T1DM in Pregnancy

Having a healthy baby
A guide to planning and managing pregnancy for women with type 1 diabetes
Type 1 diabetes
1300 136 588 ndss.com.au

The National Diabetes Services Scheme (NDSS) is an initiative of the Australian Government administered by Diabetes Australia.
Contents
About this booklet 3
Preparing for a healthy baby 4
Eating well and physical activity 14
Diabetes and your pregnancy 18
Medical tests and monitoring during pregnancy 25
Diabetes and your baby 27
Insulin changes during pregnancy 29
Labour and birth 31
Breastfeeding 36
Going home and the future 39
Your emotional wellbeing 41
Pregnancy and diabetes checklist 46
Disclaimer: This information booklet is intended as a guide only. It should not replace individual medical advice and
if you have any concerns about your health or further questions, you should raise them with your doctor.
About this booklet
This booklet is for women with type 1 diabetes who are planning a pregnancy now or in the
future. It provides information on preparing for pregnancy, as well as tips on how to manage
diabetes during pregnancy and once the baby is born.
When you have diabetes, it is important to plan and prepare for pregnancy before you start
trying for a baby. It is recommended that you have a review of your diabetes, and your
general health, at least three to six months beforehand.
In this booklet we focus on the needs of women who have type 1 diabetes and are planning
a pregnancy or who are already pregnant. Separate booklets are available from the
National Diabetes Services Scheme (NDSS) for women with type 2 diabetes or gestational
diabetes.
There are a number of risks during pregnancy for both mother and baby, but with careful
planning, as well as support from a team specialising in diabetes in pregnancy, women with
diabetes will usually have healthy pregnancies and healthy babies.
Encourage your partner, family and friends to read this booklet as well, to help them
understand more about diabetes and pregnancy. If you have any questions or need more
information contact your endocrinologist, GP, obstetrician, diabetes educator or dietitian.

About this booklet 3
Preparing for a
healthy baby
Women with diabetes can have a healthy baby, but there are a number of extra risks
associated with having diabetes during pregnancy. To reduce diabetes related risks, it is
best that you become pregnant at a time when your diabetes is well managed and there are
no other health issues. It is important that you plan your pregnancy and seek out specialist
pre-pregnancy care during this planning period.
The best preparation for a healthy pregnancy starts with getting the right advice and
assistance before you become pregnant. The first eight weeks of pregnancy is the time
when a baby’s major organs develop, so it is important for your blood glucose levels to be
as close to target as possible when you conceive and in the first part of your pregnancy.
This reduces the risk of health problems in the developing baby and the chances of an early
miscarriage.
There are other aspects of planning for a healthy
pregnancy too, such as screening for diabetes
complications, taking vitamin supplements, a review
of your current medications and having routine blood
tests. These topics will be discussed later in this
booklet.
Make an appointment with your diabetes health
professionals as soon as you start thinking
about having a baby. If you find you are pregnant
sooner than you intended, organise an immediate
appointment at your closest maternity hospital or see
an endocrinologist, a diabetes educator or a diabetes
nurse practitioner with expertise in managing diabetes
and pregnancy. They will work with you to achieve the
best outcome for you and your baby.
If you are not sure who to contact or if you live in a
rural area where there are limited services, ask your
GP about the best options for managing your diabetes
during pregnancy. This may include shared care
between local services and a diabetes and pregnancy
team in a major hospital. Services such as Telehealth
may be an option to link your local health professionals
with specialist diabetes in pregnancy services.

4 Preparing for a healthy baby
Preparing for a
healthy baby
Your diabetes in pregnancy team

There are specialised services to support women with diabetes both when planning a
pregnancy and during pregnancy.
All major hospitals with maternity services in Australia can provide information about
pregnancy and diabetes, and some also have specialised diabetes in pregnancy services.
You may also have the option of seeing a private endocrinologist with expertise in diabetes
in pregnancy. If you live in a rural area or small town, consider travelling to a major centre
that has a diabetes in pregnancy service - especially if you have had any complications from
diabetes. It is a good idea to attend pre-pregnancy care at least three to six months before
attempting to conceive.
Your diabetes in pregnancy team will be
made up of a range of health professionals
who can help you plan your pregnancy.
This may include:
• endocrinologist (diabetes specialist
doctor)
• specialist obstetrician (pregnancy doctor)
• diabetes educator or diabetes nurse
practitioner
• dietitian
• general practitioner (GP)
• midwife
• psychologist
• social worker.
If needed, you may also be referred to other
specialists such as a renal (kidney) physician
or an ophthalmologist (eye specialist). Talk
to your GP if you are not sure how to access
these health professionals in your area or
phone the NDSS Infoline on 1300 136 588
for information about services available in
your state or territory.

Preparing for a
healthy baby
Planning and preparing for pregnancy

Contraception
Timing your pregnancy is important. Contraception enables you to plan your pregnancy
around your personal circumstances, general health and diabetes management.
No single method of contraception is perfect for everyone. Different methods suit different
couples and there are many forms of contraception suitable for women with diabetes. It is
best to discuss the most appropriate contraception for your individual needs with your GP,
endocrinologist or obstetrician.
Blood glucose targets
Research has shown that if you manage your blood glucose levels well at the time you
conceive your baby and during the first two months of pregnancy, it will help to lower the risk
of miscarriage as well as birth defects in your baby. Your diabetes in pregnancy team will
discuss appropriate blood glucose targets with you and a recommended haemoglobin A1c
(HbA1c). This is a measure of your average blood glucose levels over the past three months.
Current guidelines recommend a HbA1c of less than 7% (53mmol/mol) before falling
pregnant. A lower HbA1c may sometimes be advised, however it is important to be aware
that this may increase the risk of hypoglycaemia (or low blood glucose levels). The right
balance can be difficult to achieve, so seek as much support as you can from your diabetes
health professionals to help you during this time.
“Find yourself a really good team of health professionals who know about pregnancy and
diabetes”

Preparing for a
healthy baby
Folate
Folate (also known as folic acid) is a vitamin that is very important to reduce the risk of
certain birth defects of the brain and spine. Folate can be found in a varied diet that includes
green leafy vegetables, fruit, breads and cereals, nuts and legumes. However, it is difficult
to get enough folate for pregnancy from your diet alone. Taking folic acid supplements has
been shown to reduce the risk of birth defects for all women, not just those with diabetes.
Ideally, you would start taking your folic acid supplement at least one month before your
pregnancy, and continue taking it throughout the first trimester (the first three months of
pregnancy).
It is recommended that women who have diabetes take a higher dose of folic acid than
other women because of the increased risk of birth defects. In Australia current guidelines
recommend 5mg of folic acid per day, but talk to your doctor, they may suggest you take
one 5mg tablet each day, or just a half depending on other pregnancy supplements you may
be taking.
Talk to your diabetes health professionals about taking a folic acid supplement. You do not
need a prescription to buy folic acid, but make sure you tell the pharmacist you need to buy
the 5mg tablet, not the usual 0.5mg tablet.

Preparing for a
healthy baby
Insulin
When planning your pregnancy, it is important to discuss your diabetes management with
your diabetes health professionals. This includes the types of insulin you are currently using
and the advantages and disadvantages of different types during pregnancy. Also discuss
the method of insulin delivery, whether you use an insulin pump or have multiple daily
injections.
Insulin pumps
Insulin pump therapy is becoming increasingly popular with women with type 1 diabetes.
You may want to think about this for yourself and discuss an insulin pump with your diabetes
team when you start planning for your pregnancy.
An insulin pump is a small pager-sized device that you wear constantly. It has a small plastic
cannula that delivers insulin under your skin and is changed every three days. The pump
continuously delivers a small amount of rapid-acting insulin (basal dose), and also allows
you to ‘dial up’ the dose you need when you eat or to correct a high blood glucose. Insulin
pumps have been shown to be beneficial for many women wanting to lower their HbA1c
before pregnancy, but it is still possible to meet blood glucose targets using multiple daily
insulin injections. For more information about insulin pumps including cost and availability
talk to your diabetes health professionals.
Review of medications
Many medications will need to be
stopped or changed before pregnancy
and then only re-started after pregnancy,
or sometimes not until after you have
finished breastfeeding. This is because
they have not been shown to be safe
during pregnancy or breastfeeding.
Every medication that you are taking,
including those for lowering cholesterol
and blood pressure, must be reviewed
before you become pregnant or as soon
as possible after you find out you are
pregnant.

