E-Newsletter

Featured articles edition 6

Pregnancy weight gain...know your target

When it comes to weight gain during pregnancy there’s no one size fits all, but we do know that gaining an amount of weight that’s right for you is important for a healthy pregnancy. 

Gaining too much, or not enough weight during pregnancy, can lead to increased risks for mother and baby.

Gaining too much weight during pregnancy… can lead to health problems such as high blood pressure, having a large baby and increased risk of birth complications and C-section. Extra weight gain can also make it more difficult to manage blood glucose levels and harder to return to your pre-pregnancy weight after delivery.  

Not gaining enough weight during pregnancy… can increase the risk of having a preterm birth and a baby who is small for gestational age.

There has been a trend in recent years towards not weighing women regularly during pregnancy. But we now know that tracking pregnancy weight gain can provide helpful information for pregnant women and their health professionals.

How much weight should I gain? 

The ideal amount of weight you gain during pregnancy depends on what your weight was before pregnancy. Your Body Mass Index (BMI) is used to work out the recommended amount of weight gain for you.

To calculate your BMI you can use the information below or an online BMI calculator.

  1. Your pre-pregnancy weight: _______kg
  2. Your  height: ____________ m (e.g. 170cm would be 1.7m)
  3. BMI = weight ÷ (height x height) = _____

Guidelines for pregnancy weight gain are based on your pre-pregnancy body mass index (BMI) and are shown in the table below.

 

 

 

 

 

 

If you are having twins or triplets the recommendations are for a little more weight gain. Talk with your health professional about how much is right for you.

Week by week

In the first trimester it is not expected that you will gain much, if any, weight. Some women don’t gain any weight or indeed might lose weight due to morning sickness. The average recommended weight gain week by week for the second and third trimester is shown below, with the range shown in brackets.

Know your target

Talk to your health professionals about pregnancy weight gain at your first antenatal appointment. Discuss the weight gain that’s right for you and what you might expect in each trimester of pregnancy. Ask them to track your weight at your appointments so you both know you are gaining enough, but not too much, for a healthy pregnancy.

The Australian Guide to Healthy Eating provides a general guide to food choices and recommended serve sizes for different food groups during pregnancy. Ask your dietitian for advice about healthy eating and pregnancy weight gain.

A healthy weight after pregnancy

After pregnancy many women are keen to return to their pre-pregnancy weight as soon as possible. The reality for most new mums is that life is busy and motherhood can be tiring, so be kind to yourself in the early days and just focus on eating healthy food, being active and feeling good.  

There will be changes to your sleep patterns, diabetes management and energy levels that you will need to adjust to. Once you are in a routine, you might find that joining an exercise program such as a pram walking group or mums n’ bubs exercise class can help you stay active. Breastfeeding has also shown to assist with weight loss. If you need extra support with managing your weight, ask your dietitian for advice.

For most women it can take many months to return to their pre-pregnancy weight. Ideally, you should aim to reach your pre-pregnancy weight by 6-12 months after the baby’s birth for the best long term health outcomes. If you are planning another pregnancy, it’s important to aim for a healthy weight before you fall pregnant. Talk to your doctor about how to plan for your next pregnancy.

Thank you to Robyn Barnes, Accredited Practising Dietitian, Bankstown-Lidcombe Hospital Diabetes Centre for reviewing this article.

  

Blood glucose monitoring for women with type 2 diabetes

Blood glucose levels in the target range BEFORE and DURING pregnancy, can reduce the risk of complications for mother and baby.

Blood glucose self-monitoring can help you manage your day-to-day blood glucose levels, see the effects of food, exercise and medication, and identify patterns in blood glucose levels that you should discuss with your doctor or diabetes health professional. This can help you achieve blood glucose levels in the target range for a healthy pregnancy.

If you’re a woman with type 2 diabetes and you are not using insulin, you need to know how to access to blood glucose test strips under the NDSS and what you need to do when planning for pregnancy.

Access to blood glucose test strips

If you have type 2 diabetes and are not using insulin, you can access an initial six month supply of subsidised blood glucose test strips under the NDSS. After six months, you will be eligible for access to subsidised blood glucose test strips for another six month period if your doctor or other authorised health professional considers it clinically necessary to continue testing blood glucose levels. 

Access to blood glucose test strips is determined by clinical need and there is no limit to how many six month periods of access to blood glucose test strips your doctor or health professionals can authorise. Click here for more information.

If you have type 1 diabetes or type 2 diabetes and are using insulin, the restrictions to blood glucose test strips do not apply to you, and you can continue to access supplies on an ongoing basis through the NDSS. 

What if I am planning a pregnancy?

Regular blood glucose monitoring is recommended for ALL women with diabetes planning a pregnancy.

