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You will be cared for by a team with special experience in diabetes during pregnancy.
The team includes:
- a diabetologist (diabetes doctor)
- an obstetrician (pregnancy doctor)
- a diabetes specialist nurse
- a diabetes specialist midwife
- a dietitian
Most visits will be at the hospital diabetic antenatal clinic, but you should also stay in touch with your community midwife and GP.
Keeping your blood sugar under control is very important for your health and your baby’s health.
- In the first 6–8 weeks, your baby’s heart, lungs, kidneys, and brain are forming. Good control reduces the risk of birth defects and miscarriage.
- Take folic acid 5mg daily until 12 weeks to help prevent spina bifida. You can get this on prescription from your GP.
Later in Pregnancy
If blood sugar is high:
- Extra sugar crosses the placenta to your baby.
- Your baby makes more insulin, which:
- makes your baby grow bigger (macrosomia)
- causes extra fluid around your baby (polyhydramnios)
Good control with diet and insulin (if needed) helps prevent this.
It is very rare for a baby to die in the womb, but the risk is slightly higher with diabetes.
Good blood sugar control reduces this risk as much as possible.
Eyes
Pregnancy can put extra pressure on the small blood vessels in your eyes.
To check for problems:
- have your eyes tested at 11 weeks and 28 weeks.
- if you already have diabetic eye disease (retinopathy), see your eye doctor every 3 months. You may need treatment during pregnancy.
Kidneys
Your kidneys will be checked early in pregnancy for protein leakage.
- A urine test called ACR will be done each trimester.
- High blood pressure can harm your kidneys, so it must be controlled.
- If you take blood pressure tablets, they may need to be changed to ones that are safe in pregnancy.
Pre-eclampsia
This is when you have high blood pressure, protein in urine, or abnormal blood tests.
- It is checked at every antenatal visit.
- It can harm you and your baby, so you may need extra monitoring or a hospital stay.
- Risk is higher if you have poor blood sugar control or kidney problems.
- You may be given aspirin to help prevent it.
Your goal is to keep blood sugar as close to normal as possible.
Your diabetes team will help by:
- changing your diet
- checking blood sugar often
- using different types of insulin
- adjusting insulin based on your readings, diet, and activity
Target Blood Sugar Levels
- Before a meal: 3.5 – 5.3 mmol/L
- 1 hour after a meal: 5.5 – 7.8 mmol/L
- 2 hours after a meal: below 6.5 mmol/L
Your diabetes team may set personal targets to keep you safe and avoid low blood sugar.
Metformin
Metformin is a tablet that helps your body use insulin better.
- It does not cause low blood sugar.
- It works best for high blood sugar after meals, but not always for high fasting levels.
- You start with a small dose, and it is increased slowly based on your readings.
- Side effects can include bloating, nausea, or wind. Tell your diabetes team if this happens.
Although metformin is not licensed for pregnancy, it is safe, effective, and recommended by national guidelines (NICE).
Insulin Therapy
- Women with type 2 diabetes may need insulin as well as tablets before and during pregnancy.
- Most oral diabetes medicines (except metformin) are not safe in pregnancy, so insulin is recommended for better control.
You may need:
- short-acting insulin with each meal to keep blood sugar below:
- 7.8 mmol/L after 1 hour
- 6.5 mmol/L after 2 hours
- long-acting insulin at bedtime to keep blood sugar below 5.3 mmol/L before breakfast.
Women with type 1 diabetes usually need insulin at least 4 times a day. Your specialist team will guide you.
Good blood sugar control helps you and your baby stay healthy, but tight control can sometimes cause low blood sugar, called a hypo.
- A blood sugar below 4 mmol/L is a hypo in pregnancy.
- Hypos are most common in the first 12 weeks.
- Warning signs may be harder to notice during pregnancy, so hypos can become more severe.
Always Carry Fast-Acting Sugar
If your blood sugar is below 3.5 mmol/L, take 15–20 grams of fast sugar, such as:
- 5 dextrose tablets
- 3–6 jelly babies
- 200 ml Lucozade (with 20g sugar)
What to Do Next
- Check your blood sugar again after 10–15 minutes.
- If it’s still low, take more fast sugar every 10–15 minutes until normal.
- If you’re not eating a meal soon, have a slow-release snack like a digestive biscuit or fruit.
Important
- Some women don’t feel hypos (hypo unawareness) when blood sugar is 3 mmol/L or lower.
- This can be dangerous and may cause fainting.
- Tell your diabetes team urgently if this happens.
- Keep a glucagon injection at home for severe hypos. Your nurse can teach your family how to use it.
- Let people you see often know about hypos and how to help you.
Frequent hypos are unlikely to harm your baby.
Driving and Low Blood Sugar (Hypoglycaemia)
- Always check your blood sugar before driving.
- It should be 5 mmol/L or higher before you start.