Preparing for a
healthy baby
Diabetes complications screening

Before conceiving it is important to
be checked for any diabetes related
complications in your kidneys, eyes
and nerves. You will need to have your
kidneys and eyes checked during your
pregnancy as well.
Kidneys
Your doctor will ask you to have a urine
test to check the amount of protein/
albumin passing through your kidneys.
You will also have a blood test to
check the function of your kidneys.
If there are any problems, you may
need to see a kidney specialist before
falling pregnant and you will need to
be monitored carefully during your
pregnancy (especially in relation to your
blood pressure). Even minor kidney
problems (such as slightly increased
levels of protein in the urine) can increase the risk of developing high blood pressure during
pregnancy. If you have any problems with your kidneys during pregnancy your baby’s
growth will need to be monitored carefully.
Eyes
Make an appointment to see an optometrist or an ophthalmologist (eye specialist) to
have the back of your eyes checked. Make sure they know you have diabetes. If you have
damage to the small blood vessels at the back of the eye (diabetic retinopathy), this needs
to be stable before you conceive. Ask your eye specialist if you need any treatment before
you fall pregnant.
Eye problems may appear or worsen during pregnancy, so you will need to have your eyes
checked regularly throughout your pregnancy and then again a couple of months after you
have had the baby. Usually, eye problems that occur during pregnancy improve after your
baby is born.

Preparing for a
healthy baby
Nerves
Your podiatrist, diabetes educator or doctor can test for nerve damage in your feet
(peripheral neuropathy), using simple physical examinations such as a tuning fork or a
‘monofilament’ that measures pressure sensation.
Some women with long standing diabetes may develop another type of nerve damage
called autonomic neuropathy. This can lead to problems with stomach emptying (feeling
full or bloated), bowel movement (diarrhoea, constipation) and unstable blood pressure.
In pregnancy, these problems can worsen and be very difficult to manage. Problems with
stomach emptying can also increase the risk of hypoglycaemia (low blood glucose levels).
If you have any of these complications, you should discuss them with your doctor before
conceiving.
Blood pressure
If you have high blood pressure,
you should see your doctor before
falling pregnant, especially if you
are taking any medication.
High blood pressure needs
special attention as it increases
the chance of problems in
pregnancy for you and your baby.
You may need to stop certain
blood pressure medications or
change your medications before
you conceive.

Preparing for a
healthy baby
A healthy weight
Aim for a healthy weight before becoming pregnant. A healthy eating plan and regular
physical activity can help with weight management.
The weight gain recommended for pregnancy depends on your weight before you
conceive. It is a good idea to have a review with a dietitian for guidance on pregnancy-
specific nutrition needs and your personal weight gain target. There is some weight gain
associated with a healthy pregnancy and it is generally not advisable to aim to lose weight
while you are pregnant. However, you also need to take care not to ‘eat for two’. The table
below shows the recommended weight gain targets for pregnancy depending on your pre-
pregnancy weight range (calculated using Body Mass Index or BMI = weight (kg) / height
(m) x height (m)).
Pre-Pregnancy BMI Weight range Recommended Pregnancy Weight Gain

< 18.5 Underweight 12.5 – 18kg
18.5 – 24.9 Healthy weight 11.5 – 16kg
25 – 29.9 Overweight 7 – 11.5kg
> 30 Obese 5 – 9kg
Institute of Medicine, 2009

Preparing for a
healthy baby
Nutrient supplements
In addition to a folic acid supplement, it is recommended that all pregnant women take an
iodine supplement of 150 micrograms during pregnancy and breastfeeding (unless you
have an overactive thyroid or Graves disease).
Your doctor will also check the amount of iron in your blood and advise whether you need
to take an iron supplement (most women will in the later part of their pregnancy). If you are
concerned about other nutrients, speak to your dietitian about your usual dietary intake and
ask whether you need multivitamins or other micronutrient supplementation.
Immunisation
Your GP will arrange blood tests to check your immunity to Rubella (German measles) and
Varicella (chickenpox). Contracting Rubella when you are pregnant can lead to blindness,
deafness and abnormalities in your baby. If you are not immune, you should be vaccinated
at least one month before becoming pregnant. Also discuss flu and whooping cough
vaccinations with your doctor.
Blood tests
Your doctor will check your thyroid function and may do some additional tests such as
coeliac screening and checking your vitamin D level.
Smoking, drugs and alcohol
Smoking increases the risk of damage to blood vessels in the heart, brain, feet and kidneys,
especially in people with diabetes. Smoking also harms the growth and development of your
unborn baby. You can ask your diabetes in pregnancy team about strategies to quit, or you
can call the QUITLINE on 13 78 48 or visit www.quit.org.au. Alcohol and recreational drugs
increase the risk of miscarriage and damage to your baby and should be avoided.
Hard work but worth it!
For some women, it can be demanding and stressful to achieve blood glucose levels within
the target range before conceiving, and then to maintain good diabetes management
throughout the early stages of pregnancy.
This is likely to be a challenging period of your life, so be sure to seek the support and
understanding you need from people close to you, as well as from health professionals.

Preparing for a
healthy baby
ACTION:
If you are thinking about having a baby, the following checklist summarises the advice
in this section for you.
• Contraception and general pregnancy advice: Ask your GP, endocrinologist
or obstetrician for help to choose the best contraception for you and your partner
when planning your pregnancy.
• Referrals: Ask your GP for referrals to diabetes in pregnancy specialists.
• Your team: Put together and meet your diabetes in pregnancy team.
• Blood glucose targets: Aim for an HbA1c of less than 7% (53mmol/mol) before
falling pregnant. Discuss individual targets with your health professionals.
• Folic acid supplements: Start taking high-dose folic acid for at least one
month before becoming pregnant and continue during the first three months of
pregnancy.
• Review insulin therapy: Consider whether the type of insulin treatment you are
having needs any changes, and consider whether an insulin pump might be a
good option for you.
• Medications: Ask your doctor to review all the medications you are taking to
check if they are safe to take during pregnancy.
• Vaccinations: Make sure your Rubella and chickenpox vaccinations are up to
date.
• Blood pressure: Check and stabilise your blood pressure before becoming
pregnant.
• Diabetes complications: Have a full complications screening done before you
fall pregnant. Have any complications treated and stabilised if necessary, before
falling pregnant.
• Weight management: Aim for a healthy weight before pregnancy as well as the
most appropriate weight gain for you during pregnancy.
• Smoking: If you are a smoker, stop smoking - ask your health professionals for
help.
• Alcohol and other drugs: Avoid alcohol and other drugs completely during
pregnancy.
• Diet and supplements: Take a supplement that contains iodine and check with
your doctor and/or dietitian whether you need to take a multivitamin or other
supplements.

Eating well and physical
activity
A healthy eating plan is essential for you and your baby, and it is
also important to stay physically active throughout your pregnancy.
Healthy eating
Pregnancy is a good time to update your knowledge of
food and nutrition. Your eating plan is an integral part of
your diabetes management and general health. Make an
appointment with a dietitian to discuss food choices during
pregnancy.
Your food choices are important for providing nourishment for
both you and your baby, and can help with managing
your blood glucose levels. It is
a good idea to review your
carbohydrate counting skills,
the best carbohydrate food
choices for managing blood
glucose levels and how to
adjust your insulin to match
your carbohydrate intake.
Aside from carbohydrates, there
are other nutrients that need special
attention in the lead-up to and during
your pregnancy, including protein, iron,
iodine, calcium and folate. Your dietitian
can guide you on the best food choices
to meet these extra nutritional needs for
pregnancy.
Protecting yourself from exposure to
high-risk foods that can cause infections
and harm your developing baby is very
important. These infections can be caused
by listeria, salmonella and toxoplasmosis
which can be present in high risk foods.

