Due to the increased risks presented when pregnant with diabetes, you may wish to undergo some or all of your treatment during your pregnancy at a private health clinic.

Diabetes requires extra care during pregnancy to ensure the health of the baby.

Keeping in good health not only improves the health of the mother and baby through the pregnancy but helps to improve the long term health outcomes of the baby.

Types 1 and 2 are the most common types of diabetes which, however, there is also

gestational diabetes

which is similar to type 2 and occurs during pregnancy.

Health care during pregnancy

It’s strongly recommended that you have frequent checks during your pregnancy when suffering from diabetes. It is advised to give birth in a hospital as two to four hours after birth; they will perform a heel prick

blood test

in order to see if the baby’s blood glucose is too low.

Mother’s should feed their baby within 30 minutes to keep the baby’s blood glucose at a safe level however extra care will be provided if this isn’t possible.

Some people may want to opt for private healthcare during their pregnancy which is available via two means:

• 
  As part of private health insurance
  
  
• 
  Self-funded private care
  

Diabetes, pregnancy and private health insurance

If you have

private health insurance

, you will need to check which private healthcare costs associated with pregnancy and the birth are covered.

A lot of companies that provide private healthcare will not do so for pregnancies unless you have a different cover with them for a period of twelve months and this will only be for emergencies.

It is possible that additional costs may be added for

being diabetic during pregnancy

which could differ if it is gestational or whether the patient had it before becoming pregnant.

You would be advised to look into this with your healthcare provider.

Diabetes, pregnancy and self funded private care

Private care for your pregnancy may encompass the whole pregnancy, or you may buy a private service for a particular part of your of your pregnancy, eg a midwife to oversee ante-natal or post-natal care.

The costs for private care during pregnancy will vary from clinic to clinic. Be prepared for diabetes to add to the expense.

• A birth in a London private health clinic could range upwards of £2,000 or £4,000, depending on the complication of the delivery.
• Additional nights in hospital may cost around or upwards of £1,000.
• Follow up fees and consultancy could add a further £4,000 or so.
• A private midwife can vary as many work independently, midwife charges including ante-natal and post-natal care could come to around £2,000 to £4,000.
• To have a private midwife to support at your birth may cost from £1,000.

Some NHS hospitals may also have private maternity services which could work out as a cheaper option than a fully private birth.

Ultrasound scans

Ultrasound scans has become a business in itself and may be available for as little as £50, rising in price with the length of time and the type of the scan as well as varying from company to company.

Often DVD and/or images will be available to take home.

Pregnancy risks if you already have diabetes

If a patient already has type 1 or

type 2 diabetes

, they have a higher risk of giving birth to a large baby which increases the risk of a difficult birth, and can result in induced labour or needing a caesarean section.

The more severe problems involving the baby would be:

• Having a miscarriage
• Being stillborn or dying shortly after birth
• Heart or breathing trouble directly after birth –requiring intensive care
• Heart,
  
  kidney
  
  or other congenital organ problems
• Developing obesity or diabetes in later life

In order to reduce these risks, it’s best to make sure your diabetes is under control before becoming pregnant.

Your GP can provide a blood test called an

HbA1c test

which assesses the level of glucose in your blood. The best level would be 6.1% before pregnancy however if it is higher, it is suggested that you get this under control before continuing.

Pregnancy risks if you develop gestational diabetes

You’re more likely to develop this form if:

• You’re overweight with a
  
  body mass index
  
  above 30
• You’ve given birth to a large baby, weighing more than 4.5kg (9.9Ib), in the past
• You’ve suffered with gestational diabetes before
• You have a family member such as a parent or sibling with diabetes
• Your origin is
  
  South Asian
  
  , Black Caribbean or Middle Eastern as these ethnic groups have a higher risk of developing it
  

The risks for yourself and your baby are the same as above for those with diabetes already.

If you are in any of the high risk categories, you will be offered a test to check for gestational diabetes.

The only difference with gestational diabetes is that it can be controlled by diet however if your blood sugar levels become unstable, you may be given insulin tablets or injections.

Breastfeeding is widely considered to be the best way of feeding your new born baby and this applies to mothers with diabetes as well.

We’ve taken a look at some of the common questions that get asked about diabetes and breastfeeding, and provide the answers you need to know.

Is it healthy for people with diabetes to breastfeed their baby?

Breastfeeding is considered to offer the best nutrition for your baby and diabetes need not override this advice.

Will diabetes affect the quality of my milk?

Your own blood sugar levels can affect your milk but if your blood glucose is well controlled, this should not be a problem.

Is it more difficult to produce milk with diabetes?

Insulin plays a part in milk production and so diabetes can affect your ability to produce milk.

