The most important goal in the management of diabetes in pregnancy is to ensure that the blood sugar remains as near to normal as possible. Babies of women who are diabetic are at an increased risk of congenital abnormalities. Diabetic women are at an increased risk of infection in pregnancy as well as of miscarriage and pre-eclampsia. The risk of all these problems in the pregnancy is directly related to the degree of control of the diabetes.
You may have been on the same dose of insulin for many years, but you will require increasing doses of insulin throughout your pregnancy. You will also need to increase the frequency of monitoring your blood sugar to ensure good control. Tighter control of your diabetes will mean you will be at a slightly higher risk of having hypoglycaemic attacks. For this reason, most pregnant diabetic women will usually need to have a snack mid-morning, mid-afternoon, and before bed.
Because of the increased risk of congenital abnormalities, you will be offered screening for neural tube defects and a detailed ultrasound scan at around 18-20 weeks. You should be managed by a joint pregnancy and diabetic clinic, which will include dieticians, midwives, and nurses experienced in dealing with diabetes in pregnancy. Such clinics are run in most areas and ensure that every diabetic woman is dealt with by specialists with the necessary expertise. It is important that you contact your GP or practice midwife and request that a prompt referral to such a clinic is made as soon as possible.
The management of labour in a diabetic woman follows the same principles as the management of surgery. During the labour and birth, insulin is administered intravenously according to her daily insulin requirements and her changing blood glucose level. After delivery your insulin needs will return rapidly to those prior to your pregnancy, although weight gain or breast-feeding might mean that an adjustment is necessary.