When you have become pregnant

If you have diabetes and become pregnant let your diabetes team/GP know as soon as possible. Ideally you should be seen in the joint diabetes antenatal clinic at the hospital you wish to receive your antenatal care within two weeks. Early booking and regular clinic visits ensures we can help you get the best diabetes control and care for your pregnancy.

At the combined clinic you will be able to see the Obstetrician, Midwife, Diabetologist, Diabetes Specialist Nurse and the Diabetes Specialist Dietitian. With all these people to see your first visit , which often includes a scan, can take all morning. The frequency of visits to this clinic will vary but will be at least every 2 - 4 weeks.

Blood glucose control during pregnancy

You will be asked to increase your blood glucose monitoring to at least 7 times a day - pre and post meals and pre bed. An HbA1C of 6.1% or less (IFCC HbA1C 43mmol/mol) is recommended in pregnancy. To achieve this, blood glucose levels of less than 5.5mmol/L pre meals and less than 7.8mmol/L 1 hour post meals are suggested.

Diabetes Treatment

You may find the insulin regimen you are on will need changing and you will need more injections through out the day. You will also find that as your pregnancy progresses you will require more insulin.

If you have Type 2 diabetes you may find some of your oral hypoglycaemic tablets are stopped and that you will need insulin whilst you are pregnant.

Why good blood glucose control?

Good blood glucose control is important to reduce the risk of congenital abnormalities in early pregnancy and then later in pregnancy to ensure that the growth of the baby normal.

If your blood glucose levels are not well controlled during your pregnancy it can:

• make your baby grow big - this is a condition called macrosomia. This can increase the risk of birth trauma.
• following delivery your baby can be at risk of low glucose levels (hypoglycaemia).

You will have your HbA1C checked monthly throughout your pregnancy.

What else is important?

You should take 5mg of folic acid until you have completed 12 weeks of pregnancy.

You should have your eyes photographed every trimester. This is important because the back of your eyes sometimes change quickly in pregnancy.

You will have more regular scans during the pregnancy so that the growth of the baby can be monitored.

What is gestational diabetes?

Gestational diabetes is diabetes that occurs in pregnancy and usual goes away as soon as you have had your baby. However if you develop gestational diabetes you have a 50% increased risk of developing type 2 diabetes later on in life.

How is it diagnosed?

You will have an oral glucose tolerance test to diagnose gestational diabetes. This involves having a fasting blood glucose test, then drinking a glucose drink and having another blood glucose test 2 hours later. The numbers used to diagnose gestational diabetes are slightly different to those used outside of pregnancy, but the healthcare professional should let you know the results and whether it is normal.

What happens if you have gestational diabetes?

If you are diagnosed with gestational diabetes you will be referred to the joint diabetes antenatal clinic and you will be looked after by a specialist team - Obstetrician, Midwife, Diabetologist, Diabetes Specialist Nurse and Diabetes Specialist Dietitian. Expect your first visit to take most of the morning.

You will be taught how to test your own blood glucose levels. Monitoring can be done up to 7 times a day.

How is it treated?

Gestational diabetes is usually treated with dietary and lifestyle changes first but if your blood glucose levels remain higher than ideal, diabetes treatments may be prescribed for you.

Why is it treated?

If you have raised blood glucose levels it can make your baby grow too big but be less mature. This increases the risk of birth trauma. Following delivery the baby's blood glucose level may become going too low. There is not an increased risk of birth defects.