It’s very important that pregnancy in females with type 1 diabetes is planned and closely monitored from preconception until delivery by a diabetes team (endocrinologist, diabetes educator and dietitian) and an experienced obstetrician. Contraception should be used by females with diabetes unless there is active planning for a pregnancy. In the case of planning a pregnancy it’s important to have very good diabetes control, as well as any diabetes complications being stable, and folate supplementation having been commenced.
To ensure the best pregnancy outcomes it’s important that blood glucose levels (BGLs) are well managed both before and during pregnancy. Pregnancy should not be planned until HbA1c (3 monthly average of BGLs) is within or close to the range for people without diabetes. It’s important to aim for tight blood glucose control throughout the pregnancy while still avoiding hypos.
The risks of unplanned pregnancy or poorly managed diabetes during pregnancy include the risk of miscarriage, having a baby that is too large or too small and the baby having congenital malformations (especially heart or kidney problems).
Pregnancy may also increase the risk of progression of diabetes complications, especially eye damage. There is also a higher risk of developing raised blood pressure during pregnancy and problems related to it. Studies have shown that a well-managed pregnancy with good blood glucose control and regular monitoring can reduce these risks significantly.
During labour the medical team will monitor both mother and baby carefully. Insulin is usually required during labour and may be given by regular injections, pump or via a drip (intravenous infusion). It is possible to have a natural birth, however sometimes a caesarean section will be required to deliver the baby. Both mother and baby will be closely monitored after the birth. After the baby has been born, the mother will experience a significant fall in insulin requirements especially in the first few weeks – and this may be more marked with breastfeeding. The insulin doses will be lower than before the pregnancy.
More information on diabetes and pregnancy can be obtained from the Australasian Diabetes in Pregnancy Society –www.adips.org
To hear more about women’s experiences and medical guidelines, refer to “Diabetes and Pregnancy” by Alison Nankervis & Josephine Costa, Miranova Publishers 2001. ISBN 0 9587142 31. Available for purchase from Diabetes Australia-NSW.
Expert advice from Dr Glynis Ross, Endocrinologist at The Royal Prince Alfred Hospital is gratefully acknowledged.
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