Planning a healthy pregnancy

If you have diabetes, it is highly recommended that you plan your pregnancy to get the best outcome.

Care before your pregnancy

From 6 to 12 months before you try for a baby, we recommend that you:

• talk to your GP or practice nurse about your plans
• go to a counselling session at a specialised diabetes and pregnancy clinic

Most pre-conception (before pregnancy) care for people with diabetes takes place at hospital. We hold special clinics in the diabetes centres at Guy’s and St Thomas’ and King’s College Hospitals.

Members of the diabetes and pregnancy team who help you to plan a healthy pregnancy include:

• your GP or practice nurse
• the diabetes specialist nurse
• a specialist diabetes dietitian
• your diabetes specialist doctor
• a specialist obstetrician (doctor specialising in pregnancy) or midwife

Managing your blood sugar levels

You need to have the best possible blood sugar control when you become pregnant and during the first 8 weeks of pregnancy. This is an important way to prevent miscarriage and birth defects in your baby.

If you plan to get pregnant, we recommend that you have an HbA1c of less than 7% (53mmol/mol) before pregnancy where possible. HbA1c is your average blood sugar levels over the last 3 months.

At the pre-conception clinics, we also talk to you about how best to achieve your target blood sugar levels. It is important that you work with your team to get the best possible blood sugar control.

Helpful tip: Take your blood sugar monitoring equipment to appointments with your diabetes specialist nurse or doctor. They can then check that the equipment works accurately and is up to date, and that you can download the results. This helps you to review your blood sugar patterns easily.

Your health before pregnancy

Smoking and alcohol

Smoking increases the chance of damage to blood vessels in your heart, brain, feet and kidneys, especially if you have diabetes. It also harms your unborn baby's development.

If you would like help to give up smoking, please speak to your diabetes team or contact our stop smoking service. You can also call the free National Smokefree Helpline on 0300 123 1044 (England only) for advice and support.

You need to avoid recreational drugs and alcohol. They increase the chance of miscarriage and damage to your baby.

Contraception

Using contraception helps you to plan your pregnancy for a time that is suitable in view of your:

• general health
• blood sugar control
• social circumstances

There is no single method of contraception that is perfect for everyone. Different methods suit different people. You can talk about the advantages and disadvantages of each method with your GP.

Blood pressure

Speak with the diabetes team or your GP before getting pregnant if you have high blood pressure. This is especially important if you take medicine to treat it.

High blood pressure increases the chance of certain problems during pregnancy for you and your baby. It is something that needs special attention.

Checking for diabetes complications

Before you get pregnant, or as soon as possible afterwards, it is important to have your eyes, kidneys and nerves tested. We need to check for any diabetes complications.

Your diabetes team asks you to give a urine (pee) sample. This is to check:

• how much protein passes through your kidneys
• if you have a urinary tract infection (UTI)

We test your feet for any nerve damage. This involves using a small straw-like device called a monofilament to test your feet’s sensitivity to touch.

You have an appointment to photograph and examine the back of your eyes. We can then check for any damage to the blood vessels called diabetic retinopathy. This is common in both type 1 and type 2 diabetes and can be treated.

The Diabetic Eye Screening Programme (DESP) arranges your eye screening. When you are pregnant, the back of your eyes is checked more often. This is usually done in the first 12 weeks of pregnancy and again at about 28 weeks. We have more information about diabetic eye screening in pregnancy.

If you have diabetic retinopathy (damage to the back of your eyes), your eyes may get worse when you are pregnant. After the birth, however, they usually return to the stage that were at before the pregnancy.

Your diet before pregnancy

It is important to have a healthy, balanced diet before you get pregnant. We recommend that anyone who is planning a pregnancy has an appointment with a dietitian specialising in diabetes.

If you have diabetes and are trying to get pregnant, you need to have a 5mg folic acid supplement 1 time each day. You should start taking this from at least 4 weeks before your pregnancy (and until you are 12 weeks pregnant). You need a prescription from your GP.

Your medicines

If you take tablets for diabetes, you need to speak with your GP or diabetes specialist doctor about your plans to get pregnant. Some diabetes medicines are not recommended in pregnancy and we may change your treatment.

Every medicine that you take needs to be reviewed before pregnancy or as soon as possible after you find out you are pregnant. This includes medicines for lowering your cholesterol and blood pressure. We may need to stop some medicines or change the amount (dose) while you are pregnant.

Read more about your medicines during pregnancy.

Actions to plan a healthy pregnancy