Existing health problems

Complex pregnancies

Diabetes

Diabetes is when there is a higher-than-normal amount of glucose in the blood. It may be present before pregnancy or develop during pregnancy. Diabetes that develops in pregnancy is called gestational diabetes. Gestational diabetes usually disappears after pregnancy but can happen again in future pregnancies.

Higher sugar levels cross the placenta and can cause the baby to grow larger (macrosomia). If you have or develop diabetes, you will be looked after by a specialist team who will check you and your baby closely throughout pregnancy.

Keeping your blood sugar as near normal as possible can prevent problems for you and your baby.

Pre-existing Diabetes

Diabetes is the most common pre-existing medical disorder complicating pregnancy in the UK.

Your pregnancy is regarded as high risk and you will be looked after by a specialist team who will check you and your baby closely throughout pregnancy.

The information helps you to understand the care and treatment options that should be available in the NHS.

If you are planning a pregnancy or think you are pregnant with pre-existing diabetes please contact your GP to discuss getting pregnant safely. You can find some useful starting points here: Diabetes and pregnancy - NHS

How much Folic Acid should I take?

You are advised to take 5mg

Take folic acid before pregnancy and for at least the first 12 weeks of pregnancy.

Having diabetes means that you need to take an increased dose of folic acid. This is because you may have a higher risk of having a baby with spina bifida or other Neural Tube Defects (NTD). You will need to ask your GP for a higher dose of 5mg, which is only available on prescription.

Those who have a NTD or a family history of NTD

Those whose partner has a NTD or a family history of NTD

Those with diabetes

Those with coeliac disease

Those taking anti-epilepsy medication

Those with a BMI above 30

Most pregnancy multivitamins contain folic acid. Only take a multivitamin that's made specifically for pregnancy, and be reassured it is safe to take a pregnancy multivitamin alongside your prescribed folic acid.

You can get vitamin supplements containing vitamin D free of charge if you are pregnant or breastfeeding and qualify for the Healthy Start scheme.

Hypoglycaemia

There are many causes of hypoglycaemia but it is most commonly the result of an excess of either insulin or oral hypoglycaemic medications, combined with reduced sugar intake or increased activity.  You can read about hypoglycaemia here: Low blood sugar (hypoglycaemia) - NHS

Hypo unawareness

You may find that the symptoms you experience during pregnancy are not the same ones you are used to or you may not have any symptoms. This is called hypo unawareness, and it is not unusual in pregnancy. It's important for you and your family to be vigilant to any of the symptoms detailed in the link above.

Ketone testing

Babies of Women with Diabetes

Following the birth of your baby, you will be given the opportunity to cuddle your baby skin to skin and to offer an early feed by your chosen method.

Your baby will need regular blood glucose monitoring. This can be carried out at your bedside on the postnatal ward.

How may diabetes affect baby after the birth?

Because blood glucose levels are generally higher in mothers with diabetes, and your baby may also have higher glucose levels in the womb, your baby may grow more quickly as a result. Also, after the birth, your baby's blood glucose may fall to low levels (hypoglycaemia).

Usually this is helped by feeding early and regularly. If it stays low, your baby will need to be cared for on the Neonatal Unit, but this applies to fewer than one in ten term babies of mothers with diabetes.

How will my baby's glucose levels be monitored?

Will I be able to breastfeed my baby?

Yes. This is very much encouraged.

If your baby has normal blood glucose levels, you will be able to breastfeed normally. If your baby does have low blood glucose levels, he or she may need to be given some expressed breast milk if available, or formula milk, by cup or feeding tube to resolve this. A glucose drip may be needed if milk feeding does not correct the low blood glucose readings and breastfeeding can then be commenced. You will be shown how to express milk if this is needed.

It can also be helpful to consider hand expressing colostrum from 36 weeks of pregnancy. Your midwives can discuss this with you and provide further information.

Will I be able to visit my baby on the Neonatal Unit?

Who will be around to help me?

