This will have been made before pregnancy. All women with Type 1 diabetes should be offered preconception counselling to optimise their health.
What does this mean?
For me: Pregnancy can increase your risk of developing or worsening your pre-existing diabetic eye or kidney problems. In the first trimester you are at higher risk of having episodes of low blood sugar. In the second half of the pregnancy you are at higher risk of diabetic ketoacidosis and pre-eclampsia and preterm delivery. You will need to attend more hospital visits during pregnancy and you will be under the care of a specialist team.For my baby: There is a greater risk of having a miscarriage or stillbirth. There is an increased risk of congenital abnormalities (birth defects for your baby) when your blood glucose levels are high at the time of conception, and during the first trimester. In the second half of pregnancy high blood sugar levels can increase the size of your baby or there may be a growth restriction (slow growth). This can make it make the delivery of your baby more complex. Your baby is more likely to have low blood glucose after they are born and may have other health conditions requiring specialist support.
What will the medical team recommend?
You will be seen in a joint diabetes and pregnancy clinic. Your first scan should take place at 7-9 weeks and you will need extra scans throughout the pregnancy. You will be asked to make changes to your diet and maintain/increase your physical activity.
What tests will/may be considered? How often may they be needed?
You will be asked to measure your blood sugar levels more often. You will be given more support for blood glucose monitoring and offered a continuous glucose monitoring sensor and will be given a ketone meter. You will be reminded what your target blood glucose levels should be and you should aim to keep your blood glucose within that range at least 70% of the time. You will need regular eye check-ups during pregnancy. Your blood pressure and kidney blood tests will also be monitored very closely.
What symptoms and signs should I be looking out for?
Morning sickness in the first trimester may affect your blood sugar levels. You may need anti-sickness medication if you are vomiting, so let your specialist maternity team know. Anti-sickness medication is safe to use during pregnancy. You are more likely to be unaware of your low blood sugars. You should have a glucagon pen at home and your partner/family should know how to administer this in an emergency should you become unwell.
What are the ‘red flag’ symptoms/concerns, which means that they should be reported immediately?
If you feel unwell or unable to take your regular insulin you must attend the hospital immediately. If your baby is not moving you should attend the hospital immediately.
How are recommendations made regarding treatment options?
You should be taking 5mg folic acid daily at least 3 months before conception and up to 16 weeks of pregnancy. To reduce your risk of pre-eclampsia you should take 75mg-150mg of aspirin each night from 12 weeks until 36 weeks. Your insulin doses will change during pregnancy. For example you may notice a drop in your insulin requirements in early pregnancy (typically at 8-16 weeks) and an increase in insulin requirements in the second half of your pregnancy. Be sure to discuss all treatment with your specialist team at the hospital.
How are recommendations made regarding timing of birth
You will be advised to deliver around 38 weeks gestation. This may be earlier if there are concerns about you, your blood glucose levels, or your baby. By 36 weeks your team should be working with you to make a plan for the birth.
How may this impact my birth choices?
You may be offered an induction of labour if your team feels it is safer to do so. You will need blood glucose monitoring throughout labour.
How may this affect care after the birth?
You and your baby will need to be monitored very closely after birth. Your baby is at risk of low blood sugar levels after birth. If you are breastfeeding you may find that your glucose levels drop quickly while you are feeding, and afterwards. A birth plan prior to delivery should have been agreed to regulate your insulin requirement.
What will this mean for future pregnancies? How can I reduce my risk of this happening again?
Look after your health between pregnancies.
What will this mean for future/my long-term health and how can I influence this?
Contraception and a follow up plan should be agreed before you are discharged from maternity care.
