Pregnancy and Type 2 Diabetes: What to expect from the RUH antenatal team
Planning Pregnancy?
The better the control of your diabetes, the less risk there is to your baby.
Are you on tablets? It is safer and easier to be on insulin before the pregnancy.
Are you on diet alone? If your fasting blood sugars are greater than 6 it is better to start insulin
before trying for a pregnancy.
You will need to be monitoring your diabetes by blood testing.
Speak to your Practice Nurse or contact the Diabetes Specialist Nurse for more details, and if you need
help to improve your diabetes. (A list of phone numbers is given at the end)
Aim for an HbA1c below 6.5% if possible.
Take 5mg of folic acid ideally for 3 months before you get pregnant (You will need to get a prescription
from your doctor).
If you are on any cholesterol medication you should stop this before planning a pregnancy, and if you
are on blood pressure treatment, please discuss the treatment you are on with your doctor.
Pregnant?
If you have a positive pregnancy, test contact the diabetes team as soon as possible. Ring Doctor Tony
Robinson’s secretary (01225 824530) to arrange an appointment in the Joint Antenatal clinic for the
following Friday. If you prefer, ask your GP or Practice Nurse to do this.
First Appointment:
The midwife will take your details and talk to you about the clinic. The obstetric team will confirm the
pregnancy by ultrasound scan once you are 6-8 weeks. If you are unsure of your dates then a dating
scan will be arranged.
The diabetes team will help you to make sure your diabetes is as good as possible. We will talk about
hypos and how to avoid them.
Ideal blood sugars are 4-6 before meals and about 8 when you go to bed.
We will ask to take blood for HbA1c and Fructosamine if these have not been done recently.
At the beginning of your pregnancy we would suggest seeing you in clinic 1-4 weekly depending on
how you are managing.
We suggest that we check your eyes at the start of the pregnancy and depending on the results we may
need to do this every 3 months (if you have had them photographed in the last two months that should
be OK for the initial screen).We will need to instil drops to do this effectively, so you will need to wait
for the drops to wear off, or have someone drive you home.
If controlling your diabetes is difficult or you are on tablets we will suggest you go on to insulin, given 4
times a day. This number of injections makes it easier to cope with the changes that occur during
pregnancy.
Subsequent Appointments:
At subsequent appointments we will help you to adjust your insulin, if necessary. Usually blood sugars
are reasonably stable in the first 20 weeks of pregnancy. At approximately 22 weeks blood sugars start
going up and you may need to start insulin at this time if you are not already on it. If you are on insulin
your requirements may go up 2-5 times during the next 3 months. At around 36 weeks the insulin
doses tend to level off and may even fall in the last few weeks of your pregnancy. These changes are
driven by the placental hormones and vary from pregnancy to pregnancy and from woman to woman.
We normally ask for a blood sample every 4 weeks to monitor your diabetes control.
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Screening Tests:
All pregnant women are offered a screening test to assess the chance of the baby having Down’s
syndrome. In this trust we offer a blood test at 15-18 weeks.
Some women will consider having a special scan called a nuchal translucency scan at 11-13 weeks of
pregnancy. At the present time the trust does not offer this and most centres charge approximately
£200. The midwife will discuss these tests with you.
All pregnant women are offered a scan at around 20 weeks to check how your baby is developing.
If your HbA1c was greater than 8 early on in the pregnancy we will recommend that you have scan in
Bristol at 22 weeks to perform extra checks on the development of the baby’s heart
Growth Scans:
From 24 weeks we will perform a growth scan every month, to check the baby is growing well and its
tummy is not getting too fat (Macrosomia).
Delivery:
We usually see you every two weeks in the latter half of the pregnancy, although this may vary
according the way the pregnancy is progressing.
Your baby will need to be delivered at the RUH
Most pregnant mums with diabetes will deliver at around 38 weeks, as the baby is considered mature
after 37 weeks. There is evidence that leaving the baby beyond 38 weeks may increase the chance of the
placenta failing and the baby being stillborn.
The obstetricians will discuss the method of delivery .This will depend on how big the baby is and the
method of delivery for any previous babies you will have had.
You will normally have an insulin drip put up during the delivery to control your diabetes, and this will
be stopped once baby is delivered and you feel like eating. Remember to use the doses you used before
pregnancy, if you are breast feeding (which we encourage) you will need to reduce the insulin doses
further (by approximately 25%). We will discuss this with you nearer the time of your delivery.
Your baby has an increased risk of newborn problems, the most common being hypoglycaemia. The
best way to avoid this is to keep your control as good as possible right up to the time of delivery. The
baby will be observed on the special care unit but will be returned to you as soon as the paediatricians
are happy that the baby is doing well.
Diabetes Specialist Nurses Contact Numbers:
Helen Griffiths/Ainslie Lang (RUH) 01225 824198
Sally Wylie/Sally Catchpole (Bath) 01225 824173/825976
Bernadette Hall/ Lisa Maslen (Trowbridge) 01225 766161
Nikki Hillier/Lesley Amer (Chippenham) 01249 456483
Juliet Francis (Frome) 01373 454778
Antenatal Clinic 01225 824650/824645
Delivery Suite 01225 824447/824847
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