Diabetes and pregnancy

[JoeFreeman]

Good morning all, hope you're well.

Hope you don't mind this post - thought you'd be a helpful group to ask about this. I've been talking these past few days to our nurses/Care Advisors who are doing a lot of work around pregnancy and preconception care for women with diabetes, and they're looking to do some awareness raising on the subject.

It's quite a difficult subject to focus on as the messages will vary depending on people's age and their current situation in terms of becoming pregnant.

The subjects we need to highlight are:

- Contraception (to ensure you can plan your pregnancy)
- Folic acid (you need to take 5mg every day from when you start trying to get pregnant until you are 12 weeks pregnant to prevent spina bifida)
- Blood glucose control (high glucose levels, or swinging from high to low, cause damage as the baby is forming)
- Other medications (Statins or ACE inhibitors which could damage the baby if you were on them when you conceived)

Was wondering if anyone here has any thoughts on the matter and perhaps how from experience, it would be best to approach the subject? We've got a few ideas but it's such a broad subject in terms of the different messages...

If you've got any input on such issues as whether it should be a video, website or leaflet; which age groups should be targeted (should we take a sort of sex education stance and try to educate teenagers or aim it at older age groups who may be in the process of planning a pregnancy?) they'd be great to hear.

Any thoughts would be fantastic - do feel free to email me if you'd prefer!

Thanks!

Joe

Digital Communities Manager
Diabetes UK
joe.freeman@diabetes.org.uk

 

[rachelha]

Hi Joe

I am 36 and currently 35 weeks pregnant. I am glad that this is being looked at. I know there is a pregnancy bit on the diabetes ukwebsite, but it is very difficult to find, and I did not find it hugely helpful.

Personally I think a dedicated website with a clear link to it would be best. I think alot of people look first on the web for information. I am not sure where you would distribute leaflets apart from GPs and diabetic clinics. However I do remember my doctor having a stern talk to me once when I asked for the morning after pill, if he could have given me a leaflet then with more information it would have been helpful.

I personally had a lot of support from a pre-pregnancy clinic at my hospital, but I am not sure if these are available for everyone.


Rachel

 

[Twitchy]

Hi Joe,

Great to see this is being looked at!

I think it might be a good idea to have a range of leaflets targeted at different age groups & maybe even diabetes types - eg gestational might need to be more 'from first principles'? Also what you might want to say to a teenager / pubescent child would obviously be very different from what you'd say to a woman actively wanting to try for a baby... maybe in the first case something simple that just explains how important it is if you do have an unplanned pregnancy to seek specialist diabetic orientated support (& high dose folic acid!) asap, for example via a diabetic antenatal team if planning to carry on with the pregnancy. (It happens, when in hospital there was a 14 yr old next to me - whatever people might say she was very brave & determined to give her baby a chance at life!). If nothing else, a reminder of how important it is to ensure proper contraception before properly ready to have a baby! 🙂

For an adult, I guess it would be more appropriate to focus on risks to you as well as the baby & what can be done to minimise them. Things such as the increased risk of pre-eclampsia, increased rate of retinopathy are worth mentioning, but in persective rather than scare mongering. One thing in particular that I think would be really helpful for this group would be a gentle intimation that a diabetic pregnancy is often nowhere near the "NCT Ideal" and maybe some stats (if they are available??) on the relationship of diabetes type, time since diagnosis & birth experience would be very interesting (well, I'd have been interested!). Although this is not a medical / control subject as such, the emotional impact of how different one's pregnancy & birth experience will be from what antenatal classes tell us is the one "right & natural" way can be huge & should not be underestimated by the medical professionals (in my opinion anyway! 😱)

I know it's not really what you're looking at, but the same goes for breastfeeding - almost every diabetic mum I've spoken to has at best found it a massive challenge whether due to birth experience or just trying to juggle diabetes control, expressing, feeding etc etc... if a large proportion of mums will have a c section or separation from baby for a while after the birth surely more advice up front about things like hand expressing being possible from 36wks, the importance of feeding or expressing asap after birth etc would be a good thing for those mums that did want to try... I found that unless I asked specific questions there was very little info that would routinely be available before 39ish weeks...and mine were both born before 36wks! 🙄

Anyway, hope that's useful!

(for info I've had T1 since infancy, and have a 3yr old & 5 month old, both births 'semi-elective emergency c sections' for pre-eclampsia / failing placenta)

 

[JoeFreeman]

Thank you both for your comments, very much appreciated. I'll let our Care Advisors read them too, and if they've got any comments, I'll post them back here too.

Do you think a video that we could publicise online would be a good way of doing this - perhaps targetting the younger age groups who are having sex but not thinking about pregnancy - would be a good way of getting this sort of information out there?

It's such a wide are to cover!

Joe

 

[Twitchy]

Hi Joe,

Been thinking about the video idea...I guess the dilema is that the ones you really want to reach might be those least 'interested' in their diabetes - so although it would make sense to have such a video posted on the DUK website for people to access, I guess your average teenager who is rebelling a bit probably won't be looking there... in which case maybe the 'viral' video route (youtube etc) might work?? Boy does it feel a long time since I was a teenager!!! 😱

I guess it's a fine line too between getting the message out there & making young diabetic females feel any more 'freakish' or embarrassed than they might already... I say freakish because I felt pretty negative about my diabetes at that age, I didn't know any other diabetics my age... especialy at uni when loads of people around you are in relationships the whole having to do injections thing felt like being 'broken' or something... I guess sexuality, health etc at that kind of time of life can be a very sensitive subject that needs careful handling... that was one reason for suggesting leaflets that perhaps could be targeted at diabetic clinics...maybe engaging health professionals to discuss the issue when they see girls / young women in diabetic clinics & giving them a leaflet to take? I know my diabetic team mentioned pregnancy at clinics whenever I saw them, but I'm not sure when they started mentioning it?!

Anyway, hope that makes some sense & helps!

 

[xxlou_lxx]

I personally would of liked to know that my "unplanned pregnancy" was not the end of the world eventhough my hba1c was 8.odds a couple of months before I found out...

I found it really scary and isolating knowing that I was in the dodgy category in that all diabetics should have planned previously with bs control and also with regard to the high dose folic acid 🙄

In hindsight I do know that I wouldnt of felt so stressed or depressed or paranoid about every little detail if I had known I was not the only person to go on and have a healthy pregnancy/baby regardless of it being unplanned! 🙂

 

[xxlou_lxx]

I also think that the book they give all pregnant women (ready steady baby) should be replaced if you have diabetes with one which is in depth for ladies in our position! 😉

 

[rachelha]

I also think that the book they give all pregnant women (ready steady baby) should be replaced if you have diabetes with one which is in depth for ladies in our position! 😉

I have not been given that book - weird.

 

[Twitchy]

I didn't either - maybe it's a regional thing? I got some nhs book that seemed very general - good idea about more diabetes info though! I did buy the DUK publication but some areas still felt very general...

For what it's worth Lou, both my pregnancies were planned to the 'nth' degree diabetes-wise (apart from dodgy timing re pump start 2nd time round doh! 🙄) and I still felt incredibly stressed the whole way through both...maybe being told it's a 'high risk' pregnancy everywhere you go & then not getting much emotional support doesn't help! Never easy is it?! 🙂