You may find that diabetes causes your milk to be produced a little more slowly but again, well controlled diabetes should reduce this problem.

Will breastfeeding affect my blood glucose levels?

To produce the milk, your body will use glucose from your blood so whilst you are breastfeeding, your blood glucose levels may be affected.

People taking insulin may find that their insulin requirements are reduced whilst they are producing milk.

Mothers taking glucose lowering medication should be aware of the

signs of hypoglycemia
.

Will the medication I take affect my baby?

Whilst your sugar levels can influence the lactose in your milk, the

diabetic medication
you take such as insulin, metformin and sulphonylureas should not directly affect your baby.

If you are taking other medication, check the patient information leaflet of the medication and ask your doctor if you are at all unsure.

Keeping blood sugar levels under control is hugely important for women who either have diabetes going into pregnancy or who develop diabetes during their pregnancy.

Tight blood glucose

control helps increase the chances of a successful pregnancy by cutting the risk of complications for your baby.

If you have diabetes, one of the ways your doctor or nurse will monitor your glycemic control is by carrying out a

HbA1c test

The HbA1c test measures

glycated haemoglobin

– a molecule within red blood cells that naturally bonds with glucose – to get a good indication of your

average

blood glucose over the past 8-12 weeks.

This guide outlines when your HbA1c readings will be taken and what HbA1c values should be before (planning stage), during  and after your pregnancy.

Planning pregnancy

The

NICE guidelines for Diabetes in Pregnancy

(Clinical Guideline 63) state that women with diabetes should aim to achieve

an HbA1c result of 43 mmol/mol

(6.1%) or lower.

If you are planning to become pregnant, you should be offered an HbA1c measurement on a monthly basis to help monitor your blood glucose control.

Meeting the target will help to minimise the risk of the baby developing risk of congenital malformations.

If you have an

HbA1c above 10%

, it is strongly advised to avoid becoming pregnant until

good diabetes control

is achieved and sustained.

During pregnancy

During the first trimester of pregnancy, the

HbA1c target for women with diabetes

is the same as for planning a pregnancy, that is

43 mmol/mol (6.1%) or lower

During the second and third trimesters of pregnancy, from week 13 onwards, HbA1c should not be used for assessing blood glucose control.

Throughout pregnancy, women with diabetes should aim to meet the following blood glucose targets

• 
  Before meals:
  
  3.5 to 5.9 mmol/l
• 
  1 hour after meals:
  
  7.8 mmol/l or under

If pregnancy is not planned

If pregnancy has occurred unplanned, it is important to aim to reach the

HbA1c target of 43 mmol/mol

as soon as possible.

Some women may find this difficult. In this case, it is best to aim to get as close to the target as possible.

Try not to worry if you are failing to meet the target and work with your health team on ways you can get close to the target

without becoming stressed or overly anxious

Post pregnancy

Women with diabetes can return to their normal recommended

HbA1c levels of 48 mmol/mol (6.5%) or under

after the pregnancy.

Diagnosing gestational diabetes

HbA1c is not used for diagnosing gestational diabetes. Pregnant women without diabetes will be screened for possible gestational diabetes between weeks 8 and 12 of the pregnancy and an

oral glucose tolerance test (OGTT)

will be carried out between weeks 24 and 28.

If you have had gestational diabetes during a previous pregnancy, you will be given an OGTT between 16 and 18 weeks and then at 28 weeks.

Where possible, it’s best for the mother and baby to be together straight after the birth. Keeping close contact with your baby will help to keep him or her warm and will allow you to bond with your baby straight away.

Your baby’s blood sugar levels

bb

It’s generally

recommended to breastfeed
your baby within the first half hour after the birth to keep your baby’s own blood sugar levels up.

Usually about two to four hours after your baby is born, a heel prick test (a blood glucose test taking blood from your baby’s heel) will be performed to see if your baby’s blood sugar levels are low.

If your

baby’s blood glucose remains low, they may be put onto a glucose drip.

Your sugar levels after the birth

With your pregnancy over, your insulin requirements will be less than during your pregnancy.

If you have

type 1 diabetes, you should find that your dosages will be lower after the birth.

You should receive guidance from your health team to help you safely readjust your doses.

If you have

type 2 diabetes
and were put onto insulin for your pregnancy, it is likely you will go back onto your original medication routine after the birth. Your doctor will inform you of which regime will be best.

If you developed

gestational diabetes during your pregnancy, it is likely that you won’t need to continue taking medication after the birth.

You should have a blood glucose test at your post-natal check, 6 weeks after the birth, to see whether your blood glucose levels have returned back to normal.

Breastfeeding

Breastfeeding is generally recommended as the most healthy way to feed your baby.

