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Pre-existing diabetes and pregnancy

6-minute read

If you have type 1 or type 2 diabetes and are planning a family, you should plan your pregnancy as much as possible. Controlling your blood sugars before conception and throughout pregnancy gives you the best chance of having a trouble-free pregnancy and birth and a healthy baby.

If you have diabetes and your pregnancy is unplanned, there's still plenty you can do to give your baby the best start in life.

The information on this page is for women who have diabetes before becoming pregnant.

If you develop diabetes during pregnancy, it is called gestational diabetes.

Planned pregnancy

If you can, visit your doctor or diabetes educator at least 6 months before you start trying to fall pregnant.

You will be given advice and guidance on controlling your blood sugars as tightly as possible, and taking necessary supplements like folate. You may also be advised to change medications.

If you are healthy and your diabetes is well controlled when you become pregnant, you have a good chance of having a normal pregnancy and birth.

Diabetes that is not well controlled during pregnancy can affect your health long-term and can also be risky for your baby.

Unplanned pregnancy

Not everybody can plan their pregnancy. If you have diabetes and think you might be pregnant, see your doctor as soon as you can.

Your healthcare team

You may be cared for by a team of health professionals including:

  • an obstetrician who can handle high-risk pregnancies
  • a specialist endocrinologist experienced in diabetes care during pregnancy
  • a diabetes educator to help you manage your diabetes
  • a dietitian who can provide dietary advice at all the different stages — before conception, during pregnancy and after the birth
  • a midwife who is experienced in all aspects of pregnancy and birth

Diabetes in pregnancy

While you may take good care of yourself already, pregnancy is a time when you need to take even more care. It is very important for your health and for your baby's health that your blood sugar levels are kept stable.

The ideal blood sugar level is between 4.0 and 5.5 mmol/L when fasting (before meals), and less than 7.0 mmol/L 2 hours after a meal.

There is a chance that some of the potential complications of diabetes, like eye disease and kidney disease, may develop while you are pregnant. Your doctors will keep an eye on this. There is also a risk of developing pre-eclampsia, a condition involving high blood pressure during pregnancy, which can cause problems for the baby.

Babies born to women with diabetes are at risk of being born larger than average, or with a birth defect. They may also be born prematurely or even stillborn. They are also at risk of developing type 2 diabetes in the long term.

These risks are greatly reduced if you keep your blood sugars under good control.

Medications in pregnancy

Your doctor will need to review every medication you are taking before you become pregnant, or as soon as possible after you find out you’re pregnant, as many medications need to be stopped or changed during pregnancy.

Your body’s needs for sugar and insulin will change while you are pregnant. This means the medications you need to control your blood sugar levels will change. They might change often. Your doctors will advise you how often to test your blood sugar levels and what medications to use.

Some women with type 1 diabetes will be advised to change the way they take insulin, and may be advised to use an insulin pump.

Some women with type 2 diabetes can control their blood sugars with diet only, and no medications, early in their pregnancy. But most women will need to take medications to control their blood sugar levels at some stage.

If you want to take any medication at all — prescribed, over-the-counter or alternative — check with your doctors first.

If you notice your need for medication changing suddenly, or your blood sugars changing suddenly, call your doctors for advice.

What you can do

There is a lot you can do:

  • start taking folate when you are thinking about becoming pregnant
  • see your doctors early and often
  • closely monitor your blood sugar levels
  • get advice about what to eat, and follow it
  • avoid alcohol, smoking and drugs
  • review all your medications with your doctors regularly
  • make sure all your vaccinations are up to date
  • aim for a healthy weight

Delivery and birth

You should plan the birth of your baby together with your doctor and midwife. You may be advised to have a caesarean delivery. You might be advised to have an intravenous drip with sugar and insulin while in labour. You may be advised to have your baby a little early or it may decide to arrive early on its own. Keeping your blood sugars under good control gives you the best chance of reaching full term.

Once born, your baby will be monitored closely, and may have blood tests regularly. This is to test for low sugar levels, not diabetes. Your baby may need to go to the special care nursery for a day or two.

You should be able to breastfeed your baby. Having diabetes won’t affect your breastfeeding, and insulin is not harmful to the baby. Talk to your midwife or lactation consultant if you have any concerns. You can also call the Australian Breastfeeding Association on 1800 686 268.

If you have diabetes, there is a slight chance your baby will develop diabetes, but it is far more likely that they will not.

You can get more information and e-books from Diabetes Australia. Online information is also available from the ‘Pregnancy and Diabetes’ website of the National Diabetes Services Scheme.

Sources:

Cochrane (Preconception care for diabetic women for improving maternal and infant health), Diabetes Australia (Pregnancy), Diabetes Australia (Having a healthy baby: A guide to planning and managing pregnancy for women with type 1 diabetes)

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Last reviewed: October 2021


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