Pregnancy and the birth of a baby are special events. Often a lot of planning happens before a pregnancy but sometimes a pregnancy can be unexpected. Women with type 1 and type 2 diabetes can have a healthy baby especially if their diabetes is well-monitored and their general health is good.

There are certain increased risks with diabetes and pregnancy. These include having a larger than normal baby, and an increased risk of miscarriage. Also, abnormalities in the developing baby may occur, particularly in the first 8–10 weeks of pregnancy. Women with diabetes can have feelings of anxiety and concern about having a baby, and the changes they may need to make to their diabetes management.

It is best to plan your pregnancy if you are living with type 1 or type 2 diabetes. This will give you the best opportunity for a healthy outcome for you and your baby.

Planning before conception (becoming pregnant)

Planning ahead allows time for you to have a review with your diabetes specialist, diabetes educator, dietitian and obstetrician. It helps you focus on having your diabetes well-managed and being fit and healthy before becoming pregnant. This also helps provide healthy conditions for the baby right from the start of the pregnancy. Changes can be made to diabetes management as needed and diabetes complication screening checks can be done. Any problems can then be looked at and managed. It is good to start pregnancy planning 6–12 months before you plan to get pregnant.

What does pre pregnancy planning involve?

1. Contraception
An important part of planning to have a baby. It allows you time to get fit and healthy and to get your diabetes under good control. You may wish to discuss options for contraception with your doctor.

2. Blood glucose monitoring
You will usually be required to test your blood glucose levelsat least four times a day. This provides useful information about your glucose control through the day. It helps guide any changes that might need to be made to medication or insulin.

3. Insulin adjustment
It is important that your blood glucose levels are in the recommended range for conception and pregnancy. Your insulin doses may need to be adjusted after a review of your blood glucose levels and HbA1c result.

4. Diabetes tablets
If you have type 2 diabetes and take diabetes tablets you will need medical advice about continuing to take these. You may need to change to insulin.

5. Blood tests including

• HbA1c to check your average glucose control over the last 2–3 months
• Blood tests to make sure that you are immune to certain illnesses, for example rubella (German measles) and varicella (Chickenpox)
• Kidney function test
• Thyroid function test
• Screening test for coeliac disease (if you have type 1 diabetes)

6. Blood pressure
Your blood pressure will be measured to make sure that this is within the normal range.

7. Blood pressure medication
Some medications used to treat high blood pressure are not recommended in pregnancy. It is important that your doctor knows if you are thinking about becoming pregnant so they can review your medication.

8. Folic Acid (folate)
This helps to prevent certain birth defects of the brain and spine in the developing baby. The recommended folate dose for type 1 and 2 diabetes is higher than usual and is 5 milligrams of folic acid per day.

9. Smoking
Smoking tobacco or other substances has a harmful effect on your health and can be harmful to the baby once you are pregnant. If you are a smoker then speak with your doctor or call the QUIT LINE on 137 848.

10. Alcohol
Alcohol can have a harmful effect on your body. Once pregnant, alcohol can also harm your baby. It is best to avoid drinking any alcohol when planning to become pregnant and during pregnancy. For further information refer to the Australian Guidelines – Reduce Health Risks From Drinking Alcohol OR refer to Royal Women’s Hospital Guidelines. Please talk to your doctor if you need help to work out ways to reduce your alcohol intake.

11. Weight
It is important to have your weight checked before you become pregnant. If you are overweight it is best to reduce your weight to within the healthy weight range before you become pregnant. A Dietitian can give you some helpful hints for weight loss and healthy eating.

12. Eyes
A diabetes eye assessment can make sure that the retina is healthy. Any problems that are picked up can then be managed prior to pregnancy.

13. Nerves
Nerve damage most commonly affects the feet but can affect other areas of the body. This can be checked by your diabetes specialist.

14. Kidneys
Blood and urine tests can be taken to make sure that the kidneys are healthy. Any problems can then be managed prior to pregnancy.

If an unplanned pregnancy occurs – then don’t panic. It is important that you see your doctor as soon as possible to talk about the help and support available to you for management of your pregnancy.

Public maternity hospitals will often have a pre-pregnancy planning clinic. Some women with diabetes choose to use the supportive services available through this system.

Others might choose to have their baby at a private hospital with the support of individual health professionals. These include an Endocrinologist, Obstetrician as well as a private Dietitian and Diabetes Educator.

Further information
– Download the booklet Can I have a healthy baby?
– Watch pre pregnancy planning NDSS video