Pregnancy and pre-planning
For a woman with type 1 diabetes, pre-pregnancy planning is crucial in ensuring the best possible outcome for her and her child. Your diabetes team as well as pre-conception diabetes clinics are there to help when the time is right. Speaking with experts early in the process can give both mother and child the best possible care.
Some arrangements need to be in place three months prior to conception to ensure the best start to your baby’s life. Some of the things that your diabetes team can help you with include:
- Pre-conception counselling and planning
- Strict control of blood glucose levels (while avoiding hypoglycaemia) to ensure your levels are maintained close to the normal range before conception and throughout the pregnancy
- High dose (5mg) folate supplementation
- Adjusting any medications according to your doctor/diabetes team’s recommendations
- Screening for diabetes complications, including eyes, kidneys, macro-vascular disease and autonomic neuropathy
- Quitting smoking
- Blood glucose monitoring (mandatory during pregnancy)
- Reviewing diabetes education, diet and exercise
- Reviewing self-management skills including sick day management and in-date ketone testing strips, hypoglycaemia including in-date glucagon, always carrying adequate carbohydrate foods, and taking care with driving.
A healthy pregnancy doesn’t need to be difficult
Much of the pre-planning is merely a continuation (or tightening) of normal diabetes management:
- Check your blood glucose levels as often as advised
- Take your medications as prescribed
- Enjoy a healthy eating plan
- Include physical activity in your daily routine
- Schedule and attend all medical/pre-natal appointments.
What can happen if I don’t plan my pregnancy?
Poorly controlled diabetes or an unplanned pregnancy can lead to some ill effects for a woman with type 1 diabetes, including:
- Miscarriage and stillbirths (five times higher risk)
- Neonatal death within one month of birth (three times higher risk)
- Congenital abnormalities
- Large birth weight and heightened risk of future type 2 diabetes risk
- Infant risk of hypoglycaemia after birth and jaundice
- Maternal complications, including high blood pressure and kidney problems.
What target levels should I be aiming for?
Targets may be set specifically for you by your medical team, but in general:
- Fasting blood glucose levels: less than or equal to 5.0 mmol/L
- One hour after meal: less than or equal to 8.0 mmol/L
- Two hours after meals: less than or equal to 7.0 mmol/L
- The aim is to have your HbA1C between 6-7% for three months prior to becoming pregnant.
Where can I get help?
Your diabetes team should be your first point of contact. They may be able to recommend other health professionals to extend your care. These could include an obstetrician and midwife, endocrinologist, eye specialist (ophthalmologist), renal physician, neonatologist as well as a diabetes educator, dietitian and exercise physiologist.
Can I have a healthy baby? (booklet)
Australasian Diabetes in Pregnancy Society