Mothers with diabetes may be slower to produce milk than non-diabetic mothers but this shouldn’t normally present significant problems.

Preconception care enables you to be well prepared for your pregnancy. With the additional challenges of having diabetes, preconception care carries extra benefits.

If you are planning to become pregnant, arrange an appointment with your GP or specialist so that a care plan can be prepared and you may be referred to a diabetic preconception clinic.

Preconception health assessment

As part of your preconception care you should receive a health assessment that will consider your diabetes as well as other aspects of health and fitness, such as how much exercise you’re able to do and your diet.

As part of your health assessment you should be screened for conditions which could affect your baby, such as cystic fibrosis and Huntingdon’s disease.

If you are due to have a cervical screening test, it’s best to have this done before your pregnancy.

Blood glucose control

One of the most important factors for a successful pregnancy is to keep your blood sugar levels under good control.

It is beneficial if you can establish good control before your pregnancy.

The first trimester of pregnancy is an important time so having well controlled diabetes from the outset is recommended.

You should ideally aim for an HbA1c of 6.1% (43 mmol/mol) before becoming pregnant.

• Read more about
  
  blood sugars levels in pregnancy

Medication

Some medications are not recommended for use during pregnancy.

This may include some blood pressure lowering medications and some

anti-diabetic medication

Your doctor will be able to advise you on any medication changes that may be needed.

Retinopathy

Charity Diabetes UK notes that pregnancy can lead to increased pressure in the small vessels of the retina and therefore if any

signs of retinopathy
needed to be treated, this is best done before pregnancy.

Smoking and alcohol

As smoking and

alcohol
are known to be damaging for the development of your baby, you should aim to stop drinking and smoking before starting your pregnancy.

Your healthcare team can provide help to assist you in stopping smoking and/or drinking alcohol.

Vaccinations

When planning a pregnancy, it is advised that you are up to date with vaccinations to prevent you from contracting illnesses such as chickenpox and rubella during your pregnancy.

Folic acid

It’s recommended that women planning a pregnancy take folic acid before their pregnancy where possible. Your doctor can prescribe folic acid for you.

Women with diabetes are put on a higher dose of folic acid than women without diabetes.

Diabetes and pregnancy requires extra dedication but you should receive excellent care through your pregnancy.

We look at some of the risks that are involved as well as how good control can reduce these risks and the care you should expect to receive along the way.

Diabetes and pre-eclampsia

Pre-eclampsia is a condition that causes very high blood pressure and protein in the urine which can occur during pregnancy.

Pre-eclampsia results from problems in the development of the placenta.

People with diabetes have an increased risk of pre-eclampsia occurring. You will receive blood pressure and urine tests through your pregnancy which should pick up any signs of pre-eclampsia.

Large babies

Mothers with diabetes are more likely to have large babies (weighing over 10lbs) than mothers without diabetes.

If the baby is large, you may be advised to have induced labour or a caesarean section delivery.

Blood glucose control

Good blood glucose control is important all the way through your pregnancy but is especially important at the start of your pregnancy, in the first trimester.

The target HbA1c for people with diabetes is 6.1% (or 43 mmol/mol). Keeping your blood glucose under control during your pregnancy requires dedication but you should be offered plenty of support from your healthcare team to help you achieve the target.

Medication routine

If you had diabetes before you became pregnant, you may experience some changes to your medication routine. People with type 1 diabetes on injections may be advised to go onto a pump for instance. People with type 2 diabetes may be moved from tablets onto insulin through their pregnancy, depending on the medication and the level of diabetes control needed.

Your antenatal care team should provide you with all the advice you need and answer any questions you have about your routine through your pregnancy.

Blood glucose testing during pregnancy

People with diabetes are advised to test before each meal as well as one hour after eating. Mothers on insulin are advised to test before going to sleep.

Hypoglycemia during pregnancy

As you will be aiming for tight control during your pregnancy, you may be at a higher risk of hypoglycemia.

Your care team should ensure you are prepared to deal with any instances of low blood sugar during your pregnancy.

Folic acid during pregnancy

You will be advised to take 5mg of folic acid for the first 12 weeks of your pregnancy.

This is higher than the general advice for women without diabetes, who are advised to take 0.4mg of folic acid a day.

Whilst diabetes needn’t present fertility problems, there are some conditions related to male infertility which are more likely, particularly in diabetes that has either not been well controlled or has been present for many years.

We look at what these conditions are as well as the treatment options that are available.

Conditions

A number of issues can cause infertility in men.

These include:

• Erectile dysfunction
• Retarded ejaculation (delayed ejaculation)
• Retrograde ejaculation
• Reduced sperm quality
• 
  Hypogonadism (low testosterone)
  

Erectile dysfunction (ED)

Erectile dysfunction is a common problem associated with diabetes that causes difficulty with getting or maintaining an erection.

