Complex pregnancies
Diabetes
Diabetes is a condition where the usual control of glucose in the blood is affected. 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 glucose levels as near to normal as possible before and throughout pregnancy can reduce the chance of health problems developing for your baby.
Pre-existing Diabetes
Diabetes is the most common pre-existing medical disorder complicating pregnancy in the UK.
Pregnancy in someone who lives with diabetes is regarded as higher risk and you will be offered additional care by a specialist team alongside your routine antenatal care.
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
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.
There are many causes of hypoglycaemia, and pregnancy can alter the way your body would usually be affected by your medications, diet, or activity levels. It may be necessary to switch medications, or alter aspects of your lifestyle to avoid ‘hypos’, especially if you suffer with pregnancy sickness. Your care team can help with this. 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.
Blood glucose control is very important and regular checks are essential to keep track of your diabetes.
Checking for ketones is to prevent the complication Diabetic Ketoacidosis (DKA).
NICE Guidance: managing diabetes and its complications in women who are planning pregnancy or are already pregnant.
Babies of women and pregnant people with diabetes
Following the birth of your baby, you will be encouraged to cuddle your baby skin to skin.
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.
Baby will have a heel prick test to monitor the glucose levels, in the same way that you carry out your glucose checks.
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.
Yes.
You and your partner will be welcome to visit your baby as often as you like, provide all necessary care and give cuddles. As soon as baby's blood glucose level is stable with milk feeds, he or she will be returned to the postnatal ward to be with you.
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.
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.
Pre-existing diabetes in pregnancy increases the chance that a baby needs to be born earlier, and this may mean that they require additional care in the neonatal unit after birth.
Babies born to parents with diabetes may be more likely to encounter health problems such as obesity or diabetes later in life.
If you have any questions please do not hesitate to ask.
Useful links
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
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.
Women who have a high BMI are at a greater risk of developing high blood pressure. Your midwife or doctor will be assessing your health at each antenatal visit and will check your blood pressure regularly.
Developing high blood pressure in pregnancy can lead to a more serious condition called pre-eclampsia.
Please refer to the 'Increased BMI and Labour' page for further information.
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.
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.
The risk of developing diabetes in pregnancy is related to your body size and your BMI.
The higher your BMI, the greater the risk of developing diabetes. Women who have a BMI over 30 or have other risk factors for diabetes will be offered a special test for diabetes (oral glucose tolerance test) when they are about 28 weeks pregnant.
Some women with a high BMI may be more prone to urinary tract infections.
Your midwife can refer you to a doctor if this becomes a problem for you.
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.