Pregnancy

Women with diabetes can have children. However, medical evidence shows an increased risk of complications for mother and baby when the mother has diabetes. Evidence also shows that this risk is minimised by normalising blood glucose before conception and throughout the pregnancy. You can continue to use your DAFNE skills throughout the pregnancy; in fact most women have found pregnancy and the insulin adjustments much easier to manage following DAFNE.

Planning a pregnancy will help reduce the risk of problems. Continue to use a reliable form of contraception (see below) until you have got your HbA1c as good as possible (6%-7%). Folic Acid id recommended for all women planning pregnancy - see your GP for a prescription and start this as soon as possible (you should continue taing this until 12 weeks into pregnancy).

The normal level of HbA1c is lower during pregnancy so we encourage women to try to get their HbA1c below 7% if possible. During pregnancy is one of the few times we recommend testing your blood sugar level in between meals. The target levels during pregnancy are:

• Less than 6mmol/l before meals.
• Less than 8mmol/l 1-2 hours after meals/before bed.

Blood glucose levels and insulin requirements change significantly during the stages of pregnancy. Most commonly, during the first few weeks you may experience more frequent hypoglycaemia, sometimes with a reduction in symptoms, or even severe hypos (see Severe hypoglycaemia), therefore it is useful for your partner to know how to help you to treat your hypos. You may also need to be more cautious about driving and test/record you blood glucose before getting into the car to drive. You may be advised to avoid driving temporarily if you have lost your hypo warnings.

In the latter stages of pregnancy (from around 26 weeks), insulin requirements usually increase. Follow the DAFNE guidelines for increasing your insulin doses and do not be surprised if you find your Background Insulin and/or Quick Acting : CP ratios are more than doubled by the end of your pregnancy.

Immediately after delivery of the baby, insulin doses return to pre-pregnancy (so it is useful to keep a record of what these were prior to pregnancy) and may need to be reduced further if you choose to breast-feed your baby; the guidelines for exercise can be a useful starting point for this.

Your doctor of diabetes nurse will be happy to discuss the local diabetes antenatal service and recommendations with you.