It is caused by neuropathy (nerve damage)

and reduced blood circulation typically as a result of less well controlled diabetes or long standing diabetes.

High levels of blood glucose, blood pressure and

cholesterol

are all associated with an increased risk of erectile difficulties. Getting these under control, as well as cutting down on alcohol and

quitting smoking

can help to reduce the effects of ED. A number of different treatment options are also available.

Retarded ejaculation

Ejaculation problems can also result

if nerves in the penis become damaged

Lack of nerve sensitivity is one problem which can affect the ability to ejaculation. Retarded, delayed and impaired ejaculation are all terms which describe a difficulty in achieving ejaculation.

Note that retarded ejaculation can also be caused or influenced by psychological problems, age and by certain medications.

If impaired ejaculation is brought on psychological problems then treatment,

such as through counselling or psychosexual therapy

Ejaculation problems caused by nerve damage tend not to be treatable but it may be possible to find sex positions that result in improved nerve stimulation.

Assisted reproduction technology (ART), such as IVF, can help with treating infertility if conception via intercourse is problematic or impossible.

Retrograde ejaculation

Another problem that may result from neuropathy (

autonomic neuropathy

) is retrograde ejaculation. This occurs if nerves are unable to control the

muscles of the bladder

from closing at the point of ejaculatio, which results in semen entering the bladder rather than exiting via the penis.

Retrograde ejaculation does not cause health problems but can impair conception. If looking to conceive, sperm can still be collected and used via assisted reproduction technology.

Reduced sperm quality

Research shows that diabetes can lead to reduced sperm quality but diabetes as such does not appear to affect motility of sperm (the ability of the sperm to move towards the egg) or cause infertility as a result.

Obesity, however, has been linked with

decreased pregnancy rates as well as greater pregnancy loss

when going through assisted reproductive technology.

Whilst there is inconclusive evidence that obesity affects sperm motility, there is evidence suggesting that obesity is associated with reduced sperm concentration.

Hypogonadism (low testosterone levels)

Research studies show that around 1 in 4 men with type 2 diabetes have low testosterone levels (hypogonadism). Low testosterone levels can lead to problems which can reduce fertility such as low sperm count, erectile dysfunction and

decreased sex drive

Testosterone replacement therapy can be given in a number of different ways, including by injectio, capsules and implants, to treat hypogonadism.

Medications

A number of prescription medications have been linked with problems that can lead to infertility.

• Sulfasalazine, used to treat rheumatoid arthritis, can lead to reduced sperm count.
• Chemotherapy, for cancer treatment, can reduce sperm production.
• Selective serotonin reuptake inhibitors (SSRIs), a type of antidepressant, has been associated with delayed ejaculation.
• 
  Blood pressure medications
  
  , such as beta-blockers and alpha-blockers, and diuretics are associated with increased risk of erectile dysfunction.
• Use of calcium channel blockers, an alternative blood pressure medication, has been linked directly with decreased fertility whilst they are being taken.

Congenital malformations, also known as congenital disorders or birth defects, are conditions or defects that affect the baby from birth.

Whilst congenital disorders can result from genetic reasons, other factors such as diet,

medication

and also blood sugar control can play a part.

Mothers with diabetes have a greater risk of giving birth to a baby with birth defects, however, the risk can be

reduced through good control of diabetes

and keeping a healthy lifestyle leading up to and

throughout your pregnancy

Birth defects

Whilst there are a wide range of congenital malformations that can occur, the following conditions are those that research studies have shown to be more common in babies of mothers with diabetes.

• Spina bifida
• 
  Heart problems
  
• Oral clefts
• Gastrointestinal tract defects
• Kidney defects
• Limb deficiencies

How common are birth defects as a result of diabetes?

A UK study published in 2012 showed that congenital malformations occurred in around

7% of pregnancies of mothers that had diabetes

before pregnancy (pregestational diabetes).

This represents a four times higher risk than children born to mothers without diabetes. The study mainly included mothers

with type 1 diabetes

(78% of the women).

Having gestational diabetes is also associated with a greater risk of birth defects, but the risk is significantly less than for mothers entering pregnancy with diabetes.

Having a BMI of under 25

going into pregnancy presents a lower risk of birth defects occurring.

Blood glucose control and risk of birth anomalies

If you have diabetes, keeping good control of blood glucose levels is one of the most important ways in which you can significantly decrease the likelihood of your baby developing congenital anomalies.

The

recommended HbA1c level you should aim to achieve before and during pregnancy

is

43 mmol/mol (6.1%)

Research shows that for each 11 mmol/mol (1%) rise in HbA1c above 45 mmol/mol (6.3%), the risk of birth abnormalities rises by 30%.

