For all women – with or without diabetes – planning ahead helps to ensure a healthy pregnancy and baby, says diabetes educator NYAREE LAWLER.  

Women with diabetes can have healthy babies. There are some risks to consider, but with the help of your diabetes health care team, these risks can be reduced.  

Getting ready for pregnancy 

Here’s what to do three months before you start trying for a baby.  

• Consider your body weight and whether you might benefit from some weight loss or gain before pregnancy. Being at a healthy weight can help with conceiving and reduce risk of complications during pregnancy.
  

• Aim for 30 minutes of moderate intensity exercise, at least five days per week. Try to include two sessions of strength training to improve muscle strength, which comes in handy when you are planning to carry around a baby all day!
  
  Moderate intensity exercise will feel like you are breathing harder and sweating, not just going for a casual stroll.

• Choose less processed foods and aim for five serves of vegetables and one to two serves of fruit, plus healthy fats, lean proteins and low GI carbohydrates every day – this will boost antioxidants and nutrition to set you up for a great start to conception and pregnancy.
  

• Stop drinking alcohol. There is no safe level of alcohol use at any stage of pregnancy.
  

• Quit smoking. Trying for a baby can be a great incentive to help you to quit.
  

• Start a folic acid supplement at least three months before trying to conceive. If you have type 1 or type 2 diabetes, it’s recommended that you take a higher dose of folate due to the increased risk of birth defects. Make sure your pharmacist knows that you have diabetes when you get your folic acid supplement so that you get the higher dose. 
  

• Check that your immunisations are up-to-date and discuss pre-pregnancy vaccinations with your GP. 

Added considerations for women with type 1 or type 2 diabetes 

For women with diabetes, pre-pregnancy care should begin 3-12 months before conception and include the following: 

Have a full complications screening check 

This will include examination of the eyes and feet, assessment for nerve damage, kidney check, blood pressure check and other cardiovascular assessments such as cholesterol.  

Monitoring of existing eye or kidney complications is recommended, as pregnancy can increase the risk of progression. 

Review your blood glucose levels 

High glucose levels at conception and in the first three months of pregnancy can increase the risk of miscarriage and affect the development of the baby. 

Current guidelines recommend a HbA1c of 6.5% (48mmol/mol) or less before pregnancy, but your diabetes care team will discuss your individual glucose level and HbA1c targets.  

It’s recommended to use contraceptives until your blood glucose levels are at a safe level for pregnancy.  

Review your medications 

Your diabetes care team will review all your medications and determine if they need to be stopped or changed before pregnancy. These might include medications for cholesterol, blood pressure or non-insulin diabetes medications.  

Ask your diabetes care team about any other medications that you are using, such as over-the-counter medications.   

Consider a continuous glucose monitor (CGM) 

For women with type 1 diabetes, the NDSS access to CGMs is fully subsidised if you are actively planning pregnancy, pregnant or immediately post pregnancy. To be eligible for access, you’ll need to be assessed by an authorised health professional and meet certain criteria.

Ask your diabetes care team for more information or visit the NDSS website.

Review your insulin 

Insulin is the first-line therapy for management of high blood glucose levels in pregnant women with pre-existing diabetes. Different insulins have different safety levels for use in pregnancy, so your diabetes care team will review what insulin type/s you might already be on.  

Should I get an insulin pump if I’m planning to get pregnant? 

Women with type 1 diabetes might consider an insulin pump, although diabetes can be managed successfully during pregnancy with insulin injections.  

As it can take time to get the pump settings right, if you are considering starting a pump, it is recommended to start it before trying to conceive.  

Currently the only automated insulin pump that has been approved for use in pregnancy in Australia is the Ypsomed with the CamAPS FX software.  

However, if you are already on another insulin pump, you don’t have to stop or change it, but you might need to use it in manual mode. Your diabetes care team will be able to discuss these recommendations in more detail. 

What if my pregnancy is unplanned?  

If you have diabetes and unexpectantly become pregnant, see your GP and diabetes health care team as soon as possible. 

Women with an unplanned pregnancy may not have their blood glucose levels within ideal ranges at conception and in early pregnancy, which can increase the risk of complications.  

This doesn’t mean that you shouldn’t continue with the pregnancy or that you won’t have a healthy baby, but it is important to receive prompt diabetes care to help reduce the risks. 

Are you planning a pregnancy? 

Have a chat to one of our diabetes educators on the Diabetes WA Helpline by ringing 1300 001 880. 

King Edward Memorial Hospital offers pre-conception care and counselling for women with type 1 and type 2 diabetes who are thinking of having a baby. Your GP can refer you to this service.