14 Eating well and physical activity
activity
Certain types of fish also need to be limited during pregnancy due to their high mercury
content. Seek advice from your dietitian and/or state health department on guidelines for
food safety during pregnancy. Alcohol can cause damage to an unborn baby, and should
be avoided throughout your pregnancy.
A dietitian can discuss the most appropriate foods for you during your pregnancy, provide
information on foods to avoid or limit, give you advice on pregnancy weight gain, and work
with you to help manage your diabetes during pregnancy.

activity
Physical activity
Becoming pregnant does not mean you
have to give up exercise or other physical
activity. In fact, women with diabetes
benefit from regular physical activity in
pregnancy. It is a great way to relax and
spend time with family and friends, as
well as an essential tool for diabetes
management.
Regular physical activity helps to maintain
a healthy weight during pregnancy and
has many additional health benefits,
including managing pregnancy
symptoms, such as lower back pain,
nausea, heartburn, constipation and
sleep disruptions. Physical activity is also
a great mood regulator and can help you
return to a healthy weight after you have
had your baby. Your goal, while pregnant,
should be to maintain your general health
and fitness. Pregnancy is not the time
to begin a new or strenuous exercise
routine. If you are already active, continue
your activities as long as it is comfortable
to do so. However, it is best to avoid
contact sports during pregnancy. Discuss
your current activities with your GP or
other health professionals.
“...once you know you have a life

growing inside you, your focus changes.
Be prepared to actually WANT to do
lots of blood tests, eat properly and
exercise.”

16 Eating well and physical activity
activity
HELPFUL HINTS: Physical activity

You can enjoy physical activity by incorporating activity into your daily routine. Start
with 10 minutes, two or three times a day. For example, you could:
• walk your dog (or a friend’s dog)
• join a pregnancy aqua fitness class
• swim or walk in water
• try pregnancy yoga or pilates
• walk along the beach or in the park
• walk your children to and from school
• take the family to the park for a ball game
• find out about low-impact aerobics or light resistance gym programs available in
your area.
Remember that you will need to consider the effect of physical activity on your blood
glucose levels. Exercise generally lowers blood glucose levels, so you may need
adjustments to your insulin dose or insulin pump rate. It is important to discuss physical
activity with your health professionals.

Diabetes and your
pregnancy
There are a number of ways that

pregnancy will affect your body and your
diabetes. There are also some additional
risks associated with pregnancy for
women with diabetes. Looking after
yourself and your diabetes can help to
reduce these risks.
Blood glucose targets
Your diabetes in pregnancy team will
discuss individual blood glucose targets
with you.
Current Australian guidelines for pregnant
women with type 1 or type 2 diabetes
recommend blood glucose levels between
4.0 and 5.5mmol/L fasting/before meals
and less than 7.0mmol/L two hours after
meals.
However, for women with type 1 diabetes,
the targets below may be suggested by
your diabetes in pregnancy team to take
into account the need for optimal blood
glucose levels during pregnancy, while
minimising the risk of hypoglycaemia.
Your team may also advise you to monitor
your blood glucose levels at other times.
Fasting/before meals: 4.0 – 6.0 mmol/L
2 hours after each meal: 5.5 - 7.5 mmol/L

18 Diabetes and your pregnancy
Diabetes and your
pregnancy
Hypoglycaemia (low blood glucose)

During the first trimester (the first three months of pregnancy) your blood glucose levels will
already be changing. Around the time when most women find out they are pregnant (at four
to six weeks), your blood glucose levels may be more unstable, so insulin doses may need
to be changed at this time.
From around six to eight weeks, it is common to become more sensitive to insulin, which
means the insulin you take works more effectively. This may continue until about 14 weeks
(or around three months) into the pregnancy. During this time insulin doses may need
to be reduced (usually both daytime and overnight) to avoid frequent and more severe
hypoglycaemia (hypos).
Some women also notice that their early warning signs for hypos (such as feeling shaky or
sweating) change in pregnancy. This means that hypos can happen without much or any
warning, increasing your risk of severe hypos. Frequent blood glucose monitoring can help
you with adjusting your insulin doses and reducing this risk. This is important for your own
safety and wellbeing. Your partner, family, friends and colleagues may be able to help you
identify hypo symptoms if you are finding it difficult to detect your hypos. Discuss hypo
management with your diabetes in pregnancy team.
You also need to remember to check that your blood glucose levels are above 5mmol/L
before driving. For more information refer to the NDSS booklet Diabetes and Driving.
Treating severe hypos
Severe hypos (when you can’t treat your hypo yourself and you need help from someone
else) can be more common during pregnancy, particularly in the first three months. Your
partner and family may like to meet with your doctor or diabetes educator for an information
session on when and how to use a glucagon injection (GlucaGen®) in an emergency.
A glucagon injection is an intramuscular or subcutaneous injection that can be used to
reverse hypoglycaemia in someone who has lost consciousness. It helps your body to
release glucose stored in your liver and raise your blood glucose levels quickly.

Diabetes and your
pregnancy
ACTION:
• Get into the habit of carrying a supply of hypo treatment such as glucose tablets,
glucose gel or jelly beans with you at all times. It is also a good idea to have your
hypo treatment close by your bed at night.
• Check that your glucagon is in date. If not, ask your doctor for a script to get
another one.
Ketoacidosis and high blood glucose levels

If there is not enough insulin for your body cells to use glucose for energy, your blood
glucose levels will rise and your body will break down fats instead as another energy
source. However, fat breakdown leads to your body forming ketones which you can detect
in your blood or urine. High blood glucose levels (hyperglycaemia) and ketones can lead to
a serious condition called diabetic ketoacidosis (DKA), requiring hospitalisation.
Ketoacidosis may occur when you are unwell, forget to take your insulin or don’t take
enough insulin. To check for ketones you can:
• test your blood (using a monitor which can test for both glucose and ketones in your
blood) OR
• test your urine (urine testing strips are available where you buy your blood testing strips).
The risk of ketoacidosis increases during pregnancy and is very dangerous, especially for
the baby. It is important to go to hospital immediately if your blood glucose levels are high
and there is any sign of ketoacidosis (blood ketones more than 0.6mmol/L or urine ketones
more than 1+).

Diabetes and your
pregnancy
Sick days
Everyday illnesses such as the flu and infections can cause your blood glucose levels to
rise. If you get sick while you are pregnant you will need to be particularly careful and check
your blood glucose levels more frequently. You may also need to increase your insulin
doses or have small frequent doses to prevent ketoacidosis.
Talk to your diabetes health professionals about developing a sick day management plan,
as this takes the guess work out of managing blood glucose levels when you are unwell.
Make sure you have in-date ketone monitoring strips and that you know what to do if you
find ketones present.
For more information about ketones, ketoacidosis and sick day management ask your
diabetes health professionals for a copy of the booklet Sick Day Management for Adults
with Type 1 with Diabetes or visit www.adea.com.au to download a free copy.
HELPFUL HINTS: Illness and infections

• Check your blood glucose levels more frequently when you are unwell.
• Take your insulin even if you are vomiting or not eating. Talk to your diabetes health
professionals about adjusting your insulin dose in this situation.
• Follow your sick day management plan.
• Check your urine or blood for ketones.
• Call your doctor or diabetes educator if:
– your urine ketone reading is more than 1+
– your blood ketone reading is more than 0.6 mmol/L
– you are vomiting or unable to eat or drink
– you are worried about high blood glucose levels
• See your doctor to find out the cause of the illness.
• Discuss hypo management with your diabetes health professionals.
If you are vomiting so much that you cannot keep food or fluids down, call your
doctor or diabetes educator immediately or go to the Emergency Department of your
nearest maternity hospital.

