Speak to your diabetes team about your pregnancy plans at least three months before trying to conceive. However, if like many women, you get pregnant without planning, don’t panic! Make an urgent appointment with your diabetes team to review your diabetes and general health and put a plan in place from there.
Planning your pregnancy
Guidance from healthcare professionals says that you should start working on the following goals about three months before conception:
- Try to achieve an HbA1c below 53 mmol/mol (7%), or ideally below 48 mmol/mol (6.5%) if this can be achieved without increased episodes of hypoglycaemia. The first eight to 12 weeks are when a baby’s major organs develop, so it is important to gain tight blood glucose control before you get pregnant. Persistently high blood glucose levels dramatically increase the risk of abnormal development of your baby. Work with your diabetes team to achieve the best blood glucose level you can. It might be time to consider getting an insulin pump
- You will need a medical examination by your doctor prior to and during your pregnancy. They need to check blood pressure, immunity to rubella and chicken pox, and conduct a complications screen (particularly for your eyes and kidneys)
- Start taking a folic acid supplement and daily multivitamin. Discuss an appropriate dose with your doctor and get a prescription. High dose folic acid (5mg daily) is recommended for all women planning pregnancy. Ideally you should take it at least three months before conception and continue taking it until 12 weeks into pregnancy
- Visit your dietitian. They can advise you on the most appropriate foods for you during your pregnancy
- If you smoke or drink alcohol, stop!
Once you’re pregnant (congratulations!), you need to try to achieve very tight blood glucose control. This can be extremely stressful and demanding. Your insulin requirements will change as you battle morning sickness and your pregnancy progresses and you might find your usual early warning signs of a hypo change or disappear completely. You can seek the support and understanding of family, friends and your health professionals.
Your doctor will provide you with a schedule of check-ups and tests. Certain complications are aggravated by pregnancy (e.g. kidney and eye problems). Your doctor will closely monitor you during pregnancy.
The growth of your baby also needs to be closely monitored, as they are at a higher risk of developing a condition known as ‘macrosomia’, which means ‘large body’, if your blood glucose level are high.
The baby may also have problems if you have low blood glucose levels at birth as it continues to make extra insulin for a day or two. Keeping your blood glucose levels within target will significantly reduce the risk of these problems occurring.
There is no reason for you not to expect a normal birth. You can still carry your baby to full-term and go into labour on your own, although some women are advised to have their baby early for various reasons, including diabetes control or the baby becoming too large.
You can still have a natural birth, although it is slightly more common to have a caesarean section if needed. You will be able to discuss all options with your obstetrician and make a plan for your baby’s birth towards the end of your pregnancy.
Immediately after delivery of the baby, insulin doses return to pre-pregnancy levels, so it might be worth keeping a record of what these were prior to pregnancy.
If you want to breastfeed, there’s no reason why you can’t. You’ll just need to watch for fluctuations in your blood glucose levels and plan ahead. You’ll probably need to eat more carbohydrate when feeding, especially in the early months. You may find that your milk is slower to ‘come in’, but your midwife or lactation consultant will help you and your baby to get to grips with it.
Will my baby be born with type 1 diabetes?
Only one in 10 people with type 1 diabetes have a close family member with the condition. Your baby will not be born with type 1 diabetes and the chance of them developing it in the future is only five per cent (or seven per cent if the father has type 1 diabetes too).