Pregnancy and diabetes FAQs
What if I find out I’m pregnant and it isn’t planned?
Finding out about an unplanned pregnancy may come as a shock. There are many thoughts that will go through your mind and you may be overwhelmed with emotions. But there is no right or wrong way to feel at this time.
Make an appointment with your doctor and diabetes health professionals straight away to discuss your options and any concerns you may have.
Read more about unplanned pregnancy.
Will it be more difficult to fall pregnant because of my diabetes?
If you are in good health and your diabetes is well managed, your chance of falling pregnant should not be any different from that of a woman without diabetes. There are, however, other factors that affect your chances of falling pregnant such as having polycystic ovary syndrome (PCOS), being overweight and your age. Speak to your doctor about any concerns you may have about falling pregnant.
Can women with diabetes go through In Vitro Fertilisation (IVF) if needed?
IVF is a form of assisted reproductive technology which is an option for women with diabetes who need assistance with falling pregnant. If you are planning to use any form of assisted reproductive technology it is important to talk to your diabetes health professionals first. Planning and preparing for pregnancy at least 3–6 months before you start treatment is recommended. This includes reviewing your diabetes management to ensure blood glucose levels are within the target range, being checked for diabetes-related complications, starting high dose folic acid supplements, having a review of your current medications and routine blood tests.
What does it mean to have a ‘high risk’ pregnancy?
Women who have certain medical conditions before pregnancy or complications during pregnancy are considered to have a ‘high risk’ pregnancy. This may include women with diabetes, kidney disease or heart conditions, as well as those who develop problems such as high blood pressure during pregnancy.
Having a ‘high risk’ pregnancy’ means that you will need specialised care throughout your pregnancy, which usually includes a team of health professionals. You may need to attend a major hospital that has specialist services. You will also need additional tests and ultrasounds throughout your pregnancy, as well as a birth plan suited to your individual needs.
When you have a ‘high risk’ pregnancy, the right care before, during and after pregnancy is important to ensure the best possible outcomes for you and your baby.
How is having type 2 diabetes in pregnancy different from gestational diabetes?
Some women will develop type 2 diabetes after having gestational diabetes in a previous pregnancy.
Unlike gestational diabetes (which is diagnosed late in pregnancy), having type 2 diabetes can have an effect on the baby in the early stages of pregnancy. If you now have type 2 diabetes and are planning another pregnancy you will need to plan and prepare before you fall pregnant.
Planning and preparing for a pregnancy with type 2 diabetes involves reviewing your diabetes management to ensure blood glucose levels are within the target range, being checked for diabetes-related complications, starting high dose folic acid supplements, having a review of your current medications and routine blood tests. Read more about before you fall pregnant.
What pregnancy and diabetes services are available in rural or remote areas?
If you live in a rural or remote area where there are limited services, ask your GP or diabetes educator about the services available for managing your diabetes during pregnancy. This may include shared care between local services and a diabetes in pregnancy team in a major hospital. Services such as Telehealth may be an option 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.
Will hypos during pregnancy have any effect on my baby?
Hypos (low blood glucose levels) have not been shown to cause harm to the baby. Hypos can, however, be a risk to the safety of the mother, so it’s important that you treat hypos without delay. Check blood glucose levels frequently to detect hypos and make sure your levels are above 5mmol/L and stable before driving. During pregnancy, some women with type 1 diabetes notice that their early warning signs for hypos (such as feeling shaky or sweaty) change or even disappear altogether. This means that hypos can happen without much or any warning, increasing the risk of severe hypos. Early detection and treatment is important.
Will the occasional high blood glucose level have any effect on my baby?
Your health care team will advise you on your target blood glucose levels for pregnancy. Most women find that they will occasionally have blood glucose levels outside the target range. If your HbA1c (a test which reflects your average blood glucose levels over the past 10–12 weeks) is within your recommended target range during pregnancy, occasional blood glucose levels above target have not been shown to cause harm to the baby. If you are finding that your blood glucose levels are regularly outside the target range, contact your diabetes health professionals for advice and support.
What effect do ketones have on the developing baby?
