Diabetes in Pregnancy PIAG 499

Diabetes department

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Diabetes in Preganancy (348kB pdf)

I am a young person living with diabetes… Why would need to know about pregnancy?

For people younger than 19 living with diabetes, most pregnancies are not planned.

Research has shown that the risk of unplanned pregnancy is higher for people who are younger,

or where HbA1C is higher.

If a young person with diabetes becomes pregnant, this will have important consequences for

the health of both the pregnant person and their unborn baby.

Your knowledge of diabetes in pregnancy can help you to reduce these risks.

Does controlling my diabetes change if I become pregnant?

Yes.

To reduce the risk of serious harm to you and your unborn baby, your blood sugar levels need to consistently stay in the lower end of normal:

• Blood sugar before a meal: less than 5.3mmol/L
• Blood sugar after a meal: less than 7.8 mmol/L
• HbA1C less than 48 mmol/mol

Your unborn baby needs your blood sugar level to be nearly the same as someone who does not have diabetes

Why is this so important?

If sugar levels are not tightly controlled, there is a higher risk of miscarriage (4 times higher than people without diabetes).

There is also a higher risk that the unborn baby’s organs do not develop properly (this can lead to problems with the baby’s heart or spine). Usually, this damage will already have started by 3 weeks of pregnancy (before most people will even know that they are pregnant).

If DKA occurs, then the risk of the unborn baby dying is around 40%. That means if 10 pregnant people go into DKA, only 6 of those unborn babies will survive (4 of those unborn babies will die).

Because of these risks pregnant people are invited to extra appintments (usually at the nearest hospital to you that has a maternity service, rather than Alder Hey). At these appointments, you would work with the specialist team of diabetes doctors, obstetric doctors (these are doctors who speciliase in pregnancy), midwives, and others.

How else will pregnancy affect my diabetes?

Insulin is still safe to use if you are pregnant. However, insulin will not work as well during pregnancy as it does normally. This can mean higher doses of insulin are needed (often, insulin doses double or triple during pregnancy). The insulin dose often then returns to normal again after pregnancy.

If you are pregnanct, you may find it harder than usual to tell if your blood sugars are low. To stay safe, you have to check your blood sugars more often.

Pre-eclampsia is a dangerous condition which can affect pregnant people. Compared to other pregnant people who don’t have diabetes, people with diabetes who become pregnant are at a high risk of pre-eclampsia. To monitor for pre-eclampsia, you would have to have your blood pressure and your urine regularly checked.

What if I don’t want to be pregant, but may be thinking of having sex in the near future?

Getting contraception may be what you need. 

You can talk to your GP about this, or a family planning clinic. Contraception services are free

and confidential, including for people under the age of 16.

If you’re under 16 and want contraception, the doctor, nurse or pharmacist won’t tell your parents or carer, as long as they believe you fully understand the information you’re given and the decisions you’re making, and as long as what is happening is safe.

Here are some addresses and numbers for sevices that can provide advice and contraception:

Axess 4 U (19 and under) @ The Beat

6 David Lewis Street

Liverpool

Merseyside

L1 4AF

Telephone: 0300 323 1300 (option 4)

Teenage Advice Zone (TAZ)

1st Floor Clinic Suites, Millenium Centre

Corporation Street

St Helens

Merseyside

WA10 1HJ

Telephone: 01744 646473

Brook Wirral

14 Whetstone Lane

Charing Cross

Birkenhead

Merseyside

CH41 2QR

Telephone: 0151 670 0177

If you find out that you are pregnant, you should contact the diabetes team immediately?

We will make sure you are seen regularly by the specialist team for diabetes in pregnancy.

You may need to have your eyes and kidneys checked, as pregnancy can speed up the damage done by diabetes to these parts of your body. We will arrange this, if needed.

If you have diabetes, it is important to plan carefuly how you will give birth. We can talk this through with you.

All pregnant people need to take folate. Folate is a vitamin which reduces the risk of birth defects in the baby’s spine. People with diabetes need a stronger dose of folate, and we will prescribe this for you.

We will check that any other medications that you may take are safe for you and your baby.

This leaflet only gives general information. You must always discuss the individual treatment of your child with the appropriate member of staff. Do not rely on this leaflet alone for information about your child’s treatment.

This information can be made available in other languages and formats if requested.

PIAG 499