Diabetes and Pregnancy

Pregnancy

 

Diabetes & Pregnancy

Diabetes & Pregnancy

Diabetes is the most common medical disorder complicating pregnancy in the UK.

Approximately 1 in 250 pregnant women have pre-existing diabetes (either type 1 or type 2). We aim to provide you with the right level of care, treatment and education so that your pregnancy is similar to that of a person living without diabetes.

Planning pregnancy

Planning pregnancy

We are here to help and support you throughout the planning and duration of your pregnancy.

If you have Type 1 or Type 2 diabetes, it is very important to talk to your diabetes team before you start to try to become pregnant.

Most women with diabetes have a normal pregnancy and a healthy baby, but there is an increased risk of some problems. Planning your pregancy helps to reduce these risks.

Risks to mum

  1. Eyes

    People with diabetes are at risk of developing a complication called retinopathy. Retinopathy affects the blood vessels supplying the retina – the seeing part of the eye. Blood vessels in the retina of the eye can become blocked, leaky or grow haphazardly. This damage gets in the way of the light passing through to the retina and if left untreated can damage vision. 

  2. Kidneys

  3. High blood pressure

  4. Pre-eclampsia

    Pre-eclampsia is a condition that affects some pregnant women usually during the second half of pregnancy (from around 20 weeks) or immediately after delivery of their baby.

    Women with pre-eclampsia have high blood pressure, fluid retention (oedema) and protein in the urine (proteinuria). If it's not treated, it can lead to serious complications.

    In the unborn baby, pre-eclampsia can cause growth problems. 

  5. Increased risk of infection

  6. Reduced awareness of low blood sugar (hypoglycaemia)

  7. Polyhydramnios

  8. What is polyhydramnios? 
    Polyhydramnios means you have too much amniotic fluid in your uterus(womb). It happens in about one in 500 pregnancies in the UK (Crafter 2009), so it isn't common. Most cases of polyhydramnios are mild or moderate.

    The amniotic fluid surrounding your baby protects him from being hurt if you have a blow to your tummy, or if your tummy is squashed. The fluid also protects your baby against infection, as well as helping his lungs to develop.

    The amount of fluid around your baby gradually increases until there is about one litre (1.76 pints) surrounding him at 38 weeks. This amount decreases to about 800ml (1.4 pints) by 40 weeks (Crafter 2009). Your baby will regularly swallow amniotic fluid, which then passes out of his body as urine. This is how he controls the volume of amniotic fluid around him.

    When this delicate balance is disturbed, the volume of amniotic fluid can increase rapidly. In severe cases of polyhydramnios, there may be as much as three litres (5.3 pints) of fluid, or three times the normal amount, around your baby

  9. Increased problems in labour

Risks to baby

  1. Congenital malformation (3 - 5 times higher than in the non-diabetic population)

  2. Congenital malformations are used to describe changes to the foetus and conditions with which people are born. The risk of congenital malformations is 3 - 5 times higher than in the non-diabetic population.

  3. Miscarriage

  4. Baby born early (premature)

  5. Baby born big (macrosomia)

  6. Birth injury

  7. Still birth late in pregnancy

  8. Low blood glucose after baby has been delivered

Before you get pregnant

Before you get pregnant

Things Things to do before you get pregnant:

  • Stop smoking
  • Reduce alcohol intake
  • Use effective contraception
  • Start taking 5mg folic acid daily
    When you have diabetes there is a higher risk of the baby developing spina bifida. Folic acid helps to lower this risk. This medication will need to be prescribed by your GP
  • Check your blood glucose at home 4 – 7 times daily, aim for:
    • Blood glucose levels before meals less than 5.3 mmols
    • Blood glucose levels one hour after meals less than 7.8 mmols
    • Try and write these results in a diary so that you and the diabetes nurse can start to look for patterns and trends.
  • Healthy eating 
    It is important to eat a variety of foods, have regular meals which include some starchy food e.g. bread, rice, pasta, potatoes. Eat recommended amount of fruit/vegetables. Eat iron/calcium rich foods on daily basis.  Avoid foods high in sugar and fried foods to a minimum.
  • Think about weight control and reduction of weight if necessary
  • Have regular follow ups with the diabetes team
  • Have a review of any medication you take to help control your blood glucose 
    If you are on tablets for your diabetes you may need to stop the tablets and commence insulin. If you are on diet only you will need to continue to monitor blood glucose and you may require insulin if blood glucose are above target range
  • Have a review of your high blood pressure and cholesterol tablets
  • Have your eyes and kidneys checked
  • Know your HbA1c target – target HbA1c of 48 mmol/mol (6.5%) or as close to it without having any severe hypoglycaemia.
  • Know how to manage hypoglycaemia
  • Know how to manage illness   

During pregnancy

During pregnancy

Once you are pregnant you will be referred to a joint diabetes antenatal clinic.

Your diabetes will be managed by a specialist team including obstetricians, diabetes consultants, specialist diabetes nurses, specialist diabetes midwifes and dieticians. We are all here to support you on your journey.

Your care will be individual to you and we will see you in clinic every two weeks.

Antenatal Clinics in Worcestershire

Location

Day

Time

Alexandra Hospital Monday 2pm - 4pm
Kidderminster Hospital & Treatment Centre Tuesday 9am - 1pm
Worcestershire Royal Hospital Friday
11am - 1pm

You will be given a set of orange notes called 'Diabetes in Pregnancy' which should be attached to your green pregnancy notes.

