I have diabetes. Do I need to know anything special before I get pregnant?
Written for BabyCentre UK
If you have diabetes, whether it's type 1 or type 2, there is plenty you can do to prepare yourself for pregnancy. In fact, diabetes is one of the best examples of how getting ready for pregnancy can make a huge difference to your health and the health of your baby.
If you have diabetes, you will have to manage your condition very carefully. Having diabetes does mean that you are at a higher risk of losing your baby or having a baby with a congenital condition. But with careful planning and the support of your doctor and your diabetes specialist, there is much you can do to lower these risks.
See your doctor or your diabetes specialist before you start trying for a baby, so that you can take steps to tightly control your diabetes ready for pregnancy. This will reduce your risk of miscarriage and may help to prevent you developing pre-eclampsia later in your pregnancy.
We don't know for certain why babies of diabetic mothers are more likely to miscarry or to be born with problems but it's probably largely because of blood glucose levels. This could be because the glucose levels are constantly outside the normal range or because they fluctuate a lot.
In general, birth defects are twice as likely in diabetic pregnancies compared with the general population. Babies born to mothers with diabetes are five times as likely to have heart problems as other babies. For this reason, it has been suggested that all women with diabetes be offered special heart monitoring for their baby. You should also be offered extra ultrasound scans as required.
Since most heart, kidney and central nervous system birth defects occur in the first seven weeks of pregnancy, it's essential to get your blood glucose level under control. You should keep it under control before you conceive and during your pregnancy.
It is very important to get advice before you get pregnant. It may be recommended that you change the treatment you use to control your diabetes before you conceive, for example, from oral hypoglycaemic medication to insulin. Research has shown that the rate of birth defects decreases greatly if an expectant mum gets help.
All women who are trying to conceive are recommended to take a folic acid supplement but this is even more important for your baby. Folic acid helps prevent problems caused by the spinal column not closing properly, such as spina bifida.
You will probably be advised to take a much higher dose of folic acid rather than taking the usual dose of 400 micrograms (mcg). Your doctor or diabetes specialist will advise you but the recommended amount of folic acid for most diabetic women is about 10 times the normal dose.
Before you get pregnant, taking the following steps can help maximise your chances of having a healthy baby:
Aim to achieve normal glycosolated haemoglobin levels (an indicator of blood sugar control) before you conceive.
Manage your diet carefully and monitor your glucose levels carefully and often.
Take 5mg of folic acid supplements daily and carry on taking them until you are 12 weeks pregnant.
Once you are pregnant, you should be offered:
an eye test to assess your retinas, the blood-rich internal layer inside your eyes
a renal test to check your kidney function
a dating ultrasound scan before you are 13 weeks pregnant
Having a big baby is a risk if diabetes is not well controlled. The dating scan helps the maternity team, later on in pregnancy, to work out whether your baby has grown larger than normal.
Having a big baby can make labour and birth more difficult. It is one of the reasons why having diabetes increases the chances of having an induced labour or a caesarean section. An accurate dating scan will make it less likely that your labour is induced unnecessarily.
Your doctor or diabetes specialist will be able to advise you on the best steps to take. For more support and information, visit the pregnancy and diabetes pages of charity Diabetes UK.
Reviewed March 2007
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