July 26, 2000
Question from Isle of Man, United Kingdom:
I have had type 1 diabetes for the past 16 years. I am "well controlled" and my husband and I have decided to start trying for a baby. Apart from monitoring my blood sugars, is there anything else I should be doing? I have been to see my doctor but he had no other advice for me.
There are several steps that you can take to reduce the risks of diabetes during a pregnancy. Prior to conception your blood glucose should be in very good control–fasting 60-90 mg/dl (3.3-5.0 mmol/dl), 1 hour after meals less than 130 mg/dl (7.2 mmol/dl). Your hemoglobin A1c should be in the normal range. To further reduce the risk of neural tube defects (spina bifida), you should be taking a folic acid supplement every day (0.4 to 1 mg). Maintaining good glucose control during the pregnancy, particularly in the first trimester, is very important. Since you have had diabetes for many years, it is probably worth having a baseline retinal examination and assessment of kidney function. If these tests are normal, then there is little chance of deterioration during the pregnancy due the pregnancy itself.
During the pregnancy, you will have several ultrasounds to evaluate the fetus for abnormalities as well as assessment of fetal growth. It is important the physicians taking care of you are up to date on the management of diabetes during pregnancy.