Diabetes and your
pregnancy
Morning sickness
During the first 12 to 14 weeks of pregnancy, some women feel sick first thing in the
morning, some in the evenings and others in the afternoon. Other women feel sick all day
long and may vomit frequently. For some women this may continue well into the pregnancy.
HELPFUL HINTS: Morning sickness

• Keep your fluids up: sip on drinks such as water, flat diet (sugar-free) lemonade,
diluted diet cordial, or diet icy poles.
• If you have been vomiting or unable to eat, you may need to include ordinary soft
drinks and cordial instead of diet drinks (refer to your sick day management plan).
• Eat small, frequent meals - talk to your doctor or diabetes educator about
changing insulin doses to allow for this.
• Avoid strong food odours and rich, fatty foods.
• If mornings are a problem, snack on food like dry toast or dry biscuits before
getting out of bed.
• Eat and drink slowly.
• You may find that you can tolerate cold foods better than hot food.
• Some women find ginger (tea, biscuits or tablets) to be useful.
• Ask your dietitian for some suggestions.
• Test for ketones.
• Always take your insulin, but you may need to change the dose.

Diabetes and your
pregnancy
Diabetes complications
Your doctor will advise you to have a baseline screening for all diabetes complications
before pregnancy. If there are any complications, they should be assessed and stabilised
before you fall pregnant. They will also need to be closely monitored throughout your
pregnancy. If complications are advanced, it is important to discuss the risks of pregnancy
with your doctor before planning to fall pregnant, as pregnancy does put additional stress
on your body. Some of the complications of long-term diabetes can be made worse by
pregnancy, such as renal damage (kidneys) and retinopathy (eyes).
Kidneys
Diabetes complications affecting the kidneys increase the chance that your blood pressure
will become a problem in the second half of pregnancy, usually after 26 weeks. If you have
no signs of kidney problems or only very mild problems before pregnancy, it is unlikely that
a pregnancy will have any long-term effects on your kidney function. If you already have
diabetes related kidney disease, pregnancy may cause your kidney function to worsen.
Eyes
Rapid improvements in blood glucose levels can increase the risk of developing eye
problems or make any existing eye complications worse. Gradually reducing your HbA1c
before you fall pregnant can reduce the risk of these problems occurring. If you have eye
problems that become worse during pregnancy, laser treatment is safe if you need it. Any
eye problems that may have developed during pregnancy tend to improve after the birth,
usually by the time the baby is three to four months old.
Nerves
If you have autonomic nerve damage, you may experience more problems with low blood
pressure during pregnancy. Delayed stomach emptying can also cause vomiting that can
persist throughout the pregnancy, which can be stressful and make it difficult to maintain
good nutrition. This can lead to significant problems so you should discuss with your doctor
how autonomic nerve damage may affect your pregnancy.
If you have diabetes complications it is particularly important to have specialised
management of your diabetes during pregnancy. It is best for your pregnancy to be
managed in a major hospital which has a lot of obstetric and diabetes medical support as
well as the best facilities for babies if they are born early or have any problems when they
are born.

Diabetes and your
pregnancy
Pre-eclampsia and high blood pressure

Pre-eclampsia is a potentially dangerous
complication of pregnancy. It includes
the development of high blood pressure,
protein in the urine, and swelling or
puffiness in the legs, fingers and face. It is
more common in women with diabetes.
Pre-eclampsia is dangerous for you and
your baby. It can cause problems for
your baby’s growth and is a major cause
of premature birth. Well managed blood
glucose levels before and throughout
pregnancy can reduce the risk of pre-
eclampsia but not fully prevent it.
Your doctor or diabetes in pregnancy team
will check your blood pressure and urine,
and look for signs of swelling at each visit
in the later stages of your pregnancy.
Women who have a high risk of pre-
eclampsia may be advised to take
medication such as low-dose aspirin from
early pregnancy to reduce the risk.
ACTION:
• Visit or phone your diabetes in pregnancy team regularly and understand the
signs and symptoms of pre-eclampsia.

Medical tests and monitoring
during pregnancy
Throughout your pregnancy you will need to have a number of tests to check your general
health and the wellbeing of your baby, including:
• HbA1c to assess your overall blood glucose management during pregnancy
• Full blood count and iron studies, to make sure you are not anaemic
• Kidney function tests
Other tests will be arranged by your doctor as needed.
Ultrasound scans
Ultrasound scans are used to monitor your baby’s growth and wellbeing and to check for
abnormalities in your developing baby and the risk of genetic disorders. It is likely that you
will be offered ultrasounds at the following stages:
• 7 – 8 weeks: to estimate your due date
• 11 – 13 weeks: for the first trimester
combined screening (a nuchal
translucency (NT) ultrasound and blood
test to check for genetic abnormalities,
including Down Syndrome as well as
for risk for early onset of pre-eclampsia
(high blood pressure) before 34 weeks)
• 18 – 20 weeks: for the anatomy scan (to
check for physical abnormalities)
• 28 weeks: to check your baby’s growth.
You may also be asked to have additional
ultrasound scans, usually every two to
four weeks from 28 weeks, to monitor your
baby’s growth and general health.

Medical tests and monitoring during pregnancy 25
Medical tests and monitoring
during pregnancy
Urine tests
You will be asked to give a urine sample at each visit during your pregnancy. This is tested
for ketones, albumin and protein, and it can also identify the presence of any infection that
would need to be promptly treated. A small amount of protein in the urine is not uncommon
in pregnancy. However, a larger amount may indicate that the pregnancy has affected your
kidneys or, in later pregnancy, that you are developing pre-eclampsia.
Fetal heart rate monitoring
Sometimes your obstetrician may recommend that you have a cardiotocography test
(CTG), to monitor your baby’s heart rate. This test may be recommended in the later stages
of pregnancy. A CTG takes about 30 minutes and involves two sensors being placed on
your stomach. These sensors record an electronic trace as a graph of your baby’s heart
rate, and detect any contractions in your uterus.
Blood glucose monitoring
It is essential to monitor your blood glucose levels frequently during your pregnancy. You
will be asked to monitor before meals and one to two hours after meals. You may, at times,
be advised to do some extra monitoring, such as before bed and overnight (to look for
hypos). You should also check your blood glucose levels before driving.
Monitoring will help you and your doctor to get a better understanding of your blood
glucose levels so you can adjust your insulin to achieve the best possible management of
your diabetes. Extra blood glucose monitoring can also help you reduce the tendency to
have hypos and big swings in your blood glucose levels.
Continuous Blood Glucose Monitoring
Continuous Glucose Monitoring (CGM) may be suggested during your pregnancy. CGM
uses a sensor placed under the skin to continually detect changes in glucose levels and
to provide additional information about glucose patterns. This can be useful, but does not
replace self blood glucose monitoring during pregnancy. Ask your diabetes in pregnancy
team for more information.

26 Medical tests and monitoring during pregnancy
Diabetes and your baby
Most women will have a healthy baby, but all pregnancies can have problems regardless of
whether the mother has diabetes. Having diabetes brings some additional risks for the baby,
but looking after yourself and your diabetes can help to reduce these risks.
Risks to your baby in early pregnancy
Diabetes can increase the risk of birth defects (congenital abnormalities) in babies. These
abnormalities are more common when diabetes management before and during early
pregnancy has not been optimal. Damage to the baby’s heart, spine and kidneys can
occur during the early stages of pregnancy, often before women realise they are pregnant.
Miscarriage can also occur, as it can for all women. The risk of miscarriage increases when
HbA1c is elevated before falling pregnant and in the early stages of pregnancy.
To reduce your chance
of miscarriage and of
your baby developing
abnormalities, it is important
to maintain the best
diabetes management you
can.
Your diabetes in pregnancy
team will stress the
importance of frequently
checking your blood
glucose levels and keeping
these as close to the target
range as possible. It is also
important to minimise the
frequency of mild hypos and
the risk of serious hypos,
and to try to limit the swings
in your glucose levels.
Talk to your diabetes in
pregnancy team about your
individual blood glucose
targets.

