Stages of pregnancy
Find out below how your diabetes may affect different stages of your pregnancy:
Scans and check-ups
Diabetes can impact the growth of your baby, so you will need extra scans to monitor its development. These will usually take place every four weeks from 20 weeks onwards. The obstetric team will also review you regularly as the pregnancy progresses to help plan your delivery.
Screenings
If you have complications as a result of your diabetes, pregnancy could cause further problems. The diabetes team will ensure your eyes are screened at least twice during your pregnancy and more frequently if you have a significant eye disease. Women will sometimes require laser treatment during pregnancy. Kidney disease can also get worse if you have diabetes and you’re pregnant, so conditions are monitored with blood tests and protein urine testing (ACR). If necessary you will be referred to specialist teams.
Delivery
If you have diabetes, you can usually plan to have a normal delivery. However, you’ll be advised to deliver before 39 weeks and therefore you may have an induction of labour. Delivery will be planned and will take place in an obstetric unit to ensure it is as safe as possible.
Glucose is measured every hour during labour and women often require intravenous insulin. A caesarean section is recommended to some women if there are particular reasons why this would be safer.
After delivery, the baby will need to have their glucose levels checked. The babies of women with diabetes can develop low glucose because they’ll have made extra insulin of their own if they have been exposed to high glucose in the womb. If your baby develops hypoglycaemia they may need extra feeds, or occasionally to be tube fed and monitored in the special care baby unit.
Your own insulin requirements return rapidly to normal after delivery and you can reduce your insulin doses. Breast feeding is recommended for both mother and baby and if you do this you will be required to lower your insulin doses.
Breastfeeding
Breastfeeding is widely considered to be the best way of feeding a new baby and this applies to mothers with diabetes as well. There is no reason why women with diabetes cannot breastfeed. Some people may encounter difficulties, such as a challenging delivery where they’re separated from their baby, perhaps due to a caesarean section or if the baby had to go to the neonatal unit. However, with good support and patience a good breastfeeding pattern can be established despite it being tricky at times.
It is important to be aware that breastfeeding can lower your insulin needs. This is because every time you feed your baby, glucose is lost through the breast milk and will therefore need to be replaced. As there is an increased risk of your glucose levels dropping and you having a hypo, it is important to refuel and have an extra 40-50g carbohydrate in snacks (500 calories) every 24 hours, and to have these extra snacks at the time of feeding, especially during the night. Always remember to have snacks nearby at the time of feeding.
You may need to reduce your insulin dose by around 25%. If you have any concerns then do seek advice from your diabetes team. Some medications should be avoided while breast feeding. If you are unsure about this then please check with your midwife or GP. If you are on an insulin pump then you may use the temporary basal rate function or exercise function to reduce your insulin dose by 25 %.
It is important to test frequently during this time as good diabetes control can certainly help with a more normal breastfeeding experience and help increase confidence.
Follow up
Your diabetes team will want you to attend a follow up soon after your baby is born. This is so they can provide any input you require to help you manage your diabetes, which can be difficult when you are caring for a young baby. Ideally, you will need lots of help from your partner, family and friends as will any mother of a newborn baby.
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