The importance of establishing good diabetes control for mothers with a history of Type 1 diabetes is essential. Almost continual monitoring of blood glucose levels is necessary. That means fasting levels before meals and also testing one and two hours after meals. Why this is important is because during pregnancy spikes of high glucose levels could adversely affect the pregnancy outcome. Complications that could arise include stillbirth, foetal abnormalities such as congenital heart defects, and abnormalities of the central nervous system.

Your doctor will want to establish amongst many things the most appropriate insulin regime, whether to use insulin analogues in place of human insulins or whether insulin pump therapy might be a better choice

For many years the gold standard has been the use of human insulins. The short acting insulin analogues lispro and aspart have now been demonstrated to be associated with safe and successful outcomes in pregnancy.

The most recent trials concern the long acting insulin analogue detemir (levemir) and this too appears to be associated with positive outcomes during pregnancy when compared to human insulin. There have been no sufficiently comprehensive trials using insulin glargine (lantus) to allow meaningful comment at this point in time.

The monitoring of blood glucose levels will be critical to the assessment and titration of insulin doses. There will inevitably be the issue of hypoglycaemia, why its frequency and severity is increased during pregnancy and importantly what to do about it. In addition to the diabetes input there will also be a specific obstetric programme of monitoring and scans to follow. It is usual therefore for a comprehensive package of closely monitored care to be structured for all expecting mothers with diabetes.

Routine assessments for the known long-term diabetic complications such as retinopathy (eye disease) and nephropathy (kidney disease) are mandatory. Treatment and advice may be required pre-pregnancy and close monitoring of any known complication will certainly be required during pregnancy, as these problems have been known to accelerate during pregnancy.

General nutrition will need to be discussed and folic acid supplementation in particular will need to be started as a measure to reduce central nervous system abnormalities in the developing baby. Balancing nutrition, exercise and weight whilst matching insulin requirements represents one of the very real challenges facing expecting mothers.

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