- On long journeys, do not drive if you are having hypos.
Your ability to notice and treat low blood sugar can affect how safely you drive.
By law:
You must tell the DVSA if you have had more than one severe hypo (where someone else had to help you) in the last 12 months.
High blood sugar happens when your body does not have enough insulin. This can occur if you:
- eat more or have a treat
- do less exercise than planned
- feel stressed
- are ill
From 12 to 36 weeks of pregnancy, your body becomes more resistant to insulin, so blood sugar may rise unless you adjust your treatment.
If blood sugar is high:
- increase your regular insulin doses
- you may need an extra dose of fast-acting insulin (your diabetes team will show you how)
DKA happens when your body does not have enough insulin to use sugar for energy.
Your body uses fat instead, which makes ketones. High ketones can make you very sick and harm your baby.
Test for ketones if:
- your blood sugar is above 12 mmol/l
- you are ill
- you are vomiting
When to Come to Hospital
If you have:
- 2+ ketones in your urine
- blood ketones higher than 1.5 mmol/l
You should come to the hospital straight away to be checked.
You will get advice on eating well for you and your baby.
This will help you:
- gain a healthy amount of weight
- keep blood sugar under control
The rules for a healthy diabetes diet do not change in pregnancy.
Avoid alcohol completely during pregnancy.
Exercise
- Regular exercise helps control blood sugar and keeps you healthy.
- Before starting any new exercise, talk to your healthcare team.
- Safe activities include walking and swimming.
- HbA1c blood test
- Done each trimester to check your average blood sugar.
- Target: below 48 mmol/mol (or as close as possible without causing hypos).
- Ultrasound scans
- 7 weeks: early pregnancy scan
- 12 weeks: dating scan and combined screening (checks for Down’s, Edwards, Patau syndromes)
- 20–22 weeks: detailed anomaly scan
- From 28 weeks: monthly growth scans (or every 2 weeks if needed)
- CTG (heart monitoring)
- May be done if your baby’s movements are reduced.
- Most women with type 1 or type 2 diabetes have their baby between 37 and 38+6 weeks.
- Timing depends on your blood sugar, insulin needs, and baby’s growth.
- If baby needs to be born before 36 weeks, you may get steroid injections to help baby’s lungs. You may need to stay in hospital for 24–48 hours after steroids for blood sugar monitoring.
- Usually admitted to antenatal ward in the morning.
- A hormone called prostaglandin is placed in the vagina to soften the cervix.
- Your baby’s heart will be monitored for about an hour.
Bring:
- your insulin
- blood glucose meter and strips
- hypo treatment
- Before labour, you will manage your diabetes unless told otherwise.
- During labour or a caesarean, you may have an IV drip with insulin and sugar if your blood sugar does not stay between 4 to 7.8 mmol/l.
- Blood sugar will be checked every hour.
- After the placenta is delivered, insulin dose will be reduced.
- When you can eat and drink, the drip will stop, but you must take your usual insulin first.
- Return to your pre-pregnancy insulin doses, so write them down early in pregnancy.
Babies of mothers with diabetes may have some extra risks, but most issues are temporary and treatable.
Breathing Too Fast (Transient Tachypnoea)
Sometimes your baby may breathe quickly or make a grunting sound.
This happens when there is extra fluid in the lungs.
It usually gets better by itself within 24 hours.
Low Blood Sugar (Hypoglycaemia)
Your baby may have low blood sugar soon after birth because:
- during pregnancy, your baby made extra insulin.
- after birth, your baby no longer gets sugar from you.
To help:
- feed your baby within the first hour after birth.
- your baby will be monitored until blood sugar is stable.
Your baby does not have diabetes.
Breastfeeding
Breast milk is the best food for your baby.
It helps keep blood sugar normal and lowers the risk of diabetes later in life.
It also has many health benefits for you and your baby.
If you are breastfeeding:
- reduce your pre-pregnancy insulin dose by 20–30%.
- snack on starchy foods to avoid low blood sugar.
Colostrum Harvesting
Colostrum is the first milk you make—it’s perfect for your baby.
From 36 weeks, you can start expressing and storing colostrum.
This can be used if your baby needs extra food after birth.
Your midwife will explain this around 34 weeks.
Remember
With good blood sugar control, women with diabetes can have healthy pregnancies and healthy babies.
Questions
Write down any questions so you remember to ask them at your clinic visits. No question is too small, if it worries you, please ask.
By working together on diet, exercise, and blood sugar checks, we can make this pregnancy safe and positive for you and your family.
Contact us
If you have any queries relating to this information, please contact the Maternity service.
About this information
Service:
Maternity
Reference:
M/025
Approval date:
1 March 2026
Review date:
1 March 2029
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Important note
This page provides general information only. It is developed by clinical staff and is reviewed regularly every 3 years for accuracy. For personal advice about your health, or if you have any concerns, please speak to your doctor.