Whilst the

blood glucose targets in pregnancy

are strict, your health team should help you to achieve or get as close to the targets as possible.

Medication in pregnancy

In some cases, the medication you are currently on may not be suitable for use in pregnancy.

Medicines that are not recommended for use in pregnancy include:

• 
  Statins
  
• Certain blood pressure medications
• Certain medications for type 2 diabetes

If you are on any of these medications, notify your health team. Your doctor or consultant will advise whether you need to cease taking any medication or if you will need to change to a different type of drug.

Mothers to be with

type 2 diabetes

treated that are on medication may

need to start taking insulin

for the duration of the pregnancy.

Preventing congenital malformations

In addition to keeping good control of your diabetes, there are other steps you can take to further minimise the risk of birth defects occurring. These include:

• Taking folic acid – 5mg of folic acid per day for the first 12 weeks of pregnancy is recommended for mothers to be with diabetes in the UK
• 
  Not smoking
  
• 
  Not drinking alcohol
  
• 
  Ensuring you stay physically active
  
• 
  Eating a healthy, balanced diet
  

Pre-eclampsia is a relatively common condition that can

occur during pregnancy

and can raise the risk of health complications for mother and baby.

Pre-eclampsia is characterised by

high blood pressure (hypertension) which can become very high

if not treated.

The condition usually occurs during the second half of pregnancy and treatment involves delivering the baby at the earliest safe stage.

How common is it?

Pre-eclampsia affects up to

5% of pregnancies

and tends to be more common in women with diabetes.

Symptoms of pre-eclampsia

Pre-eclampsia causes high blood pressure and also

leads to protein in the urine

(proteinuria).

If pre-eclampsia develops, it can lead to water retention (oedema) which can lead to one of more of the following symptoms.

• Severe headaches
• Swollen ankles, feet, hands or face
• 
  Blurred vision or flashing lights
  
• 
  Vomiting
  
• Pain below the ribs

If you get these symptoms, it’s important to call your midwife, GP surgery or NHS 111 to arrange diagnosis and treatment.

Causes

The cause of pre-eclampsia is not entirely understood but research indicates that the condition stems from

problems with blood vessels that supply the placenta

The risk of pre-eclampsia is more likely if this your first pregnancy.

Other risk factors include:

• Having a family history of pre-eclampsia
• Having previously had pre-eclampsia
• 
  Having a BMI over 30 (obesity)
  
• Being over 40 years old

Having diabetes is estimated to double the risk of pre-eclampsia and having kidney disease or high blood pressure can add to the risk.

Research shows that women with diabetes that have protein in their urine as a result of

diabetic nephropathy (kidney disease) have around a four times increased risk

of developing pre-eclampsia.

Diagnosis

Pre-eclampsia will be diagnosed by testing your blood pressure levels and testing for the presence of protein in your urine.

High blood pressure in pregnancy is not always down to pre-eclampsia and can be gestational hypertension in cases where protein is not present in the urine. It is essential to get a diagnosis to confirm and to best treat the condition.

Treating pre-eclampsia

Treatment for pre-eclampsia involves monitoring and managing symptoms such as high blood pressure and aiming for delivery at the earliest safe stage.

Usually delivery will be between 37 and 38 weeks of the pregnancy, which is earlier than the usual full term of pregnancy of around 40 weeks. The delivery may need to be by induced labour or carried out by caesarean section.

If the

risk of complications

to either mother or baby is high, delivery before 37 weeks may be required.

Prior to delivery, high blood pressure will usually be treated with blood pressure medication.

Complications as a result of pre-eclampsia

Complications as a result of pre-eclampsia can usually be prevented but can occur in some cases.

Complications that can affect the mother include eclampsia, a condition that causes convulsions, and stroke. High blood pressure as a result of pre-eclampsia should

usually return to normal blood pressure levels soon after the birth

Pre-eclampsia can lead to a higher risk of organ development problems in babies and stillbirth may occur in some cases.

Infertility is defined as being unable to conceive following a year of

regular unprotected sexual intercourse

The NHS states that amongst the population as a whole, around

1 in 7 couples experience difficulty conceiving

within the first year.

As diabetes can lead to additional problems that may affect fertility, the risk of infertility is therefore likely to be higher for couples in which one or more partner has diabetes.

Infertility can usually be treated but bear in mind that

treatment on the NHS

may vary depending on the cause and by funding available in your area.

Diagnosing infertility

If the cause of infertility can be identified, there is a better chance of being able to treat the problem.

Infertility can affect both partners

so it is best if you visit the doctor as a couple.