Low levels of ketones detected in the blood or urine have not been shown to have an effect on the developing baby. However, if you detect ketones, it is important to act quickly to prevent diabetic ketoacidosis (DKA). DKA can occur when you are unwell, forget to take your insulin or don’t take enough insulin. The risk of DKA increases during pregnancy and can be very dangerous for both mother and baby. For more information about high blood glucose levels and DKA talk to your doctor or diabetes educator. Read more about ketoacidosis.
How can I manage the challenges of keeping my blood glucose levels in the target range?
Keeping blood glucose levels in the target range is probably the most challenging aspect of managing your diabetes during pregnancy. While you may have felt ‘in control’ of your diabetes before, you may find that this changes once you are pregnant. Even if you follow your health professional’s advice, you may still have variations in your blood glucose levels.
Talk to your doctor or diabetes educator and discuss realistic goals for you and how you can achieve them.
How can I manage the worries I have about the health of my baby?
It is very normal to worry about whether or not you will have a healthy baby. It is important to find a health professional you feel comfortable with so you can openly discuss these concerns with them. Seek out counselling services if you feel you need additional support.
Find out as much as you can about how to reduce the risk of problems during pregnancy. The support of women with diabetes who have recently become mothers can also be helpful at this time. Remember that most women with diabetes will have a healthy baby.
Do I need to be on an insulin pump when I am pregnant?
Insulin pump therapy is becoming increasingly popular with women with type 1 diabetes. Insulin pumps can be used safely and successfully during pregnancy. Some women find that using a pump makes it easier to achieve blood glucose levels in the target range.
Insulin pumps offer the advantage of being able to make very small insulin dose adjustments which can help you with managing your blood glucose levels during pregnancy. This may be particularly useful as your pregnancy progresses, with changing hormone levels and changes to your insulin requirements.
One of the risks of an insulin pump during pregnancy is that if any problems occur that disrupt the delivery of insulin, high blood glucose levels can result very quickly. This can increase the risk of diabetic ketoacidosis which can be very dangerous during pregnancy. Frequent blood glucose monitoring and identifying any problems quickly can reduce these risks.
Some women choose to start on an insulin pump in the lead-up to pregnancy, however many other women choose to continue with insulin injections and are still able to manage their diabetes successfully throughout pregnancy. Talk to your diabetes health professionals for more information and to discuss the best options for your individual needs.
Does being pregnant with twins change how my diabetes is managed during pregnancy?
If you are pregnant with twins you may be more likely to have morning sickness and pregnancy-related health problems such as high blood pressure and pre-eclampsia. You will also need closer monitoring of your pregnancy by your health professionals. Other than higher insulin requirements during mid-pregnancy, all other aspects of diabetes management are usually the same.
Am I at risk of having a large baby even if my blood glucose levels are within the target range during pregnancy?
Women with diabetes are at higher risk of having a large baby than women without diabetes. This is because high blood glucose levels in the mother during pregnancy have been shown to pass through the placenta to the baby who then produces extra insulin. This can make the baby grow too big.
Women who have blood glucose levels above the target range during pregnancy are at greatest risk of having a large baby. Some women with diabetes who have blood glucose levels within the target range will also have large babies. It is thought that this is because the baby of a woman with diabetes is still exposed to more variable levels of glucose throughout the pregnancy than a woman without diabetes.
There are a number of other factors that can increase the chances of having a large baby. These include being overweight before pregnancy, gaining too much weight during pregnancy, a history of having large babies and your family history.
Your diabetes in pregnancy team will provide guidance on blood glucose and weight gain targets for pregnancy and closely monitor your baby’s growth during pregnancy. If they have any concerns about your baby’s growth, they will review your diabetes management, closely monitor your pregnancy and discuss a plan for your labour and birth.
Does having diabetes mean that I will need to have a caesarean section?
Although rates of caesarean section are higher for women with diabetes than those without, a vaginal delivery and natural birth are still possible for many women with diabetes.
