Worries, questions and uncertainty are common when it comes to diabetes, pregnancy and parenting. Women often have anxiety and unanswered questions. Men can be left out of the discussions, but men living with diabetes have their own worries about how their diabetes may affect their ability to have children, whether they will pass it on to their children and how they will manage fatherhood.
Issues such as planning and preconception care; managing pregnancy, birth and breastfeeding; parenting when you have diabetes to look after; and the grief of being unable to conceive a baby and/or the loss of a baby, need to be discussed.
Diabetes and Pregnancy – planning well and getting support
As a woman with diabetes it is important to have the right care before, during and after your pregnancy. All major hospitals have diabetes services who can provide information about diabetes in pregnancy. Similarly, most women’s hospitals will have a specialised diabetes and pregnancy clinic. Another option is to directly contact the diabetes educator and/or dietitian at your local hospital or at the women’s hospital in your nearest capital city.
If you are not able to attend a specialised diabetes and pregnancy service, you can speak with both your diabetes team (diabetes educator, endocrinologist) as well as an obstetrician and/or midwife about your diabetes and your family planning – it is best if you do this before you become pregnant – and you should ask your team to communicate and work to coordinate your care whilst you are planning your pregnancy.
The health professionals that generally make up a diabetes and pregnancy team who can help you plan your healthy pregnancy include:
• Endocrinologist / Diabetes specialist doctor
• Specialist Obstetrician (pregnancy doctor)
• Midwife (nurse specialised in pregnancy)
•Credentialled Diabetes Educator
• Dietitian (advice on food & healthy eating)
• GP – modified shared-care plan
• Social Worker
It can be a very stressful time for anyone venturing into pregnancy – anxiety is common and risks of postnatal depression can be higher when you have a condition like diabetes to manage. Counselling and support before, during and after pregnancy can really help to make sure you maintain your wellbeing and mental health alongside your physical health.
Here is a quick checklist that summarises the important things for you to consider if you have diabetes and are considering pregnancy (taken from the NDSS booklet):
• Visit your GP for: Referrals to diabetes and pregnancy specialists (equally important for women with type 1 and type 2 diabetes).
• Contraception and other general pregnancy advice – Ask your GP or other doctor for help to choose the best contraceptive for you and your partner to help with planning your pregnancy.
• Meet or put together your Diabetes & Pregnancy Team.
• Folate supplements : Take 5mg per day for at least one month before becoming pregnant and during the first 3 months of pregnancy.
• Review insulin therapy: consider insulin pump (at least three months before becoming pregnant) and new types of insulin.
• Review all medications you are taking with your doctor.
• Vaccinations: make sure your Rubella and Chicken Pox vaccinations are up to date.
• Blood pressure – check and stabilise before becoming pregnant.
• Diabetes Complications – full check up and screening. Treat and stabilise if necessary before becoming pregnant.
• Stop smoking if applicable – ask your team for help. Alcohol and other drugs should also be avoided.
• Diet and other supplements – check with your doctor and/or dietitian if you need to take iron, multivitamins or other supplements.
• Weight management – Aim for a healthy weight.
Difficulty getting pregnant?
Many women worry that they will have difficulty conceiving when they have diabetes. It is normal for any couple to take up to 12 months to fall pregnant. If after this time you are having difficulties, it is a good idea to talk to your doctor.
Women with type 2 diabetes or insulin resistance, may also have Polycystic Ovary Syndrome (PCOS) which is strongly associated with these things. This cause difficulties for women trying to get pregnant.
Obesity can also reduce your chances of falling pregnant. Getting as healthy as possible and aiming to lose some weight can help. Seek support to manage this, as it is not easy! If you are dealing with fertility issues this increases the stress in your life in a huge way.
Make sure you communicate with your partner and family, seek support from other women, your medical team and counselling, to deal with the ups and downs.