As there are many conditions and factors that can affect fertility, your GP will ask you a number of questions to determine what the problem may be and whether specific tests should be run.

Tests for women may include:

• Blood tests to test for hormone levels
• Ultrasound scans
• Swab tests for presence of chlamidya

Tests for men may include:

• A physical examination to check for abnormalities in the penis or testicles
• Semen analysis
• A urine sample to test for chlamidya

Chlamdiya is the most common sexually transmitted infection and can affect fertility.

Types of infertility

infertility may be categorised as

primary

infertility, if infertility occurs before a child is bor, or as

secondary

infertility if trouble conceiving occurs after a previous pregnancy.

Causes of infertility that can affect both men and women

The following reasons can affect the chances of conceiving in both men and women:

• 
  Obesity
  
• 
  Stress
  
• Exposure to toxic chemicals
• 
  Smoking
  
• Sexually transmitted infection

Certain medications may affect fertility. Chemotherapy can affect both male and female infertility as can

taking the recreational drugs marijuana and cocaine

Common causes of infertility in women

The most common causes of infertility in women are conditions that cause problems in releasing of an ovum (egg). This can happen for a number of reasons including

having PCOS

,

thyroid disease

and premature ovarian failure.

Other common problems affecting fertility include blocked or damaged fallopian tubes, pelvic inflammatory disease (PID), poor egg quality and endometriosis.

Women who have diabetes are likely to experience irregular or absent periods and premature ovarian failure. The presence of diabetes complications is also known to significantly reduce fertility rates.

• Read more about the
  
  effects of diabetes on female fertility
  

Common causes of infertility in men

The most common cause of infertility in men is related to poor quality of semen such as having a low sperm count, having decreased sperm motility (sperm that doesn’t move properly towards the egg) or abnormally shaped sperm.

Varicoceles, caused by enlarged veins within the scrotum, is another common cause of infertility in men. There are also a number of conditions that are more common in men with diabetes that can decrease or impair fertility.

These conditions include:

• 
  Erectile dysfunction
  
  – difficulty in achieving or maintaining an erection
• 
  Hypogonadism – having low testosterone levels
  
• Retarded ejaculation – impaired ability to ejaculate
• Retrograde ejaculation – a problem which prevents sperm exiting out of the penis

Read more about the

effects of diabetes on male fertility

Treatment

Treatment for infertility will depend upon the cause.

A number of common causes can be treated. For example,

metformin can help to treat PCOS

and surgery can help with treating problems cause by pelvic inflammatory disease or endometriosis.

In men, a

number of treatments are available

for erectile dysfunction and ejaculation disorders can also be treated.

If the cause cannot be identified or adequately treated, you may be eligible for assisted conception on the NHS. Assisted conception treatments include in-vitro fertilisation (IVF) and intrauterine insemination (IUI).

Eligibility for fertility treatment on the NHS may vary across different parts of the country. If you are not eligible for NHS treatment, you may wish to consider private treatment.

Prevention

In terms of the fertility problems attributable to diabetes, these risks can be reduced through

good control of blood glucose levels

and through maintaining a healthy body weight.

Some problems with fertility can be

attributed to stress

so its advisable to take measures that will reduce the amount of stress you or your partner are under.

Diabetes is associated with lower rates of fertility.

There are a number of reasons which can play a part including, obesity, being underweight, having diabetic complications, having PCOS and having an autoimmune disease.

With this said, many women with diabetes are able to conceive, particularly if diabetes is well controlled and a healthy body weight is maintained.

Conditions

The following conditions are associated with reduced fertility rates:

• 
  Polycystic ovary syndrome (PCOS)
  
• Oligomenorrhea (irregular periods)
• Secondary amenorrhea (absent periods)
• Premature menopause (premature ovarian failure)
• 
  Endometrial cancer (uterine cancer)
  
• 
  Microvascular and cardiovascular complications
  

Polycystic ovary syndrome (PCOS)

PCOS is a common condition in which a large number of cysts develop on the ovaries.

Whilst this feature does not in itself pose a health risk, it can reduce fertility. Women with PCOS have higher than normal levels of testosterone (hyperandrogenism).

PCOS can affect fertility by leading to irregular periods (oligomenorrhea) or absent periods (secondary amenorrhea). The condition can be

treated through making lifestyle changes

, while medications such as clomifene and

metformin

can help with improving the chances of conception.

PCOS is particularly

associated with obesity

and type 2 diabetes. People with type 1 diabetes that are taking high amounts of insulin daily may also be at risk of or suffer from PCOS.

Oligomenorrhea and secondary amenorrhea

Oligomenorrhea is the term for irregular periods that arrive at intervals of 35 days or more between each period.