If your doctor is concerned that a vaginal birth is not the best option for you, they will discuss this with you when you are making your birth plan. If an ‘elective’ caesarean section is advised, this will be for obstetric reasons such as the position of the baby (for example if it is not ‘head down’) or if the placenta in the wrong place, or if there are concerns about the baby’s size or growth, such as being relatively big for you to deliver. A caesarean section will not just be advised because you have diabetes.
During labour some women may need an ’emergency’ caesarean section. This might occur for reasons such as the labour not progressing, concern about the baby’s wellbeing prior to or during labour or if there are complications for the mother. If a caesarean section is recommended, your doctor will explain the reasons to you and provide information about the procedure.
What does an ‘induction’ involve?
Depending on how your pregnancy is progressing, you may need to have an induction, which means helping your body to start labour. This may be recommended for women with diabetes a little before full term, at around 38–39 weeks gestation. An induction can be performed in several ways and sometimes a combination of two or more methods will be used. Read more about the different types of induction.
Should I breastfeed my baby?
Breastfeeding has many benefits, both for you and your baby. These include benefits for your baby’s immune system, growth and development, and it can help with bonding between you and your baby. Breastfeeding has also been shown to have long-term health benefits for mother and baby.
Most women with diabetes are able to breastfeed their babies. It is important to keep in mind though, that breastfeeding may require some practice, support and persistence. Your midwife or lactation consultant can help with information and advice about breastfeeding.
How does diabetes affect my breast milk supply?
Women with diabetes may sometimes find that there is a delay with their breast milk ‘coming in’. The milk usually comes in on the third day after the birth, but it may be delayed by 24 to 48 hours.
If your baby is born early or has problems with low blood glucose levels it can also be more challenging to establish breastfeeding.
Once breastfeeding is established, some women (with and without diabetes) can have problems with maintaining their supply of breast milk. Your lactation consultant or doctor can advise you on ways to identify if your milk supply is low and how to increase it. Remember that it’s important to eat well, drink plenty of water and get adequate rest to help with breastfeeding.
How does breastfeeding affect my blood glucose levels?
Breastfeeding can cause your blood glucose levels to fall rapidly both during a feed and afterwards. Blood glucose levels can fall by 3-5mmol/L during a breastfeed, so if you have type 1 diabetes or are using insulin to manage type 2 diabetes, it is important to have some hypo treatment within reach. Frequent monitoring and aiming to keep blood glucose levels in the 5–10mmol/L range (not lower) can help reduce the risk of hypos.
What are my contraceptive choices after the baby is born?
After your baby is born, it’s important to make sure you are using reliable contraception to prevent having another pregnancy before you are ready. For advice on contraceptive choices speak to your doctor.
Read more about contraception choices for women with type 1 diabetes or type 2 diabetes.
Remember that when planning another pregnancy, having your diabetes well managed beforehand will help you to have a healthy baby.
Will my diabetes management change after I have the baby?
After your baby is born your diabetes management will need to be reviewed.
If you have type 1 diabetes, you are likely to need less insulin for the first few days after delivery and insulin doses are usually reduced by 10–20% if you are breastfeeding. Your target blood glucose levels will be higher (usually 5–10mmol/L) after the birth to reduce the risk of hypos.
If you have type 2 diabetes and you were taking metformin during pregnancy, this may be continued after your baby is born (if your blood glucose levels are outside target levels). If you were changed from tablets to insulin before or during pregnancy, your doctor will advise you on whether you still need insulin or whether you may return to treatment with tablets. If you continue using insulin the doses will be much lower and will need to be reviewed more often, especially in the first week after delivery. Your target blood glucose levels will be higher (usually 5–10mmol/L) and you will still need to do frequent blood glucose monitoring after your baby is born.
At this stage when you have a new baby to care for, it is very important to try to avoid hypos. Your diabetes in pregnancy team will discuss changes to your diabetes management plan with you.
Does having diabetes increase the chance of my baby developing diabetes?
For mothers with type 1 diabetes, the chance of your child developing type 1 diabetes before the age of 20 is around 2–3%. If you have type 2 diabetes, your child will have an increased risk of developing type 2 diabetes later in life. A healthy lifestyle that includes regular physical activity, making healthy food choices and maintaining a healthy weight reduces the risk of future type 2 diabetes.