Pregnancy and Type 1 diabetes
If you have type 1 diabetes you may have been told all sorts of things about your chances of having a healthy pregnancy and baby. You may have seen and read horror stories and feel very uncertain and scared, about embarking on the parenting journey. While negative pregnancy outcomes may have been a common scenario before the 1920’s when insulin was introduced, it does not have to be the case today. Armed with up to date information and the latest in diabetes management tools, a healthy pregnancy and baby is entirely possible and usually the case.
With tight blood glucose management and good care from your medical team, your chances of having a healthy baby are about the same as for a person without diabetes. Although you need to monitor your pregnancy more closely than most mothers without diabetes, it is something the majority of women are more than happy to do in order to have the best health for themselves and their babies.
If you are planning a pregnancy, or are already pregnant, you may feel overwhelmed. Type 1 diabetes is tiring, pregnancy is tiring and the management of type 1 diabetes in pregnancy = super tiring! But it is short term pain for long term gain.
You may be given instructions, feedback and information on management of type 1 diabetes during your pregnancy journey that are scary and seem impossible. As you read and learn more about what you need to do, it will quickly become apparent that these seemingly complicated instructions are actually quite simple and that most of them are just the same concepts you are used to in management of your type 1 diabetes. Targets may be tighter, but you will most likely want to achieve these and be prepared to put in the extra work.
At the same time you need balance, you need to be realistic and you need to be able to live your everyday life – most women will have work, relationships and other children to manage. It is entirely normal for any woman who is pregnant to worry – so some of your worrying will be natural and part of the journey. Taking care of yourself as the number one is the best way to deal with this special time.
Relaxation and mindfulness strategies (learning to be present and not buy into negative and distracting thoughts) can assist you to remain focussed on the here and now, as well as daydreaming about what your baby will look like, who they will be and how you will be as a parent! It is important to practice regular down time.
Although successful diabetic pregnancies are more common, you must still be informed of the risks in order to work on lowering them. Uncontrolled blood glucose levels can result in a very large baby (over 10 pounds), breathing difficulties, and increased risk of obesity or diabetes when an adult. If the baby is too large to be delivered vaginally, a cesarean section will be necessary. Low blood sugar in the baby after birth could occur and could require the baby stay in intensive care.
Remember, having diabetes in pregnancy is NOT a guarantee that you will have problems or complications. If you can get your blood glucose into good tight control, your risks are lowered considerably.
Preconception planning for type 1 diabetes in pregnancy:
It is always best to plan your pregnancy and have your diabetes under control three to six months before becoming pregnant. Work with your healthcare team to get their official go-ahead before trying to conceive. This way your blood glucose levels can be in tight control during the critical development period – the first eight weeks.
However, if you are like most of us, you might not have planned that well! Perhaps you are already past the first eight weeks and your diabetes in not in the control you would like it to be.
Key point – Remember – no matter what stage of pregnancy you are in, you can still try to get into tight control and lower your risks.
If you have just found out you are pregnant, the important thing is to just forget about the past, try not to worry about the future, and start working as hard as you can with your support team to get into tight control. Please consult with qualified professionals in order to find the right regimen and treatment for you. Do not make changes without consulting your health care team.
Type 2 diabetes and pregnancy
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. Many medications will need to be stopped or changed for the duration of your pregnancy.
Aim for a healthy weight before becoming pregnant. A healthy eating plan and regular activity can help with weight management. Speak with a dietitian if healthy lifestyle advice is required. Some weight gain is associated with a healthy pregnancy and it is not advisable to aim to lose weight during pregnancy.
Trying to minimise weight gain will help and exercise and healthy eating is great for you and your baby. Counselling can assist with some of the emotional reasons behind unhealthy eating patterns as it is easier said than done! In pregnancy it is easy to think you are “eating for two.” This is not the case and it is important to remember once you have the baby you will need to be as fit as possible to recover from the birth and care for your new baby and growing child.
