Diabetes and Pregnancy: What the Guidelines Recommend

‘Pre-existing diabetes’ means a person already has diabetes before becoming pregnant. It includes all types of diabetes except gestational diabetes, or GDM for short. GDM only occurs during pregnancy, and it goes away once the baby is born, although the parent will be at an increased risk of developing type 2 diabetes.

In Australia, about 0.6% of pregnancies involve pre-existing diabetes and this number is increasing. This increase is mostly linked to type 2 diabetes and a rise in obesity; people developing diabetes at younger ages; women having children later in life; and an increase in ethnic groups at higher risk of diabetes.

People living with diabetes can have healthy pregnancies that lead to a happy and healthy baby. However, pregnancy is often more challenging when a person is also living with diabetes.

People with diabetes can sometimes find it harder to become pregnant, especially if they have complications from diabetes such as eye, kidney, nerve, or heart disease. They are also more likely to have health problems during pregnancy and birth, especially if blood glucose levels are often above target, this is known as hyperglycaemia.

Hyperglycaemia can lead to an increased birth weight, increasing the risk of pregnancy and birth complications. It can also lead to babies having low blood glucose after birth and/or needing care in a neonatal intensive care or special care unit.

The risk of these issues occurring can be reduced. The ADIPs guidelines emphasise that pre-pregnancy planning, and pre-pregnancy diabetes management is very important. Focus is on healthy eating, physical activity, taking recommended supplements, managing blood glucose levels, and screening for other medical problems.

The ADIPS guidelines recommend that before pregnancy, people with diabetes should have their glucose management, eyes, kidneys, heart, blood pressure, and feet checked. Contraception is recommended until diabetes is well managed and all checks are complete.

During pregnancy, birth and the newborn stage.

The ADIPS guidelines recommend people should be cared for by a specialist diabetes and pregnancy team that includes mental health support. This team helps people understand their choices and supports them through the pregnancy. People living in regional and remote areas can access telehealth care.

The focus of care during pregnancy for someone with pre-existing diabetes is on nutrition, physical activity, managing glucose levels within recommended targets and supporting the parent’s mental health. This can mean diabetes management changes for the person.

During pregnancy, medications may need to be ceased, introduced or increased. Glucose levels need to be monitored more closely, and glucose targets will be more rigid. People may need to make significant changes to their diet and activity levels. Regular checks will monitor the growth of the baby, monitor for pre-eclampsia and check kidney function and blood pressure.

During and after birth.

Both maternal and foetal health will be closely monitored. This is why the ADIPS guidelines stress the importance of a specialist team to aim for the best outcomes.

The ADIPS guidelines were established by a multi-disciplinary team of specialists to provide practical guidance to clinicians to ensure people living with pre-existing diabetes have the best chance of having safe pregnancies and healthy babies.