Your patient handheld records will help you to be involved in your care, as well as helping other doctors and nurses in seeing what care you have received.

You will need to continue to check your blood glucose before and after meals aiming for:

  • Blood glucose levels before meals less than 5.3 mmols

  • Blood glucose levels one hour after meals less than 7.8 mmols

Be aware that tight diabetes control is likely to increase the frequency of mild hypoglycaemia (blood glucose below 4 mmols). More information on hypoglycaemia is available  by talking to a member of your diabetes team.

If you are having frequent low blood glucose or experience a more severe hypo episode (blood glucose below 2.8mmols), or someone else has had to help you to manage your low blood glucose then contact the diabetes team to discuss this.

Remeber to always carry some rapid acting glucose with you (glucogel, dextrose tablets, lucozade, orange juice, jelly babies) and know how to manage illness. 

You should be aware that insulin requirements will normally increase during the course of pregnancy – this is due to both you becoming more resistant to the insulin that you are taking and also the hormone effect once you are pregnant.

A HbA1c will be taken every four to six weeks – aiming to keep your HbA1c around 48 mmol/mol (6.5%).

If you require further dietician input please inform a Diabetes Specialist Nurse.

It is important that your diabetes nurse or doctor clearly write what insulin/tablets and dose you were on in your orange notes. Once you have had your baby you will be prescribed your insulin/tablets as per plan.

Your pregnancy appointments

Your pregnancy appointments

The information below helps you to plan your pregnancy appointments, although this outlines the minimum visits you should have, you are normally seen every two weeks in your antenatal clinic for review of your diabetes care.

First Appointment

With Diabetes Doctor or Diabetes Specialist Nurse (DSN)

Your care should include
  • Advice, information and support about your blood glucose levels
  • Discussions about your current medication.
  • HbA1c (if no result within past 4 – 6 weeks)
  • Eye examination/kidney test if not done in past year – given advice on retinal screening service in Worcestershire.
  • Further advice on managing low blood glucose.
  • Advice on diabetes management and illness.

7 – 9 weeks

With Midwife/obstetrician

Your care should include
  • An ultrasound scan to check how many weeks you are pregnant.

10 weeks

With DSN/diabetes doctor and midwife

Your care should include:
  • Information, education and advice about how diabetes will affect your pregnancy, birth and early parenting.
  • HbA1c blood test.

12 weeks

Stop taking your folic acid

16 weeks

With DSN / diabetes doctor

Your care should include
  • Advice on having second retinal (eye) screening scan performed.
  • Ongoing support with diabetes control and changes to treatment.
  • HbA1c blood test.

20 weeks

With DSN / Diabetes doctor / midwife / obstetrician

Your care should include
  • An offer of an ultrasound scan to check physical development of your baby including a test to check the development of your baby's heart.
  • HbA1c blood test.

25 weeks

With Midwife / diabetes doctor

Your care should include
  • If this is your first baby your midwife or doctor will offer tests to check yours and your baby's wellbeing.

28 weeks

Your care should include
  • Advice on having third retinal (eye) screening scan.
  • An offer of an ultrasound scan to check your baby’s growth.
  • Measuring your blood pressure, testing your urine

32 weeks

Your care should include
  • An offer of an ultrasound scan to check your baby’s growth.
  • Measuring your blood pressure, testing your urine.

Once you have planned your pregnancy

Once you have planned your pregnancy

Things to do once you have planned your pregnancy:

  • Stop contraception once your HbA1c has reached the target 48 mmol/mol

  • Continue to check blood glucose at home (4 - 7 times daily) before and after food, or as advised by your diabetes nurse and aim for:

  • Blood glucose levels before meals less than 5.3 mmols

  • Blood glucose levels one hour after meals less than 7.8 mmols

  • Continue taking 5mg folic acid daily

  • Access medical care as soon as pregnancy has been confirmed

Who do I need to contact?

Redditch and Bromsgrove Diabetes Team - 01527 488656

Kidderminster Diabetes Team - 01562 513239

Worcester Diabetes Team - 01905 760775

During labour and delivery

During labour and delivery

Your healthcare team should advise you to have your baby in hospital so that appropriate care for your baby can be given 24 hours a day.

Your obstetrician/midwife will discuss the risks and benefits of vaginal births, induced labour and caesarean section.

It is important that your blood glucose is well controlled during labour and birth to help prevent your baby's blood glucose level becoming low following birth.

During labour your blood glucose will be monitored very closely and you may need to have an insulin infusion, this is where a continuous amount of insulin is fed into your blood through a tube.

If you have any concerns about labour please discuss these with your diabetes team.

Your healthcare team should advise you to have your baby in hospital so that appropriate care for your baby can be given 24 hours a day.

Your obstetrician/midwife will discuss the risks and benefits of vaginal births, induced labour and caesarean section.

It is important that your blood glucose is well controlled during labour and birth to help prevent your baby's blood glucose level becoming low following birth.

During labour your blood glucose will be monitored very closely and you may need to have an insulin infusion, this is where a continuous amount of insulin is fed into your blood through a tube.

If you have any concerns about labour please discuss these with your diabetes team.

Care after your baby is born

Care after your baby is born

Once your baby is born you can go back to your usual treatment. If you take insulin you will need to go back to what dose you were taking before you got pregnant. If you are breastfeeding you may need to reduce your insulin by a further 20%.

If you were taking tablets and plan to breastfeed you will need to seek advice from your diabetes team.

It is important to stay in contact with your diabetes team and be offered an appointment to see the diabetes consultant.