Diabetes and your baby 27
Diabetes and your baby
The aim is to have your HbA1c less than 7% (53mmol/mol), if possible for three months
before falling pregnant. Your diabetes in pregnancy team can advise you on your personal
HbA1c goal before you conceive. Have your blood glucose meter checked and upgraded,
if necessary, to make sure your blood glucose readings are accurate.
Along with your own efforts to achieve target blood glucose levels, pregnancy-related
changes will also cause a drop in your HbA1c. The recommended HbA1c during pregnancy
is 6% or lower, but this should be discussed with your diabetes team.
High blood glucose levels during pregnancy
Glucose can freely cross the placenta to your baby, so your baby’s blood glucose levels will
reflect your own. If your blood glucose levels are high, the normal response of your baby will
be to produce extra insulin for themselves (this occurs from about 12 weeks gestation). The
combination of extra glucose and extra insulin can make your baby grow too big. Having a
large baby can cause problems during labour and delivery.
Risks to your newborn baby
Babies may have low blood glucose levels (hypoglycaemia) after birth as they can continue
to make extra insulin for a day or two after delivery. Hypoglycaemia is more likely to occur
if babies are born early or if they are very small or large. Your baby could also have trouble
with feeding, breathing or other medical problems. Keeping your blood glucose levels as
close to target as possible during pregnancy and birth will dramatically reduce the risk of
these problems.
Does the insulin I inject harm my baby?
No. It is important to know that the insulin you inject does not cross the placenta and cannot
harm your baby.
Will my baby be born with diabetes?
No. Your baby will not be born with diabetes. For mothers with type 1 diabetes, the chance
of your child developing type 1 diabetes before the age of 20 is only 2-3% and 5-6% if the
child’s father has type 1 diabetes. However, if both parents have type 1 diabetes, the risk for
the child is much higher with about a one in three chance of the child having diabetes by
age 20.

28 Diabetes and your baby
Insulin changes during
pregnancy
Insulin requirements tend to change constantly

throughout pregnancy as different hormones
take effect and your baby grows. You need to
be prepared to adjust your insulin doses on a
regular basis. It is not uncommon to need to make
adjustments to your dose at least once a week.
If you are not sure how to adjust your insulin doses,
ask your diabetes in pregnancy team for advice.
Adjusting insulin doses in pregnancy is more
challenging than usual, so make sure you know
how to get in touch with your diabetes team and be
prepared to contact them more often.
Early pregnancy changes
Many women find it extremely challenging to maintain optimal blood glucose levels in the
early stage of pregnancy with so many hormonal and physical changes occurring. For
around the first six to eight weeks of pregnancy your blood glucose levels may be more
unstable. Following these early pregnancy changes to your blood glucose levels, you may
find that your insulin requirements are lower until the end of the first trimester. You are likely
to need to reduce your insulin doses at this time to reduce the risk of hypos occurring,
especially severe ones. It is also important to be aware that during pregnancy, sometimes
hypos can occur without much (or any) warning. Preventing a hypo is better than treating
one. Try not to miss any meals or snacks and check your blood glucose levels regularly.
Mid to late pregnancy changes
From the second trimester of pregnancy, especially after 18 weeks your insulin requirements
will usually start to rise. By around 30 weeks you may need as much as two or three times
your daily pre-pregnancy insulin dose. This is because the hormones made by the placenta
interfere with the way your insulin normally works - as the pregnancy hormones rise, so
does your need for insulin. In the second half of your pregnancy you are likely to need
more mealtime, rapid-acting insulin, compared with the long-acting/basal insulin. Insulin
requirements tend to continue to rise until about 36 weeks, when they may plateau or
start to fall a little. If you notice your insulin requirements fall significantly and rapidly in late
pregnancy, this can be a sign of problems with the pregnancy - contact your specialist for
advice immediately.

Insulin changes during pregnancy 29
Insulin changes after
the birth
Changes after the birth

Once your baby is born and your placenta is delivered, your insulin
requirements will fall dramatically. The mother’s insulin requirements
tend to be very low for the first few days after the baby is born and
then gradually increase. Your target blood glucose levels should
be reviewed after delivery. You will still need to do frequent blood
glucose monitoring after your baby is born. Target blood glucose
levels after delivery will be higher than your pregnancy targets, to
reduce the risk of hypos while you are establishing breastfeeding
and a new routine with your baby. It is usually recommended to
keep blood glucose levels in the 5–10mmol/L range at this stage.
In the first few weeks, you will usually still need less insulin than you did
before the pregnancy. If you are breastfeeding, once your milk comes
in your insulin requirements may decrease again. Your endocrinologist
or diabetes educator will help you re-adjust your insulin doses after
delivery. Before you go home from hospital, discuss with your diabetes
health professionals the best way of contacting them over the next few
weeks/months as it can be challenging managing your diabetes in the
early weeks with a new baby.
ACTION:
• Have an insulin management plan for immediately after delivery.
• Carry hypo treatment with you at all times.
• Keep hypo treatment by your bedside and nearby if you are breastfeeding.
• Check you have a glucagon script and current supply, and that your partner/family
knows how to use it.
• Make a plan with your diabetes in pregnancy team about when and how often to
check your blood glucose levels.
• Review your sick day management plan.
• Have a list of contact details for your diabetes in pregnancy team and have these
readily available.

30 Insulin changes after the birth
Labour and birth

work with you towards the ultimate
goal of having a healthy baby.
As a woman with diabetes it may be
possible for you to have a full term
delivery and natural birth. However,
your doctor will probably recommend
delivering your baby at around 38-39
weeks or even earlier if there are
problems during your pregnancy.
Reasons for earlier delivery may
include high blood pressure or pre-
eclampsia, your baby becoming too
big or perhaps not growing enough.
Occasionally it may also be because
your diabetes is getting difficult to
manage or if there is a concern about
a fall in your insulin requirements or
your baby’s activity level.
discuss what to expect during labour
and delivery. This will include a plan
for insulin adjustment, blood glucose
management and who to contact
if you go into labour earlier than
expected.
Induction of labour
Depending on how your pregnancy is
progressing, you may need to have
an induction, which means helping
your body to start labour. An induction
can be performed in several ways and
sometimes a combination of two or
more methods will be used.

Labour and birth 31
Labour and birth
These Include:
• Gel insertion – this involves inserting a prostaglandin pessary or gel into your vagina,
to help the cervix to soften and open. This, in turn, tells your uterus to start contracting.
Some women need two or three doses of gel before labour begins.
• Oxytocin drip – this method involves an intravenous (IV) line (or drip) being inserted into
a vein in your arm, and the oxytocin hormone being slowly delivered into your blood to
help your uterus start contracting. The drip may be used alone or with a gel insertion.
• Balloon induction – this involves a catheter being inserted into your vagina. Water is
then pumped into the device, which gently puts pressure on your cervix, assisting dilation
and encouraging your uterus to start contracting.
• Rupture of membranes (breaking waters) – this method involves rupturing the
membrane, or bag of fluid, around your baby. Your membrane is gently broken using an
‘amnihook’, which looks like a long crochet hook, and the gush of fluid may encourage
your uterus to start contracting and bring on labour.
Caesarean section
If your doctor is concerned about you not being able to have a vaginal birth (for example, if
they suspect your baby is large or there are other obstetric problems), they will discuss this
with you when you are making a plan for your baby’s birth. This is usually towards the end of
your pregnancy at around 35 - 36 weeks.
If a caesarean section is advised, it will be according to your obstetric needs, not just
because you have diabetes. Birth by caesarean section is not a decision taken lightly,
as there are risks involved with such major surgery. The medical decision to perform a
caesarean section should be discussed with you in detail, so your doctor can explain the
risks and benefits involved.
If you are having a caesarean section, you will usually have to fast for about six hours
beforehand, so you should discuss with your diabetes in pregnancy team the options for
managing your blood glucose levels and insulin doses during this time. It is a good idea to
make a management plan with your diabetes in pregnancy team well before the birth.
In some circumstances a caesarean section is undertaken as an ‘emergency’. This might
happen if there are problems with you or your baby, or because the labour is not progressing
the way it should.

