This will have been made before pregnancy. Ideally all women with type 2 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. You are at higher risk of diabetic ketoacidosis and pre-eclampsia. You will need to attend more hospital visits during pregnancy and you are more likely to be delivered early (around 38 weeks of pregnancy).For my baby: There is a greater risk of a miscarriage or stillbirth. There is an increased risk of congenital abnormalities if your blood glucose levels are consistently raised at the time of conception. In the second half of pregnancy the sugar level can increase the size of your baby or there may be growth restriction slow growth). This can make it make the birth of your baby more complex. Your baby is more likely to have low blood glucose levels (hypoglycaemia) after birth and may have other health conditions requiring specialist support.
What will the medical team recommend?
You will be seen more frequently in a joint diabetes and pregnancy clinic. Your first scan should take place at around 7-9 weeks and you will need extra scans throughout the pregnancy. You will be asked to make changes to your diet and maintain/or 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 at least four times a day: once before breakfast (fasting) and one hour after each meal. You will be given more support for blood glucose monitoring and may be offered a continuous glucose monitoring sensor. You will need eye check-ups during pregnancy. Your blood pressure will also be checked regularly.
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 team know. Anti-sickness medication is safe to use during pregnancy.
What are the ‘red flag’ symptoms/concerns, which means that they should be reported immediately?
If you feel unwell or are unable to take your regular insulin you must attend the hospital. 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. Medications that are safe to use in pregnancy are metformin and insulin. You may need more insulin as you progress through your pregnancy.
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 the size of 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 feel 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 glucose 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.
