Diabetes and pregnancy

If you have diabetes, you're at a higher risk of having problems during pregnancy and labour, including stillbirth. You're also at an increased risk of premature birth, and having a large baby (more than 4kg in weight).

But there's a lot you can do to help you and your baby stay healthy. If you have diabetes and you’re thinking of having a baby, the first step is to speak to your diabetes care team. They may refer you to a specialist pre-conception clinic for women with diabetes.

There's more on what to expect during a diabetic pregnancy in our Diabetes page in The Pregnancy Care Planner.

Cathy Moulton, care advisor for Diabetes UK, says, “Planning is the key to a good pregnancy when you have diabetes. Ideally you will ensure that you have close control of your blood glucose (sugar) levels before you become pregnant.

“Poor blood glucose control during the first eight weeks of pregnancy increases the risk that your baby will have serious health problems.”

Your diabetes care team can help you have a well-planned and controlled pregnancy. If you want to have a baby, make an appointment to get advice from your team before you start trying to get pregnant.

It's important to be fully in control of your blood glucose level before becoming pregnant. Your diabetes care team will talk to you about managing other aspects of diabetes, including checking your eyes for diabetic retinopathy, and checking your kidneys.

If you're taking medicines for other health conditions, these may have to be changed or altered.

You can learn more about staying well with diabetes in Living with diabetes.

“Of course, not all pregnancies are planned,” says Moulton. “But if you have diabetes and you’re pregnant, you need to take action. The sooner you do it, the lower the chance of complications for you and your baby. Contact your diabetes care team right away.”

For women with diabetes, pregnancy can be a particularly challenging time. Keeping you and your baby healthy takes extra planning, patience and careful management.

You should be referred to a specialist antenatal clinic for women with diabetes. The team can give you detailed advice on how to manage each stage of your pregnancy.

It's common for blood glucose levels to change in new ways as your pregnancy progresses. For example, many women find that their levels fall lower than usual during the first three months of pregnancy.

It’s important to attend all of your antenatal appointments. And remember, you can always go to your diabetes care team with questions and concerns.

Hypos (low blood glucose)
Some women find that close control of their blood glucose levels makes them more susceptible to hypoglycaemic attacks in which blood glucose falls dangerously low. It's important that you know how to manage them. Your care team can help.

You can be prepared by doing the following:

• Carry a hypo treatment (glucose tablets, glucose gel or fruit juice) with you everywhere.
• Keep a glucagon kit with you at all times. If you don’t have one, ask your GP or diabetes care team. The kit enables you to give yourself a simple injection that will bring you out of a hypo. Make sure that you, and people around you at work and home, know how to use it.

Hypers (high blood glucose)
Some women find that at certain stages of pregnancy – often in the last months when they're eating more – their blood glucose rises higher than usual.

Know how to test your urine or blood for ketones. These are acids that your body produces when it burns its own fat. They're a sign that your blood glucose is too high and that you need to adjust the way you're managing your condition.

Call for emergency help if you're unwell and think you may be developing diabetic ketoacidosis (DKA).

Diabetes that starts in pregnancy is called gestational diabetes.

Gestational diabetes lasts only as long as the pregnancy lasts. Close to the start of pregnancy, every woman should be assessed for the risk factors for gestational diabetes. These include:

• being overweight or obese
• having a close family history of diabetes
• if you've previously given birth to a very large baby (over 4.5kg)
• having gestational diabetes in a previous pregnancy
• being of south Asian, black Caribbean or Middle Eastern descent.

If you've been diagnosed with gestational diabetes, diet and lifestyle changes are often enough to control the condition.

With the advice of your diabetes care team, you should increase your levels of physical activity. You should also be referred to a registered dietitian who will advise you about adopting a healthy balanced diet. If blood sugar levels are not controlled by these measures, then tablets or insulin therapy will be considered.

Women with gestational diabetes need to be as careful about blood glucose control and health as those with type 1 or type 2 diabetes.

If you’ve had gestational diabetes your risk of developing type 2 diabetes at some point in your life rises to 30%. You're also at increased risk of developing gestational diabetes during subsequent pregnancies. 

Even after pregnancy you should stay aware of the other risk factors of diabetes and visit your GP if you're having any symptoms. Your GP should arrange for you to be tested each year for type 2 diabetes.

To learn more, read Gestational diabetes.