Diabetes and your unborn baby
Diabetes is a condition in which the amount of sugar (glucose) in the blood is too high.
Glucose comes from the digestion of starchy foods, such as bread and rice. Insulin, a hormone produced by your pancreas, helps your body to use glucose for energy.
Three types of diabetes can affect you when you're pregnant:
The information on this page is for women who have pre-existing diabetes in pregnancy.
Most women with diabetes have a healthy baby, but diabetes does give you a higher risk of some complications.
If you already have diabetes
If you already have type 1 or type 2 diabetes, you may be at a higher risk of:
People with type 1 diabetes may develop problems with their eyes (diabetic retinopathy) and their kidneys (diabetic nephropathy), or existing problems may get worse.
If you have type 1 or type 2 diabetes, your baby may be at risk of:
- not developing normally and having congenital abnormalities, particularly heart and nervous system abnormalities
- being stillborn or dying soon after birth
- having health problems shortly after birth, such as heart and breathing problems, and needing hospital care
- developing obesity or diabetes later in life
Reducing the risks if you have pre-existing diabetes
The best way to reduce the risk to your own and your baby's health is to ensure your diabetes is controlled before you become pregnant.
Ask your GP or diabetes specialist (diabetologist) for advice. You should be referred to a diabetic pre-conception clinic for support before you try to get pregnant.
Find diabetes support services near you.
You should be offered a blood test called an HbA1c test, which helps assess the level of glucose in your blood.
It's best if the level is no more than 6.5% before you get pregnant, as long as this does not cause problems with hypoglycaemia.
If your HbA1c is higher than this, you would benefit from getting your blood glucose under better control before you conceive to reduce the risk of complications for you and your baby.
Your GP or diabetes specialist can advise you on how best to do this.
If your HbA1c is very high (above 10%), your care team should strongly advise you not to try for a baby until it has fallen.
Folic acid
Women with diabetes should take a higher dose of folic acid. The normal daily dose for women trying to get pregnant and for pregnant women is 400 micrograms.
Diabetic women should take 5 milligrams (mg) a day. Your doctor can prescribe this high-dose folic acid for you, as 5mg tablets are not available over the counter.
Taking folic acid helps prevent your baby developing birth defects, such as spina bifida. You should take folic acid while you are trying to get pregnant, until you are 12 weeks pregnant.
Your diabetes treatment in pregnancy
Your diabetic treatment regime is likely to need adjusting during your pregnancy, depending on your needs.
If you take drugs for conditions related to your diabetes, such as high blood pressure, these may have to be altered.
It's very important to keep any appointments that are made for you so your care team can monitor your condition and react to any changes that could affect your own or your baby's wellbeing.
Expect to monitor your blood glucose levels more frequently during pregnancy. Your eyes and kidneys will be screened more often to check they are not deteriorating in pregnancy, as eye and kidney problems can get worse.
You may also find that as you get better control over your diabetes you have more low blood sugar (hypoglycaemic) attacks. These are harmless for your baby, but you and your partner need to know how to cope with them.
Find out about treating a hypoglycaemic attack, and talk to your doctor or diabetes specialist.
Diabetic eye screening in pregnancy
You will be offered diabetic eye screening at recommended intervals during pregnancy if you had diabetes before you got pregnant (pre-existing diabetes).
This screening test is to check for signs of diabetic eye disease, including diabetic retinopathy.
Everyone with diabetes is offered diabetic eye screening, but screening is very important when you are pregnant because the risk of serious eye problems is greater in pregnancy.
Diabetic eye screening is strongly recommended in pregnancy. It is part of managing your diabetes, and diabetic retinopathy is treatable, especially if it is caught early.
If you decide not to have the test, you should tell the clinician looking after your diabetes care during pregnancy.
Read more about diabetic eye screening.
Labour and birth
If you have diabetes, it's strongly recommended that you give birth with the support of a consultant-led maternity team in a hospital.
Read more about where you can give birth, including in hospital.
Babies born to diabetic mothers are often larger than normal. This is because blood glucose passes directly from you to your baby, so if you have high blood glucose levels your baby will produce extra insulin to compensate.
This can lead to your baby storing more fat and tissue. This in turn can lead to birth difficulties, which requires the expertise of a hospital team.
After the birth
Two to four hours after your baby is born they will have a heel prick blood test to check whether their blood glucose level is too low.
Feed your baby as soon as possible after the birth – within 30 minutes – to help keep your baby's blood glucose at a safe level.
If your baby's blood glucose can't be kept at a safe level, they may need extra care. Your baby may be given a drip to increase their blood glucose.
Read more about special care for babies.
When your pregnancy is over, you won't need as much insulin to control your blood glucose.
You can decrease your insulin to your pre-pregnancy dose or, if you have type 2 diabetes, you can return to the tablets you were taking before you became pregnant. Talk to your doctor about this.
If you had gestational diabetes, you can stop all treatment after the birth.
You should be offered a test to check your blood glucose levels before you go home and at your six-week postnatal check. You should also be given advice on diet and exercise.
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