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Folate for the best start

Stir fry vegetablesFolate (also known as folic acid) is an important vitamin for a healthy pregnancy. It is needed for growth and development of the baby, especially in the early stages of pregnancy.

Folate plays a vital role in the development of a baby as soon as it is conceived. Getting enough folate in your diet as well as via supplements (tablets) will help with the normal, healthy development of the baby’s neural tube in the spine, which occurs around 4 weeks after conception. Because some women don’t realise they are pregnant so soon after conception, it is important to build adequate folate stores in your body before pregnancy.

Folate in your diet comes from green vegetables such as broccoli, spinach, brussel sprouts and asparagus. Because folate is water and heat-sensitive, it is important to cook these vegetables quickly and with minimal water, for example, by stir-frying or steaming.

Other folate-containing foods include breads and fortified cereals, nuts, legumes (such as kidney beans and chickpeas) and fruit. Wheat flour that is produced in Australia for bread-making purposes has been fortified with folate, but this doesn’t include organically produced wheat flour.

Although folate is found in many foods, it’s important for women planning pregnancy to take additional folate via a supplement. This is especially important for women who have type 1 or type 2 diabetes because the risk of neural tube defects is higher.

Women with type 1 or type 2 diabetes who are planning to become pregnant should take a supplement containing 5mg folic acid for at least one month before conception. This is a higher dose than for women who do not have diabetes prior to pregnancy.

Talk with your diabetes health professionals about a suitable dose of folic acid—they may recommend you take half to one 5mg tablet each day. This will depend on whether you are also taking a pregnancy multivitamin supplement that also contains a small amount of folate.

The additional pregnancy multi-vitamin tablet is recommended because it also contains iodine—another important nutrient for a healthy pregnancy. After the first trimester you can stop taking the folate supplement and continue taking the pregnancy multi-vitamin supplement.

Folic acid supplements in the recommended high-dose of 5mg can be purchased from most pharmacies. If you talk to a pharmacist it is important to remember your requirements for the larger dose, otherwise they may assume you mean the lower 0.5mg dose!

Talk with your dietitian or endocrinologist if you need more advice.

Thank you to Julia Zinga, Accredited Practising Dietitian, Royal Women’s Hospital Melbourne, for contributing this article to the e-newsletter. 

Pumping for pregnancy

Pregnant woman using insulin pimpWhen planning a pregnancy, you may consider an insulin pump to help you achieve blood glucose levels in the target range before trying for a baby. Ideally you would consider starting on a pump 3–6 months prior to conceiving so that you give yourself and your diabetes team time to stabilise your blood glucose levels (BGLs) as well as giving yourself time to adjust to using the pump.

What is an insulin pump?

An insulin pump is a small electronic device which continuously delivers small doses of quick acting insulin via a cannula into the subcutaneous tissue (the fatty layer just under the skin). Compared with insulin injections, a pump more closely mimics the way a pancreas normally provides background (basal) insulin.

 You also program the pump to deliver bolus insulin to cover the carbohydrate in snacks and meals or to correct high blood glucose levels. Pumps have many functions which are helpful in managing the changes your body will experience during pregnancy, such as hypoglycaemia, high glucose levels after meals and fluctuations in blood glucose caused by changing hormone levels in pregnancy.

The pros and cons of pumping for pregnancy
Pros Cons
  • Can help maintain target HbA1c with less hypos
  • Cannula change every 2–3 days (instead of multiple daily injections)
  • Extended insulin bolus delivery for variable appetite/delayed food absorption
  • Allows for temporary reduction in basal insulin with morning sickness and exercise
  • Flexibility when breastfeeding
  • Need to check blood glucose levels frequently
  • Requires time for intensive pump education
  • Needs prompt troubleshooting to prevent high BGLs and ketoacidosis
  • Requires accurate carbohydrate counting
  • Finding suitable sites for cannula insertion as abdomen grows
  • Attached to the pump 24/7

Cost and access

Insulin pumps are now commonly used in the management of type 1 diabetes and are also available to people with type 2 diabetes. Private health fund membership will cover the pump purchase, as long as you are on the right level of cover. Some diabetes services may also have loan pumps for pregnant women. The ongoing costs for the cannulas and insulin reservoirs are heavily subsidised by government once you are registered as a pump user with NDSS.

If you are interested in finding out more about pumps, talk to your diabetes team. They may be able to help with organising the pump for you, providing education and ongoing support or if not, refer you to a service which will be able to help you.

Thank you to Kaye Farrell, Credentialed Diabetes Educator, Westmead Hospital for contributing this article to the e-newsletter.

Research update

The benefits of pre-pregnancy care for women with diabetes

Pregnant woman with partners hand on stomachIn a study published in The Journal of Clinical Endocrinology & Metabolism, researchers reported on the outcomes of a regional pre-pregnancy care program for women with type 1 and 2 diabetes. The newly developed pre-pregnancy care program was implemented at antenatal centres across the Irish Atlantic Seaboard with 149 women (36%) attending.

Compared with women who did not attend pre-pregnancy care, those who did attend were more likely to take folic acid prior to pregnancy (97.3% vs 57.7%), and less likely to smoke (8.7% vs 16.6%) or be taking medications which were potentially unsafe for pregnancy at conception (0.7% vs 6.0%).

Women who attended pre-pregnancy care also had lower HbA1c levels throughout pregnancy (first trimester HbA1c: 6.8% vs 7.7%, third trimester HbA1c: 6.1% vs 6.5%) and the infants born to mothers who attended experienced a lower rate of serious adverse outcomes, as well as reduced admissions to Neonatal Intensive Care.

In summary, the research showed that attendance at pre-pregnancy care improved pregnancy preparation and outcomes for women with diabetes.

Source:  Egan AM, Danyliv A, Carmody L, Kirwan B, Dunne FPJ, A Pre-pregnancy Care Program for Women With Diabetes: Effective and Cost Saving. Clin Endocrinol Metab. 2016, 101 (4):1807-15. doi: 10.1210/jc.2015-4046.


What pregnancy and diabetes services are available in rural or remote areas?

If you live in a rural or remote area where services are limited, ask your GP or diabetes educator about options available to help you with planning and managing diabetes during pregnancy.

These may include shared care between local services and a diabetes in pregnancy team in a major hospital or Telehealth to link your local health professionals with specialist diabetes in pregnancy services. You may also want to consider travelling to a major centre that has a diabetes in pregnancy service—especially if you have had any diabetes-related complications.