How does my diabetes affect my pregnancy?

Written by: Dr Bobby Huda
Published: | Updated: 11/02/2019
Edited by: Bronwen Griffiths

Many pregnant diabetic women will have a healthy baby and birth, but there is a risk of complications to both the mother and the child and it is important to be aware of these. The most important thing to do if you are diabetic and planning on having children is to manage your diabetes well, both before, during and after pregnancy. Dr Bobby Huda, a leading endocrinologist, explains how diabetes affects pregnancy and how your treatment for diabetes can change as a result of being pregnant.

What risks are there of being diabetic and pregnant?

There are risks to the unborn baby, including:

  • Congenital abnormalities
  • Macrosomia, also known as large for gestational age baby (this can result in a difficult birth or the need for a caesarean section)
  • Miscarriage
  • Stillbirth

There are also risks to the mother, including:

  • Gestational hypertension
  • Pre-eclampsia
  • Increased caesarean section rate
  • Shoulder dystocia (a problem during birth when extra help is needed to deliver the baby, which can cause nerve damage in the shoulders or arms)

What special measures need to be taken if you are pregnant and diabetic?

The blood sugars need to be tightly controlled, both before and during pregnancy. If you are planning your pregnancy, before you become pregnant you should request monthly HbA1c tests which measure your blood glucose levels. If your blood glucose levels are at a certain level (more than 10%), you will be advised to delay trying for a baby until it has decreased. Before and during pregnancy it is also important to take higher levels of folic acid each day until you reach the 12 weeks of pregnancy. These can be prescribed by your GP or specialist.

Will my diabetic treatment change whilst I am pregnant?

Your diabetes treatment, in general, will intensify with some medications needing to be changed as well as more frequent monitoring from a multi-disciplinary team, including an obstetrician, diabetologist, dietician, specialist nurse and a midwife. You will also be advised to monitor your blood glucose levels more closely during pregnancy as morning sickness can affect them.

 

If you are diabetic and considering having a baby, make an appointment with an expert to discuss your new treatment plan.

By Dr Bobby Huda
Endocrinology, diabetes & metabolism

Dr Bobby Huda is a renowned consultant endocrinologist in London with over 15 years of experience, and currently works as an NHS consultant at St Bartholomew's and the Royal London Hospitals, Barts Health NHS Trust. Having completed his medical training at the University of Liverpool, he went on to general and specialist training at the prestigious University Hospital Aintree, Liverpool, King's College Hospital, and Guy's and St Thomas' Hospitals in London.

At the forefront of his field, he takes a particular clinical interest in type 1 and antenatal diabetes and sits on several regional and national committees. He was a Clinical Lecturer at the world famous diabetes centre at King's College Hospital and gained valuable expertise in antenatal diabetes and insulin pump/glucose sensor therapy. Following successful completion of his PhD, he was awarded a National Institute of Health Research (NIHR) Academic Clinical Lecturer post in Diabetes & Endocrinology at King's College London from 2011 to 2012, further pursuing research interests in obstructive sleep apnoea and inpatient diabetes. More recent research is centred around Gestational Diabetes and the use of Artifical Intelligence in managing gestational diabetes. He is currently co-applicant on two £2 million grants researching these areas. He has recently co-authored the Royal College of Obsterician & Gynaecologists' guidelines on Alternative testing for Gestational diabetes during the Covid-19 pandemic.

Passionate about teaching and research, he currently holds lecturing positions at a number of prestigious establishments including King's College London and Barts and the London Medical School. He has also published over thirty articles in peer-reviewed journals and several book chapters. 

He has considerable clinical expertise in type 1 diabetes, insulin pump/ glucose sensors, MODY diabetes and diabetes in pregnancy. Specifically he has experience with all current insulin pumps, hybrid closed loop systems and real time Continuous Glucose Monitoring/ Flash glucose monitoring. He leads the Barts Health Genetic Diabetes clinic and has significant experience in assessing and managing atypical/MODY diabetes. He has experience in managing women with gestational diabetes, alternative tests to the Glucose Tolerance Test and significant experience in managing women with type 1, type 2, MODY diabetes during pre-conception, pregnancy and the post-partum period. He leads a multi-disciplinary busy diabetes antenatal clinic and works closely with obstetricans, dieticians and opthalmologists to optimise pregnancy care. He also leads the North-East London Sustainability and Transformation Preconception workstream and works closely with fertiliity services within the NHS and private sectors, to promote optimal glucose control during and after assisted conception. He represents North-East London on the London Diabetes Clinical Network groups for Type 1 diabetes, Inpatient diabetes and Diabetes in Pregnancy and sits within a Expert Reference Group for the National Gestational Diabetes Audit. He has previously sat on NICE committees for Diagnostic Assessments of insulin pump technology.

He also consults on inpatient diabetes, diabetes foot problems, genetic forms of diabetes and type 2 diabetes/ insulin resistance. He is currently not consulting on general endocrinology.

His medico-legal work has spanned both defendant and claimant reports and covers all aspects of diabetes including diagnosis of diabetes, diabetes foot ulcers, Charcot's foot, diabetes preconception/pregnancy and inpatient diabetes.

 

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