32 Labour and birth
Labour and birth
Managing diabetes during labour

Your own blood glucose levels in the time leading up to the birth have an important effect
on your baby’s blood glucose levels. The higher your blood glucose, the higher the glucose
supply will be to your baby before birth. The extra glucose stimulates the baby’s pancreas
to make more insulin. After birth, your glucose supply to your baby suddenly stops, but your
baby may continue to produce excess insulin for several hours and even up to one or two
days after birth. This can cause hypoglycaemia in the baby. If you have blood glucose levels
close to the recommended range during labour, this lowers the risk of your baby having low
blood glucose levels at birth.
When an induction or caesarean section is planned, your diabetes in pregnancy team will
discuss with you a plan for managing your diabetes. This will include adjustment of your
insulin doses/pump rates or changing the way insulin will be delivered.
When you are in labour, your blood glucose levels will be monitored frequently (usually
hourly) and the amount of insulin you are being given will be adjusted to keep your blood
glucose in the normal range. An
intravenous (IV) insulin infusion
and IV glucose (sugar) are often
used throughout labour, which
allow small amounts of insulin and
glucose to run into your blood
continuously. Alternatively, rapid-
acting insulin injections every two
to four hours may be used during
labour to manage your blood
glucose levels.
If you use an insulin pump, you
may be able to continue using it,
but with modified basal rates and
smaller bolus doses. This will only
be the case if this can be managed
safely at the hospital where you
will deliver your baby and blood
glucose levels can be kept within
the target range.

Labour and birth 33
Labour and birth
Managing diabetes after delivery

After your baby is born your diabetes management plan will need to be reviewed. You are
likely to need less insulin for the first few days after delivery and your target blood glucose
levels will be higher (usually 5-10mmol/L). At this stage when you have a new baby to care
for, it is very important to try to avoid hypos. Your diabetes in pregnancy team will discuss
changes to your diabetes management plan with you.
ACTION:
• Talk to your diabetes in pregnancy team before labour about pain relief options,
diabetes management and any other questions or concerns you may have.
• Have a written plan for your diabetes management during birth, regardless of the
birthing method.

34 Labour and birth
Labour and birth
After your baby is born

After the birth, your baby will be examined by a paediatrician, your obstetrician or a midwife.
If your blood glucose levels have been stable during your pregnancy and the birth, and your
baby has no problems, your baby will probably go with you to your hospital room.
If your baby is born very large, very small, prematurely or is having breathing problems or
low blood glucose levels, they may need to be observed in a Special Care Nursery for a day
or two. Not all maternity hospitals are equipped with a high-level Special Care Nursery, so in
some circumstances your baby may need to be transferred to another hospital.
Skin-to-skin contact between you and your baby will be encouraged at birth because it will
help you to develop a close bond with your baby. It also allows your baby to suckle and
will help to keep your baby’s temperature more stable. Ask your midwife about skin-to-skin
contact if you and your baby need to be separated due to premature delivery.
Your baby’s blood glucose level
Your baby will be tested for low blood glucose levels for at least the first 24 hours after
birth. Blood glucose tests are done by heel prick at regular intervals until the baby’s blood
glucose levels are in the normal range. This test is to check for low blood glucose levels, it is
not a check to see if the baby has diabetes and does not mean that your baby will develop
diabetes in the future. If your baby’s blood glucose level is low (less than 2.0 - 2.5 mmol/L),
your baby may need to have supplementary feeds or some glucose. Talk to your midwife
about using your breast milk for supplementary feeding.
ACTION:
• Ask your midwife or diabetes in pregnancy team for a tour of your hospital’s
Special Care Nursery before your due date.
• Ask about early skin-to-skin contact with your baby.

Labour and birth 35
Breastfeeding
Breastfeeding has many benefits, both for

you and your baby. These include benefits
for your baby’s immune system, growth
and development, and it can also help
with bonding between you and your baby.
Breastfeeding and diabetes
Most women with diabetes are able to
breastfeed their babies. It is important to
keep in mind though, that breastfeeding
may require some practice, support and
persistence.
It is a good idea to see a lactation
consultant four or five weeks before your
baby is due to find out as much as you
can about breastfeeding. You can also
discuss diabetes and breastfeeding and
any challenges you may come across.
Women with diabetes sometimes find
that there is a delay with their breast milk
‘coming in’. The milk usually comes in on
the third day after the birth, but it may be
delayed by 24 to 48 hours. If your baby
is born early or if you have problems with
low blood glucose levels after delivery it
can also be more challenging to establish
breastfeeding initially.
The lactation consultant may discuss with
you the option of antenatal expressing
and storing colostrum (early breast
milk) before the birth of your baby. It’s
important to note however, that the
advantages and disadvantages of
antenatal expressing for mother and baby
are still being researched.

36 Breastfeeding
Breastfeeding
Early breastfeeding
Try to feed your baby as soon as possible after delivery and then at least every three to four
hours during the first few days to help your baby maintain their blood glucose levels. If your
baby is at high risk of hypoglycaemia, you will be advised to breastfeed more often (at least
every three hours).
If you don’t have your baby with you, ask your midwife about expressing milk (colostrum)
within the first four hours of your baby’s birth. Your breasts make milk on a supply-and-
demand basis. If you express, your breasts will keep producing milk which you can then give
to your baby by bottle, spoon or tube.
Blood glucose levels
Your insulin requirements may be quite small in the first few days or so after delivery, but you
will still need to do frequent blood glucose monitoring so you can adjust your insulin doses.
It is usually safest to keep blood glucose levels in the 5-10mmol/L range at this stage, not
lower, to reduce the risk of hypos. Keep in mind, it can be really hard to get blood glucose
levels within the recommended range while breastfeeding.
Hypoglycaemia
Your blood glucose levels may fall rapidly
during and following breastfeeding, just
like with any other physical activity, so
be prepared to treat hypos while you are
breastfeeding. Blood glucose levels can
fall by 3-5mmol/L during a breastfeed,
so it is important to have some hypo
treatment within reach while you are
breastfeeding.
You may need to:
• discuss strategies to prevent hypos
with your health professional
• develop a routine for feeding your
baby, so you can have your meals
on time and reduce your risk of
hypos

Breastfeeding 37
Breastfeeding
• snack before or during breastfeeding (e.g. fruit, crackers, sandwich) or speak with your
health professional about adjusting your insulin dose/pump rates
• treat yourself as soon as you notice any hypo symptoms
• check your blood glucose after a feed, to see how much your levels are falling,
especially during the night.
Breastfeeding information and support
Your midwife or lactation consultant can support you to establish breastfeeding and give you
strategies for successful breastfeeding. Most Australian hospitals have baby-friendly health
initiatives to help support early breastfeeding.
If you don’t plan to breastfeed for long, remember that just six to eight weeks of
breastfeeding will still give your baby many benefits, including immunity from infections.
Breastfeeding may also reduce the chance of your baby developing diabetes later in life.
For more information contact:
• the lactation consultant at your local hospital
• your Child and Family Health Nurse
• the Australian Breastfeeding Association helpline on 1800 686 268.
ACTION:
• Talk to your diabetes team about targets for blood glucose levels and insulin
adjustments during breastfeeding.
• Eat regular meals and snacks to prevent hypos.
• Monitor your blood glucose levels more frequently and discuss any concerns
with your diabetes health professionals.
• Talk to your midwife or lactation consultant about breastfeeding strategies.
• Ask about storing breast milk to supplement feeds if necessary.