Talk to your doctor or credentialled diabetes educator BEFORE you start trying for a baby. If you are not currently testing your blood glucose levels, they can complete a Blood Glucose Test Strip Six Month Approval Form stating that you have a ‘clinical need’ for self-monitoring. This will give you access to subsidised test strips through the NDSS for six months. To continue testing after six months, your health professional will need to complete this form again and lodge it with the NDSS.

It is recommended that you start planning and preparing for pregnancy at least 3-6 months before you start trying for a baby. Talk to your doctor or diabetes health professional about what you need to do to plan for pregnancy, your blood glucose targets and self-monitoring.

There are other aspects of planning for a healthy pregnancy too, such as screening for diabetes complications, taking pregnancy supplements, having a review of your current medications and routine blood tests.   Click here for a pregnancy planning checklist.

 

Benefits of continuous glucose monitoring (CGM) during pregnancy

An international study on continuous glucose monitoring (CGM) in women with type 1 diabetes during pregnancy is the first in the world to show benefits for both maternal blood glucose levels and infant health outcomes.

The CONCEPTT study took place in 31 hospitals across seven countries and included 325 women who were pregnant or planning a pregnancy. Women in the study undertook either CGM or finger-prick blood glucose monitoring.

The women using CGM had a small, but significant, reduction in HbA1c levels at 34 weeks’ of pregnancy, as well as an increased amount of time in the target blood glucose range, fewer high blood glucose levels, and less variable blood glucose levels when compared to those using conventional finger-prick blood glucose monitoring.

The outcomes were also positive for babies born to women using CGM. There were fewer infants born large for gestational age, as well as lower rates of neonatal hypoglycaemia, fewer admissions to neonatal intensive care for more than 24 hours, and a one day shorter hospital stay among infants of mothers using CGM during the first trimester.

The benefits of CGM were seen both for women using multiple daily insulin injections and those using insulin pump therapy. The findings however, didn’t show any benefit of CGM in women planning pregnancy.

The authors concluded that there is a benefit to offering CGM to all pregnant women with type 1 diabetes using intensive insulin therapy in the first trimester.

Source: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)32400-5/fulltext

 

Iodine – the forgotten nutrient? 

Iodine is an essential mineral found in small amounts in the food we eat.  The thyroid gland uses iodine to produce hormones which are vital for normal development of the brain and nervous system before birth, in babies and young children. For this reason, it’s important that pregnant and breastfeeding women get enough iodine.

In Australia, the National Health and Medical Research Council recommend that all women who are pregnant, breastfeeding or considering pregnancy, take an iodine supplement of 150 mg each day to prevent iodine deficiency.

However, in a recent survey of pregnant women attending an Australian metropolitan hospital, only 45% of women were aware of the recommendation to take an iodine supplement from preconception (before pregnancy) until the completion of breastfeeding and only 37% reported taking an iodine containing supplement before pregnancy.

A study of Australian health care professionals including obstetricians, gynaecologists, GPs, midwives, dietitians and lactation consultants also found that while most health professionals are aware of the recommendations for iodine supplementation during pregnancy, there were gaps in knowledge about the dose and recommended duration of iodine supplements.

These recent studies suggest that more needs to be done to raise awareness among women planning for pregnancy and health professionals about current recommendations for iodine supplementation.

Women with diabetes should speak with their GP, endocrinologist, diabetes educator or dietitian about iodine supplements as part of their pre-pregnancy planning. Women with known thyroid conditions should seek advice from their doctor before taking a supplement.

Source: http://www.womenandbirth.org/article/S1871-5192(16)30094-4/pdf

Cox AG, Cooray SD, Robinson PJ, Bahemia N, Davis SR, Bell RJ, Topliss DJ, Schneider HG, Sztal-Mazer S. Awareness and use of iodine supplementation amongst women attending a low risk pregnancy clinic. ADIPS SOMANZ Joint Scientific Meeting 20-22 Oct 2017, Canberra.

 

Seeking consumer input

The NDSS is seeking expression of interest from women with diabetes to provide feedback on new information for the NDSS pregnancy and diabetes website. Topics for review include - how partners can support women during pregnancy; how family and friends can support women during pregnancy; and diabetes and fertility treatment.

Each review should take less than 30 minutes. All participants* who complete the review will receive a gift voucher as a token of appreciation. Email Mel Morrison for more information.

*Note that a maximum of 10 consumers are being sought to complete this review, these selected participants will receive a token of appreciation for each webpage reviewed once feedback has been received.

 

Can women with diabetes go through in-vitro fertilisation (IVF) if needed?

IVF is a form of Assisted Reproductive Technology which is an option for women who need assistance with falling pregnant, including women with diabetes.

If you are planning to use any form of Assisted Reproductive Technology it is important to talk to your diabetes health professionals first. Planning and preparing for pregnancy at least 3-6 months before you start treatment is recommended.

This includes reviewing your diabetes management to ensure blood glucose levels are within the target range, being checked for diabetes complications, starting high dose folic acid supplements, having a review of your current medications and routine blood tests.