Talk to your doctor, Credentialled Diabetes Educator, obstetrician for pre-pregnancy planning and care. You can receive advice and guidance on blood glucose management, a review of all self care skills and knowledge, an assessment of diabetes equipment and management of hypoglycaemia and hyperglycaemia. Risks can be greatly minimised by ensuring excellent blood glucose control at the time of conception and during the first eight weeks of pregnancy.
- Are over 30 years of age
- Have a family history of type 2 diabetes
- Are overweight
- Are from an indigenous Australian or Torres strait islander background
- Are from a Vietnamese, Chinese, middle eastern, Polynesian or Melanesian background
- Have had gestational diabetes during previous pregnancies.
Staying healthy and fit ready for baby!
Most of us dread getting on the scales at the doctor’s office. This happens when you have diabetes anyway. Throw pregnancy in to the mix and the focus is well and truly placed on the number on the scales. When you are pregnant there is a big focus on weight gain. Some people feel they will just lose it all later; others worry they are not gaining enough weight and that this will be bad for their baby.
In reality, weight change during pregnancy varies considerably from woman to woman. The most important thing is that the weight gain is moderate for you and your own body size and shape. If you gain a moderate amount of weight, then you know your baby is getting the nutrients he or she needs. It also helps to ensure your health during and after the pregnancy, and will make blood glucose levels easier to manage.
Weight Gain Guidelines
Here are some averages to give you an idea of how much they weigh:
• At birth, a baby weighs about 3.3kg (women with diabetes may have heavier babies)
• The placenta, which keeps your baby nourished, weighs 0.7kg.
• The amniotic fluid, which supports and cushions your baby, weighs 0.8kg.
But what about the other two thirds of extra weight? These can be accounted for by the changes that happen to your body while you’re pregnant.
Again, the figures are averages:
• The muscle layer of your uterus (womb) grows dramatically and weighs an extra 0.9kg.
• Your blood volume increases and weighs an extra 1.2kg.
• You have extra fluid in your body weighing about 1.2kg.
• Your breasts weigh an extra 0.4kg.
• You’ll store fat, about 4kg, to give you energy for breastfeeding.
By the end of pregnancy you may weigh about 12.5kg more than you did before you became pregnant. Remember that this is only an average weight gain. Baby Centre has a pregnancy weight gain estimator work out your figures for you.
Read more here about weight gain guidelines.
After the first 12 weeks of pregnancy, most women require an extra 300 calories per day, as well as a modest increase in protein. Keep in mind that in most cases, it is not a good idea to lose weight during pregnancy. The goal is to be as healthy as you can and manage your diabetes as well as looking after your developing baby.
Physical activity and a healthy diet will benefit both you and your baby. As with general guidelines, moderate physical activity, with the approval of your doctor, of at least 30 minutes per day is generally recommended. Cardiovascular exercises such as swimming, walking or cycling help you to stay fit and burn extra calories.
Muscle-building exercise can also be highly beneficial because it helps to increase your metabolism. Incorporate activity into your daily life – walk to the shop instead of driving, or take the stairs instead of the elevator. Minimise the amount of time you spend engaged in sedentary activities such as watching TV or using the computer.
Being a dad when you have diabetes
Managing your diabetes as you go through pregnancy with your partner is very important so you can stay healthy and on top of things. You will be facing broken sleep, mood swings for both your partner and yourself and increased stress. All of these things can make your diabetes become harder to manage.
If you can schedule some regular down time and stay healthy, it will hold you in good stead for managing this very special time.
If you are worried about hypoglycemia and being responsible for a small baby, you are not alone! Most people with diabetes, in particular type 1 diabetes, worry about this. Again, communication with your partner is best, so you can have strategies for management of your diabetes in the midst of a busy household with a new baby.
Once you have older children life gets very hectic! It is important that you can still take time to look after yourself. Thinking about diabetes complications and what might happen to your children if you were to become sick is common, but unhelpful. Learning how to be mindful and stay focussed on the wonderful experience of being a Dad can help.