Pregnancy with Diabetes
The importance of preparation and planning
Long before diving into the apps that inform you of the week by week development of a baby from “lentil to grape to watermelon”, pregnancy planning is a must. It is the first step in creating your own little bundle.
Through preconception planning, you can aim to be the healthiest version of you with the best possible diabetes management you can obtain.
Adding type 1 or type 2 diabetes to the pregnancy algorithm may mean there’s a little more to consider but with well managed blood glucose (sugar) levels, pregnancy generally results in the normal birth of a healthy baby.
One of the most important considerations in “getting pregnant” is pre-pregnancy planning and care. Here is a checklist of things you can do prior to falling pregnant.
Make an appointment with your doctor to discuss general pregnancy planning advice.
Your doctor should review any medications you are taking to ensure they are safe during pregnancy. They may check your blood pressure and discuss any immunizations that are recommended.
It is most likely that your doctor will also request some blood tests. In most cases it is desirable to discuss the most appropriate contraception to use until you are ready to start trying to conceive.
Make an appointment with your diabetes specialist or team and let them know you are wanting to get pregnant.
They can provide you with guidance about blood glucose management and your current treatment. Your diabetes team will also provide recommendations regarding individualized blood glucose and HbA1c targets prior to conception.
Your diabetes team will journey with you once you conceive and assist you to maintain good blood glucose management during the pregnancy. Having a good connection with your diabetes team is very important.
Start taking a high-dose (2.5–5mg) folic acid supplement each day.
Folic acid helps the growth of a baby, especially early in pregnancy. It supports the normal development of a baby’s neural tube which is in the spine. Folic acid also reduces the risk of birth defects. You should discuss this with your doctor as well as any other nutritional supplements recommended.
Have a full diabetes complication screening completed.
This includes blood tests and eye, feet and dental checks. This will help you and your diabetes team to keep on top of any changes that may occur during pregnancy.
Aim to be in the healthy weight range through good nutrition and exercise.
You may consider making an appointment with a diabetes dietitian or exercise physiologist to discuss your individual needs and to assist you with blood glucose management, nutrition and physical activity.
During the first eight weeks of pregnancy the baby develops its major organs. This is part of the reason why it is very important to have good blood glucose management prior to conception. Sub-optimal blood glucose levels before and during early pregnancy can increase the risk of birth defects.
Some of the other possible risks to the baby if blood glucose levels are elevated during pregnancy include premature delivery, large birth weight, low blood glucose at birth or breathing difficulties.
For mum the risks include worsening of some diabetes complications, high blood pressure during pregnancy and difficulty birthing resulting in an intervention such as a caesarean section.
Although the above risks may seem to paint a grim picture, with good blood glucose management more often than not, mum and baby are healthy and well. Keeping in close contact with your diabetes team and having a pre-pregnancy plan will assist you and your future baby to be as well prepared as possible.
Diabetes can be overwhelming at times and even more so when considering pregnancy. Having a good diabetes team to support you will be of significant help. They will be able to remind you that the hard work is worth it!
It’s even worth giving birth to “your watermelon,” not to mention the many sleepless nights and dirty diapers that will follow!
Good Luck!
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