Secondary amenorrhea is said to occur if you have previously had a normal menstrual cycle but have stopped getting a periods for 6 months or longer.

Both type 1 diabetes and type 2 diabetes are associated with increased risks of late and absent periods (oligomenorrhea and secondary amenorrhea).

PCOS and obesity can contribute to these conditions and so can being underweight, with

women going through diabulimia

at particular risk.

Premature menopause

Premature menopause, also known as premature ovarian failure, is defined as reaching the menopause (the time when periods stop) before 40 years old. Research by Sytrotmeyer et al, in 2003, shows that

type 1 diabetes

is associated with a greater risk of menstrual problems including premature menopause.

Early menopause has also been associated with other autoimmune conditions such as Addison’s disease and Hashimoto’s thyroiditis, as well as hypothyroidism (an underactive thyroid gland).

Research by Elbers et al, from 2011, suggests that

type 2 diabetes

is also associated with greater rates of premature menopause.

Endometrial cancer (uterine cancer)

Endometrial cancer

, which is more common in women with type 2 diabetes and PCOS, can lead to infertility if the cancer is not diagnosed and treated at an earlier enough stage.

Microvascular and cardiovascular complications of diabetes

A 2007 study by Jonasson et al showed that women with type 1 diabetes with complications of diabetes, including microvascular (retinopathy, neuropathy and nephropathy) and

cardiovascular complications

, experienced much lower rates of fertility.

Medications

Some medications may also be associated with decreased fertility. Such medications include:

• Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or aspiri, may make conception more difficult if taken in high doses or over long periods of time.
• Chemotherapy drugs, for
  
  treatment of cancer
  
  , can increase the risk of ovarian failure.

Miscarriage

Miscarriage is more likely as a result of diabetes, particularly if diabetes is not well controlled before or during the pregnancy.

It is therefore strongly advised to achieve good control of blood glucose levels before you intend to conceive.

• Read more about
  
  diabetes and pregnancy
  

It is estimated that between

2% and 3%

percent of
pregnant women are affected by gestational diabetes during pregnancy.

If the mother’s
body cannot produce sufficient insulin to overcome this, diabetes in
pregnancy can develop.

Genetics and pregnancy

Genetics is a prominent factor as to whether your child will develop diabetes, with the risk heightened if the newborn’s parents or siblings have diabetes.

The risk percentages vary between type 1 and type 2 diabetes and are also dependent on which parent has diabetes. Read more about

genetics and diabetes

Pregnancy and Diabetes

Blood Sugar Levels

Diabetes During Pregnancy

Preparing for Pregnancy

Diabetes and Breastfeeding

Post-Pregnancy Care

HbA1c and Pregnancy

Type 1 diabetes and pregnancy

People with

type 1 diabetes
should aim to achieve tight control of their diabetes prior to and throughout their pregnancy.

To help you to meet the target level of diabetes control, you may be put onto an insulin pump, if you are not on one already, and your health team should provide plenty of support.

Type 2 diabetes and pregnancy

Pregnancy typically places higher demands for insulin than normal and therefore it is quite common for people with

type 2 diabetes
to be put onto insulin during their pregnancy.

Whether you are put onto insulin or not, you should receive plenty of help from your health team to ensure your diabetes is well controlled through your pregnancy.

Gestational diabetes and pregnancy

Gestational diabetes is a form of diabetes that develops during pregnancy if the body cannot fully cope with the additional insulin demands of both the mother and baby.

The first line of treatment for gestational diabetes is through diet and exercise, however, diabetes tablets and insulin may be needed if blood glucose levels remain high.

• Read more about the symptoms, risk factors and treatment for
  
  gestational diabetes

Target blood glucose levels before and during pregnancy

The

target HbA1c
(a measure of long term diabetic control) for people with diabetes prior to and during pregnancy is 6.1% (or 43 mmol/mol).


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Risks for your baby from diabetes during pregnancy

The following risks are more common as a result of diabetes:

• Abnormal development, particularly with the baby’s heart
• Heart and breathing problems shortly after birth
• Stillbirth or death shortly after the birth
• Developing diabetes later in life

These risks can be reduced with good diabetes control.

Risks for a mother from diabetes in pregnancy

Raised blood sugar levels during pregnancy increases your chances of having a larger baby, which could mean the need to have an induced labour or a caesarean section delivery.

The chances of suffering a miscarriage are also higher with diabetes. Similarly to the risks for your baby, the risks for you can also be reduced with well controlled diabetes.

Diabetes and preconception care

If you have diabetes prior to being pregnant, it is highly recommended to prepare for your pregnancy by ensuring you receive preconception care. Make an appointment to discuss the best preparation for your pregnancy.

