Planning and good A1c
It is vital that women who have either type 1 or type 2 diabetes avoid unplanned pregnancies. High blood sugars associated with diabetes can damage the baby in the days immediately following conception when the baby’s organs are being formed, and the person often does not yet know they are pregnant.
Women should avoid pregnancy until their glycaemic control is within the recommended target levels and they have been assessed for the presence of any complications that need to be treated before pregnancy.
Babies born to mothers with poorly controlled diabetes are at higher risk of congenital malformations, stillbirth and neonatal death.
“If somebody has an HbA1c above 60 mmol/l we would strongly discourage them from becoming pregnant. The higher the A1c the higher the risk of congenital abnormality,” said Rita Ford, Advanced Nurse Practitioner.
Good control before pregnancy
Women who have type 1 diabetes and are planning to become pregnant need to establish good glycaemic control and an A1c (long-term blood glucose level) of under 7% for three months in a row before they become pregnant.
Women who have type 2 diabetes should aim to get their A1c down to 6.5%.
If a woman is planning to have a baby, the first thing she should do is let her healthcare providers (GP and diabetes nurse/clinic) know and see what advice they have to offer. It is much easier for people to achieve good glycaemic control with some help.
Care during early pregnancy
When a woman has achieved good glycaemic control and has no other complications and then actively tries to become pregnant, she should then be very observant for when she might become pregnant.
When a woman with diabetes has confirmed her pregnancy, she will be transferred to the diabetes-obstetric clinic at her local maternity hospital. After the baby is born, the mothers return to their normal clinic for their diabetes care.
Eating well & pregnancy
If you have diabetes and you are thinking about having a baby it is very important to attend the pre-conception clinic so that you can optimise your blood sugars before you become pregnant.
If you plan your pregnancy, attend a pre-conception clinic or at least discuss pregnancy with your GP, it can help you avoid any complications during early pregnancy. Early assessment can help you to:
- Improve how you manage your diabetes
- Assess your diet and lifestyle
- Manage your day-to-day blood glucose levels
- Manage your A1c (long-term blood glucose levels)
- Make sure your eyes are healthy
- Gain tighter control of your blood glucose
Your blood glucose control needs to be much tighter during pregnancy, so you may need to check your blood sugars more frequently and your medications may need to be changed or discontinued.
You should not lose weight during pregnancy.
If you need to lose weight, do so at least three months before you become pregnant so that you do not limit your nutritional intake near or around the time you become pregnant.
If you are overweight during pregnancy you may be increasing your risk of developing blood pressure problems. For this reason, you should start your pregnancy at a healthy weight.
Everyone gains weight during pregnancy. This is natural and is needed to support the growing foetus, placenta, increased blood volume and fat stores. How much you gain is very individual, in general expect to gain anything from one to two stone (7kg-14kg).
Weight gain in pregnancy generally occurs in the second half of your pregnancy, so if you do not put on much weight in the first three months there is no need to worry.
Information from Diabetes Ireland