Planning a pregnancy with type 1 or 2 diabetes

Why is it so important to plan my pregnancy with diabetes?

Most women and birthing people with diabetes have a healthy baby. But planning a pregnancy when you have diabetes is important.  

This is because there is a higher chance of health problems for you and your baby if your condition is not well controlled. These may include:

• having a large baby (making labour more difficult)
• miscarriage
• birth defects
• stillbirth.

This may be difficult to read. But try to remember that most people will have healthy pregnancies and healthy babies if their diabetes is well controlled. You will also be offered extra care and support to manage your condition during your pregnancy. 

Right from when I was diagnosed, my diabetes team said to me ‘If you're ever thinking of having a family, you need to let us know because there are special things you have to do.

Maria

Preparing for pregnancy with type 1 or 2 diabetes

The first thing to do is talk to your GP or diabetes team. Try to do this before you stop using contraception.  

Your healthcare professional should give you information about how diabetes affects pregnancy and how pregnancy affects your condition.

Diabetes may cause some fertility issues, making it harder to get pregnant. Talk to your doctor if you have any concerns about your fertility.

There are several steps you can take before getting pregnant that will give you the best possible chance of having a healthy pregnancy.  

Get your HbA1C to the recommended level

Your care team should offer you an HbA1c test every month. This tells you your average blood glucose level over the last 2 to 3 months.  

Your team will help you aim for a target HbA1c of below 6.5% before you get pregnant (if this doesn't cause problems with hypoglycaemia). Any decrease in levels towards this target will help reduce the risk of problems for your baby.  

If your HbA1c is very high (10%), your care team will strongly advise you not to try for a baby until it has fallen. This is because of the increased risk of serious problems.

Check your blood glucose levels

Your care team should talk with you about how to control your blood glucose and agree ideal (or target) levels with you that are manageable without causing hypoglycaemia.  

The targets might be different before you go to bed and if you need to test after meals.

Testing your blood glucose  

If you have type 1 diabetes you should be offered a continuous glucose monitor to test your blood glucose during pregnancy, or a flash glucose monitor if you prefer.  

If you do not have type 1 diabetes, you may still be offered continuous glucose monitoring if you are having trouble with blood glucose control (for example, if you are having lots of hypos).

If you are not offered continuous or flash glucose monitoring, you should be offered a monitor and testing strips. 

I have always known I wanted children and I have always had this ideal in my head, so of course for me I was going to do this right. I wasn’t going to put my baby at any risk. 

Laura

Take a higher dose of folic acid

Everyone is recommended to take folic acid from before they get pregnant until they are 12 weeks pregnant. Folic acid can help prevent birth defects known as neural tube defects, including spina bifida.  

People with diabetes have a higher chance of having a pregnancy affected by neural tube defects. So you are recommended to take a higher dose of folic acid (5 milligrams). This isn’t available over the counter, but your GP can prescribe it.  

Try to take folic acid 3 months before you stop taking contraception to let it build up in your system before you get pregnant.  

Speak to your doctor about your folic acid intake if it is taking longer for you to get pregnant.

Don’t worry if you have become pregnant without taking folic acid. Many women have been in this situation and their babies have been healthy – just start taking it straight away now and until you are 12 weeks pregnant.  

Check your diabetes medication

Your care team should talk to you about your diabetes medications. They may advise you to change them while you are trying for a baby.

If you are taking tablets, you may be advised to switch to insulin injections. You may be able to take metformin tablets as well as, or instead of, insulin injections.

If you take insulin, you may be able to carry on or you may be advised to change to another insulin. Your care team will talk to you about this.

Your care team should also talk with you about any other medications that you are taking. You may be advised to stop taking certain tablets for high blood pressure and replace them with others that are safer to use when trying for a baby and during pregnancy.  

Statins are not usually recommended if you are trying for a baby or pregnant.  

1011You will also need to stop taking other injected medications often used for type 2 diabetes, such as Victoza (liraglutide) and Byetta (exenatide) or similar. These are not safe in pregnancy.

Do not stop taking any medications before speaking to your healthcare professional.  

Have your eyes and kidneys checked  

Kidney tests

People with diabetes are at higher risk of having kidney problems, known as diabetic nephropathy. This stops the kidneys from working properly and increases the risk of a serious pregnancy complication called pre-eclampsia.  

Your care team should offer you tests to check that your kidneys are working properly before you stop using contraception. Depending on the results, you may be referred to a kidney specialist.

Eye tests

If you want to start trying to get pregnant, your diabetic care team should offer you an eye screening if you have not had one in the last 6 months.

Look at your lifestyle  

There are lots of other things you can do before getting pregnant that will make a difference to your health and your baby’s.  

Find out more about the 12 things to do when trying for a baby.