Pre-existing diabetes in pregnancy

Once pregnancy is confirmed, you are advised to complete an online/self-referral form to notify the hospital you are pregnant. Please notify the GP, as they may adjust your medication accordingly. 

Your referral will be given to the diabetic team and contacted within 1 week to discuss your current wellbeing and arrange your registration appointment.

The Diabetic Team will: 

  • Advise you about stopping any medications which are contraindicated in pregnancy
  • Recommend folic acid 5mg for the 1st trimester of pregnancy.
  • Recommend blood glucose monitoring. 
  • Ensure you are on the correct medication and dosage depending on your glucose control.
  • Arrange a confirmation scan prior to your booking appointment.
  • Book your registration appointment. 

Blood glucose monitoring

You are advised to monitor your blood sugars daily until the delivery of your baby. The recommendations are:

  • You will need to test 4 times a day.
  • Aim to keep Blood Glucose levels between
     4 - 5.3 mmols      fasting (before breakfast)
     4 - 7.8 mmol       1 hour after main meals (breakfast, lunch and dinner)

If you are already monitoring your blood sugars and they are higher than target ranges please call the diabetic team on 01895 279678 to discuss further.

Folic Acid

You are advised to take folic acid 5mg in pregnancy until 12 weeks gestation to reduce the risk of your baby developing birth defects, such as spina bifida. A GP will have to prescribe this, because you cannot buy 5mg tablets from a pharmacy or shop without a prescription.

Booking appointment

Your booking appointment is normally arranged between 8-9 weeks gestation. 
With your consent, a referral for retinal screening and dietician will be done once your appointment is completed. For more information on retinal screening please look at the document for the eye screening programme.

You will be recommended by your midwife to start Aspirin 150mg after 12 weeks gestation until 36 weeks gestation. This will help reduce the risk of pre-eclampsia (high blood pressure in pregnancy) and support fetal growth.

A HbA1c test is taken to assess your diabetes control and is repeated in each trimester of pregnancy. This test measures the average blood glucose level over the previous 2-3 months which helps determine and ensure safety in your pregnancy.

After completing your booking appointment, a referral is made to the joint diabetic clinic within 2 weeks for an assessment and plan of management for your pregnancy.

Blood glucose monitoring

If you have type 1 Diabetes, you should be offered a continuous glucose monitor to test your blood sugars. If you do not have this device fitted at present, the diabetic team will discuss and offer you this at your next appointment.

It is a sensor attached to your stomach which checks your blood sugars throughout the day. You may still need to do finger prick testing at times if your sensor alarms you with a high/low result.

If you do not have Type 1 Diabetes, you may still be offered a continuous glucose monitor if you are having trouble with controlling your blood sugars (e.g. hypoglycaemia).

If you have type 2 diabetes, most patients are offered capillary blood glucose monitoring, which is given and taught by the diabetic midwives.

Ketones testing strips: ketones testing strips and a monitor should be given by the diabetic team for patients with type 1 diabetes, to reduce risks of Diabetic Ketoacidosis. Please discuss this with the team at your booking appointment.

Joint Diabetic Clinic (DBC)

The Joint Diabetic clinic runs every Monday morning (except bank holidays) to see all birthing people with pre-existing diabetes. The clinic is run by a multidisciplinary team, including endocrinologists, obstetric consultants, diabetic midwives, and diabetic nurses. 

Depending on your diabetes control, you will be arranged an appointment 1-4 weekly in DBC for a review of your diabetes control in pregnancy.

In between your face-to-face appointments, you may be arranged telephone appointments by the diabetic midwives to adjust your medication accordingly.

Ultrasound scans

Growth scans will be arranged at approximately 28/32/36 weeks gestation. This is done to check your baby’s growth and amniotic fluid volume and the results will be discussed with an obstetrician after completion.