The Diabetes in Pregnancy team provides care for women with pre-existing diabetes who are planning pregnancy, during the antenatal period and in the first six weeks after the baby is born. The team also care for women who develop gestational diabetes in pregnancy.
The team consists of a consultant diabetologist, consultant obstetrician, specialist midwife, midwives, diabetic specialist nurses, dietitian and midwifery support worker.
The joint diabetic antenatal clinic is held weekly on Tuesday mornings in the Women and Children’s Clinic and the diabetes midwives run a midwife led clinic on Thursday mornings.
Evidence informs us that preconception advice and support minimises the risks of adverse outcomes for mothers and babies.
Things to do before you get pregnant:
- Use contraception
- Stop smoking and reduce alcohol intake
- Start daily 5mg Folic Acid
- Regular monitoring of blood glucose. Aim for 5-7mmol/l before meals or the targets set by your diabetes team
- Eat healthily and exercise. Aim for a BMI <27
- Review blood pressure and cholesterol. Ensure medication use is safe in pregnancy
- Assessment of diabetic retinopathy (eyes) and nephropathy (kidneys) before pregnancy
- Know advice about hypo's due to impaired awareness of hypoglycaemia during pregnancy
- Test blood ketones when unwell
- Ask about a structured education programme to improve diabetes control
- HbA1c is <48mmol/mol (<6.5%) if safely achievable without causing hypoglycaemia
- Stop contraception once HbA1c is <48mmol/mol (<6.5%)
- Positive pregnancy test - early referral to pregnancy diabetes team at local hospital
- Continue daily 5mg Folic Acid up to 12 weeks gestation
- Continue to monitor blood glucose HbA1c 48mmols/mol
- Achieving optimum glucose control improves the chances of having a healthy pregnancy and baby. Aim for HbA1c of 48 mmol/L
- Taking Folic acid 5mg prior to pregnancy and for the first 12 weeks of pregnancy reduces the risk of neural tube defects (spina bifida) This is only available on prescription.
- Early referral to the diabetes pregnancy team is important as soon as a pregnancy is confirmed. Women are offered one to two-weekly contact with the team during pregnancy and extra ultrasound scans to monitor the pregnancy
Gestational diabetes can develop in pregnancy at around 24 -28 weeks gestation and is diagnosed by a Glucose Tolerance Test (GTT) The Community Midwife screens for risk factors for GDM at booking and a GTT will be taken at 24-28 weeks. If you have had a previous bariatric surgery such as gastric bypass or sleeve, a home blood glucose monitoring will be offered at 24-28 weeks. If you have had a GDM in a previous pregnancy and/or take anti-psychotic drugs, you will be offered an immediate GTT and if normal again at 24 -28 weeks.
The level of glucose in your blood before and after the GTT will show whether you have gestational diabetes or not. If your GTT result is abnormal you will be referred to the diabetes pregnancy team. The Diabetes Specialist Midwife will contact you to coordinate your care.
The risk of developing gestational diabetes can be reduced by:
- Being physically active 30 mins a day for five days a week i.e. yoga swimming and walking
- Eating healthily – making healthy food choices and eating smaller portions high in fibre low in sugar and fat
- Eating five to seven portions of fruit and vegetables a day
- Avoiding weight gain in pregnancy and losing weight after pregnancy if you are overweight
The Diabetes Specialist Midwife provides support and advice on both diabetes and midwifery care throughout pregnancy and the postnatal period. The Diabetes Specialist Midwife can be contacted on 01253 955626.
