Healthcare during pregnancy if you have diabetes

Diabetes and pregnancy

The tests and other healthcare that you need when you are pregnant depend on your individual situation. Your diabetes specialist doctor and nurse talk to you about this in more detail.

You usually have a healthcare appointment every 1 to 2 weeks. Throughout your pregnancy, you have regular contact with the diabetes specialist nurse. About every 4 weeks, you see an obstetrician (doctor specialising in pregnancy) or midwife. You see them more often in the last 3 months of your pregnancy.

We arrange and talk to you about your timetable of appointments at your initial booking appointment.

Tests during pregnancy

Throughout your pregnancy, your healthcare team orders tests to check your general health and your baby’s wellbeing.

Blood tests

When you are pregnant, we do blood tests to check:

  • your haemoglobin level (a protein in red blood cells that carries oxygen throughout the body). We can then make sure that you are not anaemic (when you do not have enough healthy red blood cells or haemoglobin)
  • if your thyroid works properly. The thyroid is a gland in your neck that makes hormones affecting things like your heart rate and body temperature
  • your HbA1c (average blood sugar level over the last 3 months). It is crucial to aim for a level of less than 7% (53mmol/mol). This is to make sure that the chance of your baby having birth defects is the same as for someone without diabetes

We order more blood tests at your booking appointment.

Ask your healthcare team for the results of all your blood tests when you are planning to get pregnant and during your pregnancy. You can then track your own progress.

Ultrasound scans

We do ultrasound scans to check if your baby has any birth defects and help to predict the chance of genetic conditions. We offer you:

  • an early scan at about 7 weeks to confirm the number of babies and if your pregnancy is progressing without problems inside the womb
  • a nuchal scan at about 11 to 13 weeks to estimate your baby’s chance of having Down’s syndrome and some other genetic conditions
  • an anomaly scan at about 20 weeks to check your baby’s development and look for any rare conditions
  • a fetal heart scan at about 20 to 22 weeks to check the structure and development of your baby’s heart

We usually ask you to have more scans at about 28, 32 and 36 weeks. This helps us to monitor your baby’s growth and general condition.

Urine tests

At each hospital appointment during your pregnancy, we ask you to give a sample of urine (pee). We test this sample for harmful substances called ketones and protein.

If you have protein in your urine, this may suggest that:

Blood sugar tests after meals

Together with your regular monitoring of blood sugar levels throughout the day, we ask you to do tests 1 hour after each meal. You have probably not needed to do this before.

The extra tests help you and your diabetes specialist doctor to understand your blood sugar levels in more detail. You can then adjust your insulin to get the best control of your diabetes.

Summary of your healthcare during pregnancy

This table summarises the healthcare that you can expect throughout your pregnancy.

Period of time Summary of your healthcare
3 months before you are pregnant

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.
When your pregnancy is confirmed

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.
When you are 12 to 16 weeks pregnant

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.
When you are 18 to 22 weeks pregnant

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.
When you are 24 to 34 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.
When you are 36 weeks pregnant

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.
During labour and birth

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.
While you are breastfeeding your baby

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.

 

Resource number: 1702/VER4
Last reviewed: September 2022
Next review due: September 2025

A list of sources is available on request.

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