What it means for you
If you have type 1 or type 2 diabetes, you may be at higher risk of having:
- a large baby – which increases the risk of a difficult birth, having your labour induced or needing a caesarean section
- a miscarriage
People with diabetes are at risk of developing problems with their eyes (diabetic retinopathy) and kidneys (diabetic nephropathy).
Some people with type 1 diabetes can develop diabetic ketoacidosis, where harmful chemicals called ketones build up in the blood.
Pregnancy can increase your risk of developing these problems or make existing ones worse.
What it means for your baby
If you have type 1 or type 2 diabetes, your baby may be at higher risk of:
- having health problems shortly after birth, such as heart and breathing problems, and needing hospital care
- developing obesity or diabetes later in life
There's also a slightly higher chance of your baby being born with birth defects, particularly heart and nervous system abnormalities, or being stillborn or dying soon after birth.
But managing your diabetes well, before and during your pregnancy, will help to reduce these risks.
Reducing the risks
The best way to reduce the risks to you and your baby is to ensure your diabetes is well controlled before you become pregnant.
Before you start trying for a baby, ask your GP or diabetes specialist (diabetologist) for advice. You should be referred to a diabetic pre-conception clinic for support.
You should be offered a blood test, called an HbA1c test, every month. This measures the level of glucose in your blood.
It's best if the level is no more than 6.5% before you get pregnant. If you can't get your level below 6.5%, try to get it as close as possible to reduce the risk of complications for you and your baby.
If your blood glucose level is above 10%, your care team should strongly advise you not to try for a baby until it has fallen.
You should continue using contraceptives until you get your blood glucose under control. Your GP or diabetes specialist can advise you on how best to do this.
If you have type 1 diabetes, you should be given testing strips and a monitor to test your blood ketone levels, to check for diabetic ketoacidosis. You should use these if your blood glucose levels are high, or if you are vomiting or have diarrhoea.
Women with diabetes should take a higher dose of 5 milligrams (mg) of folic acid each day while trying to get pregnant and until they are 12 weeks pregnant. Your doctor will have to prescribe this, as 5mg tablets are not available over the counter.
Taking folic acid helps to prevent your baby from developing birth defects, such as spina bifida.
Your diabetes treatment in pregnancy
Your doctors may recommend changing your treatment regime during pregnancy.
If you usually take tablets to control your diabetes, you'll normally be advised to switch to insulin injections, either with or without a drug called metformin.
If you already use insulin injections to control your diabetes, you may need to switch to a different type of insulin.
If you take drugs for conditions related to your diabetes, such as high blood pressure, these may have to be changed.
It's very important to attend any appointments made for you so that your care team can monitor your condition and react to any changes that could affect your or your baby's health.
You will need to monitor your blood glucose levels more frequently during pregnancy, especially since nausea and vomiting (morning sickness) can affect them. Your GP or midwife will be able to advise you on this.
Keeping your blood glucose levels low may mean you have more low-blood-sugar (hypoglycaemic) attacks ("hypos"). These are harmless for your baby, but you and your partner need to know how to cope with them. Talk to your doctor or diabetes specialist.
Diabetic eye screening in pregnancy
You will be offered regular diabetic eye screening during your pregnancy. This is to check for signs of diabetic eye disease (diabetic retinopathy).
Screening is very important when you are pregnant because the risk of serious eye problems is greater in pregnancy.
Diabetic retinopathy is treatable, especially if it is caught early.
If you decide not to have the test, you should tell the clinician looking after your diabetes care during pregnancy.
Labour and birth
If you have diabetes, it's strongly recommended that you give birth in a hospital with the support of a consultant-led maternity team.
Your doctors may recommend having your labour started early (induced) because there may be an increased risk of complications for you or your baby if your pregnancy carries on for too long.
If your baby is larger than expected, your doctors might discuss your options for the delivery and may suggest an elective caesarean section.
Your blood glucose should be measured every hour during labour and birth. You may be given a drip in your arm with insulin and glucose if there are problems.
After the birth
Feed your baby as soon as possible after the birth – within 30 minutes – to help keep your baby's blood glucose at a safe level.
Your baby will have a heel prick blood test a few hours after they're born to check if their blood glucose level is too low.
If your baby's blood glucose can't be kept at a safe level, or they are having problems feeding, they may need extra care. Your baby may need to be fed through a tube or given a drip to increase their blood glucose.
Read more about special care for babies.
When your pregnancy is over, you won't need as much insulin to control your blood glucose. You can decrease your insulin to your pre-pregnancy dose or return to the tablets you were taking before you became pregnant. Talk to your doctor about this.
You should be offered a test to check your blood glucose levels before you go home and at your 6-week postnatal check. You should also be given advice on diet and exercise.