Managing type 1 or 2 diabetes in pregnancy

If you have type 1 or 2 diabetes, you will be offered extra care to help manage your condition in pregnancy.  

On this page

Your antenatal appointments

Your healthcare team

Managing your diabetes 

Your first trimester

Your second trimester

Your third trimester

Your baby's movements

Your antenatal appointments

Every pregnancy is different. Your care may be slightly different from that of other people with diabetes. If you’re ever unsure about anything to do with how to manage your diabetes, don’t be afraid to ask your healthcare team. They’re there to support you.

You should be seen in a joint diabetes and antenatal clinic as soon as you find out you are pregnant.  

You’ll have extra support for diabetes management, as well as the routine antenatal care appointments with your community midwife.  

This includes extra tests and ultrasound scans to check your health and your baby’s health. You may be offered an early pregnancy scan between 7 and 9 weeks, as well as the routine scan at 10-14 weeks.

Your blood pressure and urine will also be tested at each visit, to check for pre-eclampsia (a pregnancy-specific condition).

You will need to keep a close eye on your glucose levels during pregnancy, and may need to make changes to your diet.  

You will have regular contact with your healthcare team to review your glucose levels. This could be as often as every 1 to 2 weeks. The team can support you with any lifestyle changes you may need to make. 

Try to go to any appointments you have, so that your healthcare team can help to keep you and your baby safe.

Your healthcare team

Which specialists you will see depends on what services there are in your local area. But your team might include:

• A specialist midwife – there may be a diabetes midwife or clinic lead midwife, who will give you specialist support while you are pregnant, during the birth and after the birth.
• An endocrinologist or diabetologist – this is a doctor who specialises in diabetes.
• An obstetrician – a doctor who specialises in pregnancy and birth.
• A diabetes nurse specialist – a nurse specialising in caring for people with diabetes.
• A dietitian – a healthcare professional who can provide advice on your diet.
• Kidney or eye specialists (nephrologists or ophthalmologists).

These professionals will work with the other members of your healthcare team, such as your GP and your community midwife. 

Managing your diabetes

Your diabetes team may advise changes to your current treatment plan during pregnancy.  

You will need to monitor your glucose levels more often during your pregnancy. Morning sickness can affect your glucose levels, and insulin resistance can change throughout your pregnancy. Your healthcare team will be able to tell you more about this.

Target glucose levels for pregnancy

Your healthcare team will give you a target range for your blood sugar levels. This is often a capillary plasma glucose level no higher than:

• 5.3mmol/l first thing in the morning (before eating)
• 7.8mmol/l 1 hour after each meal
• 6.4mmol/l 2 hours after each meal
• And above 4mmol/l for those taking insulin.

However, speak to your team about your own personal target levels, and the best way to maintain them.

Find out more about how to manage your glucose levels.  

Diet and exercise

You may be advised to make changes to your diet and activity levels during pregnancy, to help manage your diabetes.

Eating a healthy, balanced diet can help to stabilise your blood glucose levels. Aim for foods that are low in sugar, and have a low glycaemic index.

If you want support, ask your diabetes team for a meeting with a dietician. They can help you balance cravings and morning sickness with getting the best foods for you and your baby.

Staying active is also important for a healthy pregnancy, and may also help to manage your blood glucose levels. If you exercised before getting pregnant, it’s usually safe to carry on as normal, but speak to your midwife or diabetes team if you have any concerns.

Find out more about diet and exercise in pregnancy with type 1 or 2 diabetes.  

Diabetes tech

You may be offered diabetes technology to help maintain your blood sugar levels. The most common type is continuous glucose monitoring (CGM). This measures your glucose levels in real time, and provides alerts if they’re too high or low.

Some people may also be offered an insulin pump, which delivers a constant stream of insulin to help maintain healthy glucose levels.

Speak to your healthcare team about your options.

Find out more about using insulin in pregnancy with type 1 and type 2 diabetes.

Hypolglycaemia

In early pregnancy (about 9-16 weeks), you may have low blood sugar (hypoglycaemia) more often. This won’t harm your baby, but could put you at risk. 

