Preparing for pregnancy
Optimal diabetes control reduces the risk of miscarriage, congenital malformations and antenatal complications. Hyperglycemia increases the risk of congenital malformations from 3% to 6%.
There are some key priorities for this visit:
Antenatal care
Ideal glucose levels during pregnancy
Hypoglycaemic events are not harmful to fetal development, but the counterregulatory response and post-hypo hyperglycemia may be harmful. Don’t overtreat hypoglycaemic events.
Effects of diabetes on the pregnancy
Maintaining optimal glucose control and avoiding excessive gestational weight gain reduces these risks.
How to optimize glucose control in pregnancy
Glucose levels change throughout the pregnancy, so it’s good to know what to expect and how to deal with it. For support with this care and any medication decisions, refer your patient to a diabetes antenatal clinic.
The keys ways to improve glucose control in pregnancy are:
What’s best to eat during pregnancy?
| What’s best to eat during pregnancy? |
|
High fibre foods eg. vegetables, beans, lentils, nuts, avocados, berries, multigrain bread
|
Eggs
|
Dairy
|
Meat, chicken, fish
|
|
Healthy fats eg. avocado, olive oil, oily fish, nuts, yoghurt, cheese
|
Fruit
Eg. banana, grapes, watermelon, stone fruits, mango, pineapple
strawberries, raspberries, blueberries, kiwi fruit, pears, passionfruit
|
High fibre grains and cereals
Examples: Multigrain bread, traditional oats porridge, barley, All Bran, multigrain Weetbix Avoid overeating carbohydrate foods, even if they are low GI. If the glucose level is high after eating a meal, there was more carbohydrate there than the available insulin could cope with. |
Non-carbohydrate foods and seasonings
|
| What’s best to eat during pregnancy? |
|
High fibre foods eg. vegetables, beans, lentils, nuts, avocados, berries, multigrain bread
|
Eggs
|
Dairy
|
Meat, chicken, fish
|
|
Healthy fats eg. avocado, olive oil, oily fish, nuts, yoghurt, cheese
|
Fruit
Eg. banana, grapes, watermelon, stone fruits, mango, pineapple
strawberries, raspberries, blueberries, kiwi fruit, pears, passionfruit
|
High fibre grains and cereals
Examples: Multigrain bread, traditional oats porridge, barley, All Bran, multigrain Weetbix Avoid overeating carbohydrate foods, even if they are low GI. If the glucose level is high after eating a meal, there was more carbohydrate there than the available insulin could cope with. |
Non-carbohydrate foods and seasonings
|
Eating the following foods promote optimal glycaemic control and have novel health benefits for the developing fetus.
Post-pregnancy care
After the delivery, the glucose levels will fall, and insulin will be ceased.
Metformin will be continued to control postpartum glucose levels. It is safe to take while breastfeeding. If post-partum glucose levels rise above 8 mmol/L, insulin will be re-started at low doses.
At the 8-week postpartum check, review the status of your patient’s diabetes:
