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Diabetes and pregnancy

More than morning sickness and food cravings

This information is equally important for women with type 1 diabetes and type 2 diabetes.

The experience of becoming a mother is different for all women

First time mums enter an unknown world of morning sickness and strange food cravings during pregnancy. Second and third time mums find that their new experiences are different from their last. It’s fair to say, that this is a time of mixed emotions. Having diabetes adds a whole new dimension to this.

If you have diabetes and are considering pregnancy, there are many considerations (beyond dealing with morning sickness) to help manage a healthy pregnancy. These considerations start before you even become pregnant. The first eight weeks of pregnancy is when the baby’s major organs develop. High blood glucose levels during this time may lead to abnormal development of the heart, spine or kidneys. This is often a time when pregnancy is not realised, therefore planning to make sure that blood glucose levels are as close to the target range before conception can help to reduce the risk of these complications.

The following provides a comprehensive checklist of topics that should be discussed with your diabetes team:

Contraception

Using appropriate contraception will help to avoid pregnancy while you are taking the time to ensure your diabetes management and health is in check.

Target HbA1c

It is recommended that women planning a pregnancy maintain an HbA1c below 7% (53mmol/mol) for at least three months prior to becoming pregnant and during pregnancy. This is a general target (and often challenging to achieve), so discuss your individual target with your endocrinologist.

Regular blood glucose monitoring

Regular blood glucose monitoring will help you and your diabetes team recognise any adjustments that may be required to your diabetes management.

Review type 2 medications

Some diabetes medications are not known to be safe during pregnancy, therefore your doctor may advise you to transfer onto insulin before and during pregnancy. 

Review insulin doses (including insulin pump settings)

Insulin regimens and doses may need to be adjusted in order to achieve your target HbA1c before conception. These doses will continuously be monitored, as they will change during pregnancy, delivery and while breast-feeding.

Cholesterol and blood pressure medications

Discuss with your doctor about cholesterol lowering medications and review blood pressure medications as these may need to be ceased.

Blood pressure

Check and stabilise blood pressure.

 Screening for diabetes complications

Complications may worsen during pregnancy and become difficult to manage.

High dose (5 mg) folate supplementation

This is much higher than the usual 0.5 mg tablet available and should be taken one month before conception and for the first 12 weeks of pregnancy. Your doctor may suggest that you take half to one 5 mg tablet each day depending on other pregnancy supplements you may be taking.

150 microgram iodine supplementation

This is recommended during pregnancy and breastfeeding unless you have an overactive thyroid or Graves disease.

Learning or refreshing carbohydrate counting skills

This can help to match insulin doses to food intake to help manage blood glucose levels.

Optimal nutrition

A well balanced diet is essential for the growth and development of a growing baby. Important nutrients to consider during pregnancy include protein, iron, iodine, calcium, omega-3 fish oils and vitamin D. Check with your dietitian before becoming pregnant that you are meeting requirements and determine the need for additional supplementation.

Maintaining healthy weight

Carrying extra weight can affect fertility and affect how insulin works (insulin resistance). Seek the right support to manage your weight in a healthy way to optimise your health and chances of falling pregnant.

Regular movement

Regular movement is essential to help maintain general fitness, muscle mass, an optimal weight and reduce insulin resistance that occurs during all pregnancies. Always discuss new exercise regimens with your GP or specialist before getting started.

Quit smoking

Call QUITLINE on 13 78 48 or visit www.quit.org.au

Rubella (German measles) and chicken pox

Ask your doctor to check your immunity to rubella and chicken pox before you become pregnant – you may require vaccinations. High blood glucose levels during pregnancy can lead to macrosomia (large baby), leading to delivery complications and hypoglycaemia for the baby at birth. For this reason, it is important to continue to work closely with your diabetes team to manage blood glucose levels during pregnancy.

Support is available

Although there is a lot to think about, there is a lot of support available, and mothers living with diabetes will tell you that this hard work is totally worth the reward of a healthy bundle of joy.

Read the original article

Click here to read the original article. Published in Diabetes SA Living Magazine – March 2015, page 14; Author: Kerryn Boogaard, Accredited Practising Dietitian & Credentialled Diabetes Educator.

Additional information

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