During your stay on the postnatal ward, you will be allocated a midwife who will care for you and your baby following birth until you can go home.

Should your baby be admitted to the Neonatal Unit, the neonatal team will keep you informed of the plan for your baby's care from admission to discharge. A named Nurse will offer support during your visits.

Asking questions may help with your understanding and help to reduce your anxiety.

Feel free to ask.

Could my baby have any other problems?

Your baby may have some difficulty with breathing as the lungs of babies born to mothers with diabetes sometimes mature a little slower than normal. This problem is usually mild but may require treatment with oxygen or ventilation.

Babies born to mothers with diabetes are more likely to become jaundiced (a yellow colouring of the skin). This also is usually mild and often clears without treatment.

If you have any questions please do not hesitate to ask.

Useful links

🡭 Epilepsy

🡭 Mental Health

Raised BMI/Obesity

Maternal obesity has become one of the most commonly occurring risk factors for complications in pregnancy. Obesity in pregnancy is usually defined as a body mass index (BMI) of 30 kg/m2 or more at the first antenatal consultation. BMI is a simple index of weight-for-height and is calculated by dividing a person's weight in kilograms by the square of their height in metres (kg/m2).

Your BMI is recorded in your pregnancy notes and is a useful measurement for pregnancy.

An underweight person has a BMI less than 18.5

A person of a healthy weight has a BMI 18.5 to 24.9

A mildly overweight person has a BMI 25 to 30

A moderately overweight person has a BMI 30 to 35

A seriously overweight person has a BMI over 35

Blood clots & raised BMI

A raised BMI is linked to an increased risk of venous thromboembolism ("blood clots"). This is especially true if you have had a blood clot before or a first degree relative has had one before they were 50 (mother, father, brother, sister or any other children).

Your midwife will refer you to an obstetrician if they have concerns about this. To reduce this risk, all pregnant women are encouraged to stay well hydrated and active during pregnancy. When admitted to hospital, you will be advised to wear support stockings.

Women that are most at risk of developing blood clots may be prescribed additional medication. Your risk of having blood clots is assessed by your midwife and doctor throughout your pregnancy and postnatal period.

High blood pressure

Increased BMI and Labour

Increased BMI and your scans

If you have a high BMI, especially with body fat around your tummy, the ultrasound image will not be as clear.

This limits our ability to pick up any problems with the baby and reduces the ability to see how well the baby is growing. Therefore we will offer you extra scans from 28 weeks.

It is also more difficult to determine which way your baby is lying using abdominal palpation. Like every mum-to-be, it is important to monitor your baby's movements and contact your midwife if you have any concerns.

Raised BMI and anaesthetic

Research indicates that women who have a high BMI at the start of their pregnancy are at a higher risk of complications during their pregnancy and labour.

If you have a BMI over 40, you will be referred to a senior anaesthetist at the hospital during your pregnancy. This appointment is for the anaesthetist to assess you and to discuss your options for pain relief in labour, as well as develop a plan should you need an emergency anaesthetic.

Having an increased BMI can make it more difficult for an epidural to be inserted. It is safer to have an epidural than a general anaesthetic because there are more complications associated with a general anaesthetic if a person has an increased BMI.

Risk of developing Diabetes

Urinary Tract Infections

Being overweight in pregnancy and after birth

Useful links

Genital Herpes (Herpes Simplex Virus) in Pregnancy (HSV)

This information is for you if you are pregnant and want to know about genital herpes and pregnancy. If you are a partner, relative or friend of someone who is in this situation, you may also find it helpful.

If you have HSV and are pregnant it is important to inform your midwife.

Genital Herpes in Pregnancy

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Useful links

Diabetes UK

Diabetes UK

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Tommy's

Tommy's

🡭 Epilepsy

🡭 Mental Health

Raised BMI/Obesity

Genital Herpes (Herpes Simplex Virus) in Pregnancy (HSV)

Genital Herpes in Pregnancy

Genital Herpes in Pregnancy