Healthcare during pregnancy if you have diabetes

You meet your diabetes and pregnancy team.

• Take a 5mg folic acid supplement 1 time each day.
• Use contraception until it is a suitable time to try for a baby.
• Aim to have an HbA1c (which measures your blood sugar levels over the previous 3 months) of less than 7%(53mmol/mol).
• You have a test to check if your thyroid works properly and a diabetes review. If you have type 1 diabetes, you also need a screening test for coeliac disease. This is a condition where your immune system attacks your own tissues when you eat a protein called gluten.
• You have a review of your medicines.
• You have a review with a dietitian specialising in diabetes.

Please contact us as soon as you know that you are pregnant. You can then come to the diabetes antenatal clinic.

• If you already take insulin, make a note of your insulin doses before you were pregnant. You need to refer to them after birth.
• You have an early scan when you are about 7 weeks pregnant. This is an ultrasound scan to confirm the number of babies and if your pregnancy is progressing without problems inside the womb.
• If your early scan is OK, start taking 150mg of aspirin 1 time each day.
• We arrange for you to have various blood tests.
• Book your combined diabetes antenatal clinic appointment and diabetic eye screening appointment. 
• You have a review of your blood sugar levels. We give you advice about adjusting your diabetes tablets and/or insulin.
• We give you a prescription for a GlucaGen® HypoKit® (an emergency kit to treat very low blood sugar). We offer training for your partner or family on how to use this kit.
• It is important to have a healthy, balanced diet.
• You have an initial booking appointment with our specialist midwifery team. During your booking visit, we arrange an appointment for your nuchal scan. This is when you have screening tests to predict your baby’s chance of Down’s syndrome and some other genetic conditions.

We check your health and your baby's health during this stage.

• You have your nuchal scan.
• You book your anomaly scan. This is an ultrasound scan to check your baby’s development and look for any rare conditions.
• You have a review of your blood sugar levels. We give you advice about adjusting your diabetes tablets and/or insulin.
• We arrange your 2nd diabetic eye screening appointment.
• You have a review with the diabetes midwifery and obstetric (pregnancy) teams.

We continue to check your health and your baby's health during this stage.

• You have your anomaly scan.
• You have a fetal heart scan at Evelina London Children's Hospital. This is to check the structure and development of your baby’s heart.
• An obstetrician (doctor specialising in pregnancy) reviews your ultrasound scan results.
• You have a review of your blood sugar levels. We give you advice about adjusting your diabetes tablets and/or insulin.
• You have a review with your specialist diabetes midwife when you are 20 weeks pregnant.

You come to the diabetes antenatal clinic regularly to get support with managing your diabetes.

• You have a review of your blood sugar levels. We give you advice about adjusting your diabetes tablets and/or insulin.
• We arrange your 3rd diabetic eye screening appointment.
• You have growth ultrasound scans when you are about 28 and 32 weeks pregnant. These scans check that your baby is growing correctly.
• You have a review with the diabetes midwifery and obstetric teams.
• Our midwives offer antenatal classes to help you prepare for the birth and being a new parent.

You continue to visit the diabetes antenatal clinic regularly for support with managing your diabetes.

• You have a review of your blood sugar levels. We give you advice about adjusting your diabetes tablets and/or insulin.
• You make a diabetes birth plan with the diabetes team.
• You make a delivery birth plan with the obstetric team.
• We review your HbA1c (average blood sugar level over the last 3 months).
• You have your final growth ultrasound scan at about this time.

We recommend that you have your baby when you are between 38 and 39 weeks pregnant.

• The diabetes midwifery and obstetric teams care for you and your baby during the labour and birth.
• The diabetes team is available to monitor your blood sugar closely.

Talk to your midwife about ways to breastfeed your baby successfully.

• Breastfeeding takes a lot of energy and increases the chance of hypos (episodes of low blood sugar). Talk to your diabetes team about reducing your insulin or tablets.
• While breastfeeding, make sure that you always have snacks available to treat any hypos.