It’s important that you and those you spend the most time with know how to manage hypos. Talk to your diabetes team about this.  

Find out more about hypoglycaemia (hypos) in pregnancy.

Your first trimester

Your booking appointment

Your first antenatal appointment is called a booking appointment. Ideally, you should have this before you’re 10 weeks pregnant.  

Unless they discussed these things with you before you got pregnant, your midwife or specialist diabetes team should talk to you about:

• how pregnancy may affect your blood glucose levels
• how diabetes may affect your pregnancy, labour and birth
• how your diabetes will be managed during pregnancy
• what diabetes medication you are taking and if you need to make any changes
• any other medication you’re taking and if you need to make any changes
• how to keep your glucose levels within safe limits during pregnancy, including advice on diet and exercise.

Blood sugar (HbA1c) test 

You should be offered an HbA1c test during your booking appointment. This is a test that measures the average level of glucose in your blood over the past 2-3 months. You will be offered this test again later in your pregnancy – maybe quite often - though it can be less reliable as your pregnancy progresses.

If you have type 1 diabetes, you should be offered continuous glucose monitoring. This measures your glucose levels in real time, and can alert you if it gets too high or low.

You may also be offered CGM if you have type 2 diabetes and struggle to keep your blood sugar levels under control.

Low blood sugar (hypoglycaemia) 

Pregnancy can make it harder for you to recognise hypoglycaemia, especially in the first trimester. 

It’s important that you and the people you spend a lot of time with can recognise hypoglycaemia, and know how to help if you need it. This could include a partner, family members, friends or work colleagues.

Find out more about hypoglycaemia.

Folic acid

You will need to start taking a high dose (5mg) of folic acid every day. Ideally, you should start this from about 3 months before getting pregnant, but if not then start as soon as you find out you’re pregnant. Keep taking it until you are 12 weeks pregnant.

You take folic acid as a tablet. It lowers the risk of having a baby with spina bifida or other problems that affect their spine and neural tube.

You’ll need to get this prescribed by your GP because you can’t get a higher dose of folic acid over the counter.

Find out more about folic acid in pregnancy.

Vitamin D 

People who are pregnant or breastfeeding should take 10 mcg of vitamin D every day between September and March. You may need to take it all year round if you have dark skin, spend a lot of time inside, or cover your skin when you go outside. Vitamin D keeps your bones, teeth and muscles healthy.

Find out more about vitamin D in pregnancy.  

Morning sickness and diabetes 

If you have morning sickness or hyperemesis gravidarum and you vomit, this can affect your glucose levels. You will need advice about how to time your insulin injections. If you are being sick, talk to your healthcare team.  

For many people, morning sickness passes after the first trimester.  

Diabetic ketoacidosis (DKA)

Diabetic ketoacidosis (DKA) is a serious problem that can occur in people with diabetes if their body doesn't have enough insulin. This causes harmful substances called ketones to build up in the body, which can be life-threatening if not spotted and treated quickly.

People with type 1 diabetes are at higher risk of DKA (although anyone with diabetes can get it). If you have type 1 diabetes, you should be given ketone testing strips and a monitor at the start of your pregnancy.

You should test the ketone levels in your blood if your glucose is above target (known as hyperglycaemia) or if you are unwell.  

If you have type 1 or type 2 diabetes, you should get urgent medical advice if you have hyperglycaemia that is not improving or you are feeling unwell. 

Find out more about illness and insulin.

Eye examinations 

People with diabetes are at risk of developing problems with their eyes (retinopathy). Pregnancy can increase your risk of these problems, or make existing ones worse.

You’ll be advised to attend an eye examination at your booking appointment (unless you have had one in the last 3 months), and again in the third trimester.  

If eye screening shows that you have diabetic retinopathy (damage to the back of the eye), you may be referred to an eye specialist. You should also be offered another eye examination at 16-20 weeks.

Kidney tests 

People with diabetes are at risk of developing problems with their kidneys (diabetic nephropathy). Pregnancy can increase your risk of these problems, or make existing kidney problems worse.