38 Breastfeeding
Going home and the future
Taking home a new baby is incredibly exciting, but this can also be a stressful time. Some
women with diabetes find it very hard to make their own health a priority and give their
diabetes the attention it demands during this busy period. Take advantage of any assistance
your family and friends can offer. If you don’t have any support nearby, it may be a good idea
to organise help with things like shopping, cooking and housework. It is best to start thinking
about this and getting plans in place before the baby arrives.
When you first go home with a new baby, especially for the first few weeks, you will be kept
busy looking after your baby. You may find that this new routine, along with disturbed sleep,
means that you don’t manage your diabetes as well as you would like. It is very important
both for you and your baby that you stay healthy and safe, so remember the following:
• Don’t forget to take your
insulin.
• Avoid hypos so that you
are safe to take care of
yourself and your baby.
• Check your blood
glucose levels at least
four times a day, so that
you know whether your
blood glucose levels are
dropping, and to guide
your insulin doses.
• Aim to keep most of your
blood glucose levels
between 5-10mmol/L.
• Ask for help from your
diabetes in pregnancy
team, even after your
baby is born.

Going home and the future 39
Going home and the future
Contraception and future pregnancies

Make sure you are using suitable contraception to avoid having another pregnancy before
you are ready. Remember that planning another pregnancy and having your diabetes well
managed beforehand will help you to have a healthy baby.
If you decide to not have any more children, you may want to consider a tubal ligation or
discuss a vasectomy with your partner. There are also a number of very effective long-term
but reversible contraception options, including intra-uterine devices (IUDs) and hormone
implants. Discuss the available options with your doctor.
Looking after your health
Once you are getting some more sleep and managing a new routine with your baby (usually
three to six months after the delivery), it is a good time to become more aware of your health
needs again. Review your diabetes management with your diabetes health professionals to
keep yourself healthy so that you feel well, reduce the risk of long-term health problems and
enjoy your new baby.
ACTION:
• Take the time to look after yourself, as well as your baby.
• Make sure you have the contact details for your diabetes health professionals for
advice and support on managing your diabetes after your baby is born.
• Review your family planning and contraception; whether you intend to have
another child or not.
• Make an appointment with your diabetes in pregnancy team or doctor before

planning your next baby.
• Talk to your GP or diabetes specialist about annual screening for diabetes

complications (kidneys, eyes, nerves etc.).
“Overall being pregnant is a wonderful, magical experience...It’s a gift that women with
diabetes in the past feared, and were advised against. Thank goodness times have
changed”.

40 Going home and the future
Your emotional wellbeing
Becoming a mother is one of the most memorable moments in a woman’s life. For women
with diabetes, pregnancy also involves a lot of planning, preparation and hard work. It is
not surprising that women with diabetes sometimes feel worried, stressed, anxious and
uncertain during pregnancy and once the baby is born. These feelings are very normal and
may come and go at different stages of your pregnancy.
It can also be a time in your life when you feel very motivated and empowered to take care of
yourself. It is really about finding a balance between the responsibilities of taking care of your
diabetes and your unborn baby and enjoying one of the most memorable times in your life.
Being pregnant and giving birth is a team effort involving you, and your partner and your
family, friends and health professionals. There will be more medical appointments than
usual, which may feel overwhelming at times. However these visits are also an opportunity to
let your diabetes in pregnancy team know how you are feeling and to discuss any concerns
or issues you have.

Your diabetes in pregnancy team is well equipped to assist you with the emotional ups and
downs you might go through during pregnancy. They are there to listen to your concerns
and to help you get the support you need. It is best not to ignore these feelings or to delay
seeking help. Looking after your emotional wellbeing is as important as looking after your
physical health.
Many women with diabetes describe a number of challenges before, during and after
pregnancy which can impact on their emotional health.
Achieving and maintaining blood glucose targets
This is probably the most challenging aspect of managing your diabetes while pregnant.
While you may have felt ‘in control’ of your diabetes before, you may find that this all
changes once you are pregnant. Even if you follow your health professional’s advice,
you may still have variations in your blood glucose levels. You may feel that your health
professionals do not always acknowledge how much effort you have put in and the
frustration it causes. It may feel like the emphasis on blood glucose levels takes away from
the positive experience of expecting a baby and what it means for you to become a mum.
If you are finding it too hard to achieve the recommended blood glucose targets, talk to your
doctor or diabetes educator/diabetes nurse practitioner to discuss realistic goals for you and
how to achieve them.
Worrying about your baby’s health
It is very normal to worry about
whether or not you will have a healthy
baby. It is important to find a health
professional you feel comfortable
with so you can openly discuss these
concerns with them. Find out as much
as you can about how to minimise the
risk of problems during pregnancy.
The support of women with diabetes
who have recently become mothers
can also be helpful at this time.
Remember that most women with
diabetes will have a healthy baby.

42 Your emotional wellbeing
Preventing and managing hypos

Frequent and sometimes severe hypos can be common, particularly in the first trimester of
pregnancy. This can be very stressful, particularly if your usual hypo signs and symptoms
change. Frequent blood glucose checks to pick up hypos early and appropriate insulin
adjustments can help reduce this risk. Your partner or family members can also help you
recognise the signs of a hypo and be trained on how to administer glucagon if needed.
Managing the concerns of well-meaning partners, friends or family members
Your partner, friends or family members may worry more than usual about you at this time.
You may feel that they are constantly watching you and that you are being judged about how
you are managing your diabetes. While they may mean well, it is important to let your loved
ones know how this makes you feel. Talk about how they could support you, what is helpful
and what is not. Reassure them that you are taking care of your diabetes, but that it is not
always easy. You could consider inviting them to be involved in your diabetes and pregnancy
care so that they better understand your diabetes management, worry less and give you the
support you need.
Going home
Taking your baby home is an exciting
time and a new chapter in your life.
While you may have felt that there was
a lot of support available while you were
pregnant, many women feel ‘abandoned’
at this time. You may be uncertain about
things such as how to care for your
baby, breastfeeding or changes to blood
glucose levels and insulin requirements.
Be reassured that help is close at hand.
There is support available from child and
family health nurses, lactation consultants
and your diabetes health professionals.
Make the time to find out what kind of
support you need and who to ask.

Postnatal depression
Many women experience changes in their emotions after having a baby. It is common to
have the ‘baby blues’ in the first week after your baby is born. Postnatal depression occurs
when these feelings last more than a week or two and interfere with your ability to function on
a daily basis with normal routines including caring for your baby or caring for yourself.
Be aware of the signs of postnatal depression such as loss of enjoyment in your usual day
to day activities, low self-esteem and confidence, loss of appetite, panic attacks, a sense
of hopelessness or fear for your baby’s wellbeing. If you are experiencing any distressing
symptoms that are causing you concern after your baby is born or your family or friends
have noticed signs of postnatal depression, your doctor, midwife, or child health nurse
can provide you with assistance or arrange for you to access psychological support. Don’t
expect that these feelings will just go away – make sure you seek the help you need.
Emotional support
There are many ways in which other people can support you through your pregnancy, the
birth and beyond. If you have a partner, initially you may be reluctant to involve them in your
diabetes management, particularly if this is something that you have always managed by
yourself. However remember that pregnancy is an exciting time for couples and your partner
may want to be part of this journey. Sharing your feelings and expressing your needs at this
time can give you the reassurance you need.
“It is important to share the experience of pregnancy with your partner. They will be
feeling the same elation and anxieties as you. By sharing them, your lives and your
pregnancy will be much happier and easier”.

