Pregnancy and diabetes
Women who have diabetes are advised to take special precautions before conception and during pregnancy to reduce the chance that their diabetes will cause harm to their baby, or to themselves. In addition, some women develop diabetes for the first time when they are pregnant (called ‘gestational diabetes’) and this guidance also applies to them.
A number of birth complications are more common in women who have diabetes compared with other women. These include miscarriage, pre-eclampsia (a condition where the mother develops high blood pressure), premature birth, stillbirth, as well as physical defects in the baby at birth or postnatal hypoglycaemia. In addition, women with diabetes may find that diabetes-related eye problems (diabetic retinopathy) worsen during pregnancy.
These complications stem from poor blood glucose control either before pregnancy, when the baby is conceived, or during pregnancy. Because of this, it is especially important for women who have diabetes to keep their blood glucose within a target range (ie, HbA1c below 7%) when planning to become pregnant and during pregnancy, particularly during the early months.
It follows that use of contraception and pregnancy planning need special consideration by women with diabetes as unplanned pregnancy poses particular risks if blood glucose is not well controlled. In addition, women with diabetes who plan to become pregnant are advised to take a daily 5 mg folic acid supplement to reduce the risks of birth defects in the baby.
It may be necessary for women to make changes to their usual diabetes management routine before and during pregnancy, such as setting a new target for blood glucose levels, monitoring blood glucose more regularly, reviewing diet and physical activity plans, or altering insulin dosing. Women who take tablets to control their diabetes may need to substitute these with insulin before becoming pregnant as some diabetes medications should not be used in pregnancy. Similarly, drugs used to treat other medical conditions might need to be stopped before conception and alternatives taken up.
Women with diabetes are encouraged to seek advice from diabetes healthcare professionals on their individual circumstances before becoming pregnant. Pre-conception services for women with diabetes also offer advice on stopping smoking, on alcohol, vaccinations and provide screening for rubella.