Pre-Conception Care for Women with Diabetes

Planning for pregnancy is an exciting time, but if you have diabetes, it comes with additional considerations to ensure both your health and the health of your future baby. Pre-conception care is crucial, and consulting with your diabetes specialist well in advance is key to a healthy pregnancy.

Why Pre-Conception Care Matters

Maintaining blood glucose levels as close to normal as possible before conception reduces the risk of complications during pregnancy. This may involve adjusting your insulin doses, modifying your medications, or even starting insulin therapy if needed. Some glucose-lowering medications might need to be discontinued to ensure they are safe for pregnancy.

Steps to Take Before Conception (Ideally 3 Months Ahead)

• Blood Glucose Monitoring: If you’re using finger-prick tests, aim for blood glucose levels between 70-110 mg/dL (4-6 mmol/L) before meals and less than 140 mg/dL (8 mmol/L) two hours after eating. For those using continuous glucose monitoring (CGM), consult your diabetes specialist to adjust settings for near-normal glucose levels.
• HbA1c Testing: Work with your consultant to achieve an HbA1c level of less than 7%, if it can be safely managed.
• Folic Acid Supplementation: Start taking high-dose Folic Acid (5mg) at least three months before conceiving. This dosage isn’t typically found in standard pregnancy multivitamins, so ask your diabetes specialist or GP for a prescription. Folic Acid helps reduce the risk of neural tube defects in the developing baby.
• Medication Review: Discuss any current medications for high blood pressure or cholesterol with your GP or diabetes specialist, as these may need to be switched to safer alternatives for pregnancy.
• Quit Smoking: If you smoke, seek immediate help to quit. Smoking can exacerbate pregnancy complications.
• Contraception: Don’t stop using contraception until your diabetes team and GP confirm that all aspects of your pre-conception care are optimized.
• Pre-Conception Care Services: Integra Healthcare and Doctors Hospital offers specialized pre-conception care tailored to women with diabetes.
• Missed Period: If you miss a period, take a pregnancy test right away. If positive, contact your diabetes specialist and OBGYN immediately to schedule an appointment. If you haven’t been taking Folic Acid, start the 5mg dose immediately.

Managing Diabetes During Pregnancy

The goal throughout pregnancy is to maintain blood glucose levels as close to normal as safely possible. This reduces the risk of complications such as having a large baby, miscarriage, organ developmental issues, low blood sugars at birth, jaundice and helps prevent pregnancy complications like pre-eclampsia and pre-term labor.

• Frequent Glucose Testing: You’ll need to monitor your blood glucose more often, possibly including testing one hour after meals. CGM systems like Freestyle Libre or Dexcom can be particularly helpful, especially if you’re on insulin.
• Insulin Adjustments: Your insulin needs will likely change—typically decreasing in the first trimester and increasing as your pregnancy progresses, especially in the third trimester. It’s common for insulin requirements to be higher than before pregnancy.
• Hypoglycemia Precautions: Since you’re aiming for tighter glucose control, the risk of hypoglycemia (low blood sugar) increases if you’re on insulin. Always carry hypo treatment with you, take precautions before driving, and have a Glucagon pen and ketone testing kits available. Regular contact with your diabetes specialist is essential, often every two weeks or even weekly during the third trimester.
• Folic Acid and Other Supplements: Folic Acid is usually continued until 14 weeks of gestation. You’ll likely be prescribed Aspirin and Vitamin D to reduce the risk of pre-eclampsia. Your blood pressure and urine protein levels will be closely monitored at each OBGYN appointment.
• Eye Health: Diabetes can affect your eyes, and pregnancy can worsen these changes. Regular retina check-ups, at least in the first and last trimesters, are recommended.

Pregnancy Appointments

At Integra, we aim to provide joint appointments with your endocrinologist and obstetrician when necessary. Typically, you’ll have appointments once in the first trimester, around 20 weeks following the anatomy scan, and roughly every two weeks during the third trimester.

• Ultrasound Scans: Around 20 weeks, a detailed ultrasound will check your baby’s development. From 26 weeks onwards, regular growth scans will monitor your baby’s weight gain.

Labour and Delivery

During labor, you may be placed on a glucose and insulin drip, with insulin doses adjusted based on your blood glucose levels.

Post-Delivery Care

After delivery, if you’re on insulin, your doses will likely return to pre-pregnancy levels. If you were on an insulin drip, it will be discontinued either immediately after delivery or with your first meal. Insulin requirements may drop further if you’re breastfeeding, and your endocrinologist will guide these adjustments.

• Breastfeeding: Maintain good glucose control and consume extra carbohydrates while breastfeeding. Schedule a follow-up appointment with your endocrinologist 6-12 weeks after delivery to ensure ongoing care.

By working closely with the healthcare team here at Integra healthcare and Doctors Hospital and following these steps, you can significantly improve the chances of a healthy pregnancy and baby.