby’s movements have slowed down, stopped or changed contact your midwife or maternity unit immediately.

Do not wait to contact your midwife or the maternity unit for advice, no matter how many times this happens.
Usually, these checks show that everything is ok. But if your baby is unwell and you get the right treatment and care as soon as possible, this could save your baby’s life. 

Find out more about your baby’s movements
 

NICE (2015). Diabetes in pregnancy: management from preconception to the postnatal period. National Institute for health and care excellence https://www.nice.org.uk/guidance/ng3

NHS. Vitamins, supplements and nutrition in pregnancy. https://www.nhs.uk/pregnancy/keeping-well/vitamins-supplements-and-nutrition/ (Page last reviewed: 14 February 2020. Next review due: 14 February 2023)
  
Weissgerber T & Mudd, L (2016) Pre-eclampsia and Diabetes Curr Diab Rep. 2015 Mar; 15(3): 579.doi: 10.1007/s11892-015-0579-4

NHS. Pre-eclampsia https://www.nhs.uk/conditions/pre-eclampsia/ (Page last reviewed: 07/06/2018. Next review due: 07/06/2021)

Oxford University Hospitals NHS Foundation Trust. Pregnancy and type 1 diabetes mellitus https://www.ouh.nhs.uk/patient-guide/leaflets/files/65650Pdiabetes.pdf (Last reviewed August 2020 Next review due: August 2023)

University Hospital Southampton NHS Foundation Trust Harvesting colostrum for your baby https://www.uhs.nhs.uk/Media/Controlleddocuments/Patientinformation/Pregnancyandbirth/Harvesting-colostrum-for-your-baby-maternity-information.pdf (Published June 2017. Due for review June 2020)
  
Royal College of Obstetricians and Gynaecologists (2012) Your baby's movements in pregnancy: information for you https://www.rcog.org.uk/globalassets/documents/patients/patient-information-leaflets/pregnancy/pi-your-babys-movements-in-pregnancy.pdf

Review dates
Reviewed: 20 July 2020 | Next review: 20 July 2023