You’ll be offered a blood and urine test to check your kidney function at your booking appointment (unless you have had one in the last 3 months). If you have diabetic nephropathy, this may affect your blood pressure and might increase the risk of pre-eclampsia. You should be offered treatment, and you may be referred to a kidney specialist. 

Your second trimester

By the second trimester (13-28 weeks), as your baby grows, your insulin needs will increase. Your diet, medication and insulin doses will be regularly reviewed. Your blood pressure and urine will be checked at each visit.

“I had a real problem with my blood sugars being really high. I was told that I would need to keep my blood sugars well controlled, but I wasn't aware of how enormous the change was going to be in terms of insulin and how much more I'd have to take.”  
Megan, mum of one

Reducing your risk of pre-eclampsia 

Having diabetes increases your risk of pre-eclampsia (high blood pressure in pregnancy). From 12 weeks, you may be advised to take aspirin each day to reduce this risk.

If your blood pressure gets too high, you’ll be seen by a specialist team and given medication if needed.  

Ultrasound scans

You’ll have an ultrasound scan at 20 weeks to check that your baby is developing healthily. This will include checks on your baby’s heart.

You’ll have another ultrasound scan at 28 weeks to check your baby’s growth. After this, you should be offered a scan at least every 4 weeks until your baby is born.

Your third trimester

Many people with diabetes might need to take nearly double their normal dose of insulin at this stage of pregnancy.  

If your insulin needs start to drop a lot at this stage rather than increasing or staying stable, you should contact your diabetes team. This may be a sign that your placenta is not working as well it should be.

Eye examinations 

You should be offered another eye examination at 28 weeks.

Ultrasound scans

You’ll be offered an ultrasound scan at 32 weeks, and again at 36 weeks.

Colostrum harvesting 

Colostrum is the first breast milk that your body makes. It may help to regulate your baby’s blood sugar levels after the birth.  

If you want to harvest your colostrum, you can usually start hand expressing for a few minutes once a day when you are 36 to 37 weeks pregnant. Do not use a breast pump until after you have given birth.

Read more about feeding your baby and diabetes.

Planning your labour and birth 

During your third trimester, your healthcare team will work with you to plan the birth. There are some risks that come with giving birth if you have diabetes, so your healthcare professionals should explain your options for giving birth before you make your birth plan.

You may talk about:

• where to have your baby (you will be advised to give birth in a hospital)
• when and how to have your baby – you may be advised to have an early induction (starting labour artificially) or a planned caesarean section at 37-38 weeks, or earlier if you have complications
• your pain relief options (if you have a vaginal birth)
• how your glucose levels will be managed during labour
• what happens if your labour starts early
• the effects of diabetes on you and your baby after birth. 

Read more about labour and birth with type 1 or 2 diabetes.

Your baby  

If you haven’t had your baby by 38 weeks, you should be offered regular checks to make sure your baby is well.

Your baby's movements

If you have diabetes, there is a higher risk of stillbirth. This may make you feel worried and anxious, but remember that this is rare (affecting less than 1.4 in 100 births to people with diabetes).

The more time your glucose levels are within the target range, the lower your risk.  

It’s important for you to be aware of your baby’s movements. Feeling your baby move is a sign that they are well.

You may feel your baby move at as early as 16 weeks of pregnancy, but it’s more likely that you’ll first feel something between 18 and 20 weeks. If you haven’t felt your baby move by 24 weeks, be sure to let your midwife know.

It is not true that babies move less towards the end of pregnancy. You should be able to feel your baby move right up to the time you go into labour, and during labour.  

Get to know your baby’s normal pattern of movements. If you think your baby’s movements have slowed down, stopped or changed, contact your midwife or maternity unit right away.

Do not wait before you contact your midwife or the maternity unit for advice, even if it’s the middle of the night. Get in contact no matter how many times this has happened. Don’t ever worry about getting in touch with them.

It’s usual for these checks show that everything is fine. But if your baby is unwell and you get the right treatment and care sooner, this could save your baby’s life.  

Find out more about your baby’s movements.