44 Your emotional wellbeing
Family and friends can also be great support people during this time. Talking openly and
honestly about your emotions can help you to express your feelings, allow your loved ones
to better understand the support you need and help you at each stage of pregnancy and
beyond.
Many women find it helpful to hear stories of how
other women with diabetes have experienced their
pregnancy. Ask your diabetes in pregnancy team if
there is a support network or group you can attend to
meet other women with diabetes. Some women have
even formed support groups in the waiting rooms of
diabetes and pregnancy clinics! Other women find
online networks, forums and blogs a useful source of
information and support.
As a woman with diabetes, pregnancy can be one
of the most wonderful yet challenging times of your
life. There are many emotions you may experience at
this time, but you are not alone. Talk to your partner,
family and friends about how you are feeling and
ask your health professionals about accessing the
support you need for your emotional wellbeing.
ACTION:
• Ask for support from your family, partner, friends and health professionals
• Seek out counselling services if you need support.

• Diabetes Counselling Online offers peer support and information with a focus on
wellbeing, at www.diabetescounselling.com.au
• If you need to talk to someone immediately contact:
- Beyond Blue Support Service on 1300 22 4636
- Lifeline 13 11 14

Pregnancy and diabetes
checklist
The following checklist provides information for you and your diabetes in pregnancy team to
guide you through the different stages of pregnancy - from pre-pregnancy planning through
to delivery and going home. Use this checklist together with your health professionals to help
you manage your diabetes and your pregnancy.
Before pregnancy (at least 3 months)
Discuss contraception with your doctor
Meet your diabetes in pregnancy team*
Discuss individual blood glucose targets
Aim for a HbA1c of less than 7% (discuss your individual target)
Review your diabetes management plan
Diabetes complications assessment (for kidneys, eyes and nerves)
Review of medications including insulin type and delivery, diabetes tablets, blood
pressure and lipid medication
Review hypoglycaemia prevention and treatment plan
Glucagon script and training for support people in the use of glucagon
Review sick day management plan
Dietitian review of weight and diet for diabetes and pregnancy
Start high-dose folic acid supplement (at least one month before conception)
Start taking an iodine supplement
Thyroid function tests and a coeliac screen
Blood test for Rubella and chicken pox immunity and if needed, immunisation at
least one month before conception
*Frequent contact with your diabetes in pregnancy team is recommended before, during and after your pregnancy.

46 Pregnancy and diabetes checklist
checklist
The first 12 weeks
GP appointment to confirm pregnancy, discuss booking birth hospital and

diabetes in pregnancy team appointments
Early pregnancy blood tests including HbA1c
Ultrasound at 7-8 weeks (to confirm due date)
Review of your medications
Review blood glucose levels, insulin requirements and blood pressure
Review sick day management plan
Maintain an adequate diet for pregnancy
Continue taking folate supplement (for the first 3 months)
Keep in touch with how you feel and talk to a health professional if needed

checklist
12 – 14 weeks
Nuchal translucency (NT) scan and associated blood tests
Book 18-20 week anatomy ultrasound to check for physical abnormalities
Review blood glucose levels, HbA1c, insulin requirements and blood pressure
18 – 20 weeks
Anatomy ultrasound (to check for the normal development of the baby)
Discuss ultrasound results
Review blood glucose levels, insulin requirements, blood pressure and any
diabetes complications
Check pregnancy weight gain

checklist
24 – 40 weeks
Regular ultrasounds to assess your baby’s growth and wellbeing (every 2-4 weeks
from 28 weeks)
Blood and urine tests (according to doctor’s assessments)
Regular review of your baby’s wellbeing by obstetric team
Blood pressure checked at each obstetric / diabetes visit
Discuss breastfeeding with lactation consultant or midwife
Review blood glucose levels, HbA1c and insulin requirements
Check pregnancy weight gain regularly
By 36 weeks, discuss obstetric delivery plan (the delivery and timing of the birth)
Discuss diabetes management during labour/delivery and develop a written plan

checklist
Breastfeeding & going home
Seek advice/help with breastfeeding
Review blood glucose levels and insulin requirements
Contact details for diabetes team for support and follow-up
Arrange follow-up appointments
Discuss family planning including contraception and pre-conception care for next
pregnancy

Acknowledgements
This booklet has been adapted from the 2008 NDSS booklet - Can I have a healthy baby?
The original booklet was jointly produced by Diabetes Australia-Victoria, the Australasian
Diabetes in Pregnancy Society (ADIPS) and the Type 1 Diabetes Network.
The revised version of this booklet has been updated and written by the Expert Reference
Group (ERG) of the NDSS Diabetes in Pregnancy National Development Program.
Members of the ERG who assisted with the revision and update of this publication are:
Assoc. Prof. Glynis Ross, Assoc. Prof. Alison Nankervis, Prof. Wah Cheung (2013-14),
Assoc. Prof. Ralph Audehm, Dr Christel Hendrieckx, Kaye Farrell, Renza Scibilia, Susan
Davidson, Adj. Prof. Greg Johnson, Melinda Morrison and Effie Houvardas.
The Expert Reference Group would like to acknowledge the assistance of:
• The Type 1 Diabetes Network
• Accredited Practising Dietitians from Mater Health Services South Brisbane, Diabetes
Victoria and Diabetes NSW
• Health professionals from across Australia and women with diabetes who provided
feedback on the booklet during the review process
This booklet has been endorsed by the Australasian Diabetes in Pregnancy Society
(ADIPS).
asian
al
r
Aust
iabetes in
pregnancy society
A.D.I.P.S.
Published December 2014

Revised June 2015

Acknowledgements 51
Notes

52 Notes
Notes

Notes 53
Notes

54 Notes
Notes

Notes 55
This booklet is for women with type 1 diabetes who are
planning a pregnancy now or in the future. It provides
information on preparing for pregnancy, how to manage
diabetes during pregnancy and once the baby is born.
For more information go to the NDSS pregnancy and

diabetes website:
www.pregnancyanddiabetes.com.au
The NDSS is an initiative of the Australian Government administered by Diabetes

Australia. The NDSS delivers diabetes related products at subsidised prices and
provides information and support services to people with diabetes. Registration is free
and open to all Australians diagnosed with diabetes.
Visit ndss.com.au or call 1300 136 588.

Version 2.0 published June 2015
1300 136 588 ndss.com.au

The National Diabetes Services Scheme (NDSS) is an initiative of the Australian Government administered by Diabetes Australia.

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Having a healthy baby

1300 136 588 ndss.com.au

About this booklet 3

Preparing for a healthy baby 4

Eating well and physical activity 14

Diabetes and your pregnancy 18

Medical tests and monitoring during pregnancy 25

Diabetes and your baby 27

Insulin changes during pregnancy 29

Labour and birth 31

Going home and the future 39

Your emotional wellbeing 41

Pregnancy and diabetes checklist 46

Having a healthy baby

Having a healthy baby

Your diabetes in pregnancy team

Having a healthy baby

Planning and preparing for pregnancy

Having a healthy baby

Having a healthy baby

Having a healthy baby

Diabetes complications screening

Having a healthy baby

Having a healthy baby

Pre-Pregnancy BMI Weight range Recommended Pregnancy Weight Gain

Having a healthy baby

Having a healthy baby

Having a healthy baby

Having a healthy baby

Having a healthy baby

“...once you know you have a life

Having a healthy baby

HELPFUL HINTS: Physical activity

Having a healthy baby

There are a number of ways that

Fasting/before meals: 4.0 – 6.0 mmol/L

2 hours after each meal: 5.5 - 7.5 mmol/L

Having a healthy baby

Hypoglycaemia (low blood glucose)

Having a healthy baby

Ketoacidosis and high blood glucose levels

Having a healthy baby

HELPFUL HINTS: Illness and infections

Having a healthy baby

HELPFUL HINTS: Morning sickness

Having a healthy baby

Having a healthy baby

Pre-eclampsia and high blood pressure

Having a healthy baby

Having a healthy baby

Having a healthy baby

Having a healthy baby

Having a healthy baby

Insulin requirements tend to change constantly

Having a healthy baby

Changes after the birth

Having a healthy baby

Your diabetes in pregnancy team will