Blood glucose control during pregnancy

Hypoglycemia
(low blood sugar levels) and

hyperglycemia
(high blood sugar levels) are both likely to happen during pregnancy.

Keeping your blood sugar levels well managed is essential to reduce the chances of complications developing for you or your baby.

Blood glucose control is one of the most important factors during pregnancy. Tight blood glucose control, helps to ensure the best chance of a successful pregnancy.

Diabetes control is important for people who have diabetes going into their pregnancy as well as people who develop diabetes during their pregnancy (gestational diabetes).

What is gestational diabetes?

It has been reported that on average 2% to 4% of women develop temporary diabetes also known as

gestational diabetes.

This happens because they are unable to produce an increased amount of insulin to overcome the resistance levels.

In gestational diabetes there is not normally any show of external symptoms normally recognised as characteristic of the disease for example excessive thirst, tiredness and increased urination.

Blood sugar control during pregnancy

Good blood glucose control reduces the risks of complications developing for the mother and baby.

The

target HbA1c for mothers

before and during pregnancy is 6.1% (or 43 mmol/mol).


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People with diabetes before their pregnancy will be advised to keep excellent control of their blood sugar before and throughout the pregnancy.

The first eight weeks of the pregnancy are a critical period and so it is highly recommended that strong control is achieved prior to becoming pregnant wherever possible.

Mothers who develop gestational diabetes will be treated initially with diet and exercise but may be put onto

oral hypoglycaemics
(tablets) or insulin injections if blood sugar levels remain high.

Diabetes management

To help you to meet the challenging blood glucose targets, you will be expected to test your blood glucose before each meal and 1 hour after eating.

People taking insulin
for their diabetes will also need to test before bed each night.

You will have blood tests performed at various intervals during your pregnancy to check your diabetes is under good control.

You should expect to receive a high standard of care from your health team throughout your pregnancy and should have the opportunity to ask any questions you may have about achieving your health targets.

How does diabetes affect the baby?

There have been reports that diabetes during pregnancy brings increased chances of having a bigger babies and birth defects.

Infant mortality and birth defects

There is a slight increase in the risk of infant mortality or birth defects in baby’s of mother with diabetes than without, however preconception care can reduce this risk by ensuring the mother is as healthy as possible before and through out

pregnancy

In addition to this if a woman has diabetes before pregnancy, diabetes related complications can worsen; this includes things like hypertensio, kidney disease, nerve damage and retinopathy which is a form of diabetic eye disease.

Excess insulin

The baby of a woman with diabetes often produces excess insulin in response to high blood glucose levels within the body of the mother.

In type 1 diabetes no significant extra insulin will be produced by your body so you may see your insulin requirements increased. Your health team should be able to advise with the best way to manage your diabetes.

At birth the baby’s blood glucose levels may be

hypoglycemic; the blood glucose level is reduced as a result of the removal of the maternal glucose source.

This is detected by a heel stick blood test and can be restored to a normal level with either oral or intravenous glucose. In addition to this a further glucose tolerance test should be done at the six-week postnatal check in order to establish whether any further treatment needs to be considered.

Foetal Macrosomia

When a pregnant woman has an abnormally high level of

blood glucose, the baby will naturally store excess glucose as body fat. For this reason, the baby will be larger than average upon reaching the gestation date.

This is a condition known as

foetal macrosomia

If a woman has gestational diabetes, there have been reports that 50% of these women will go on to develop

type 2 diabetes
within 10 to 15 years.

Risk factors for developing diabetes during pregnancy

There is an increased risk of diabetes during pregnancy if:

• The woman is overweight
• The woman is a
  
  smoker
  or around smokers more than average
• The woman is older (over 30)
• There is a family history of diabetes
• The woman is from an ethnic minority
• There is previous history of the birth of a large baby (more than 4.5 kg or 10lbs)

There is a routine antenatal test used to measure glucose levels in urine; however it has been noted it is relatively unreliable for diagnosing diabetes.

Therefore blood sugar levels are checked between 26 and 30 weeks of gestation. This is done of two separate occasions using one of two tests, either the

fasting glucose test
or the random glucose test. In addition to this if there are any abnormal results of these tests or there is a family history of diabetes, or a woman is regarded as obese she will be offered a glucose tolerance test.

Often with gestational diabetes, the woman is advised to take a number of steps to change their diet and

exercise habits
to ensure the best possible pregnancy.

It is reportedly advisable to increase participation in low-impact activities such as walking, swimming, yoga and pilates. In addition to this it is advisable to eat regular meals watching the amount of fat being eaten, remembering it is controlling the amount of fat not cutting it out of the diet completely.

Also

reducing the amount of salt in the diet
and ensuring that plenty of fruit and vegetables are included in the diet.