Featured articles edition 4
An ultrasound showing the first glimpse of your growing baby, can be an exciting, but also nerve racking time.
An ultrasound is a scan using sound waves which create echoes to produce an image on a screen. Depending on the position of your baby, the image may be easy to see or it may be hard to work out what’s what. Hard tissues such as bone will look white in the image, soft tissues will look grey, while fluids (like amniotic fluid) will appear black.
The sonographer or doctor who does the scan will be able to explain what you can see on the screen.
Ultrasounds can be used to check things such as:
- Your estimated due date
- Your baby’s heartbeat
- Your baby’s growth
- Your baby’s heart, kidneys, brain, spine and limbs
- Whether you are pregnant with more than one baby
- The sex of your baby
- Your pregnancy health and wellbeing – such as the amount of fluid surrounding your baby, where your placenta lies and the blood flow through the umbilical cord
- The risk of Down syndrome (along with a special blood test)
- Any abnormalities, such as spina bifida
What scan and when?
The routine ultrasounds offered to women with diabetes during pregnancy are the same as for women without diabetes. Along with these, some extra scans may also be recommended. The main scans offered during pregnancy will include:
An early dating scan – at 7-8 weeks to estimate your due date
Nuchal translucency (Down syndrome) scan – at 11-14 weeks
Anatomical ultrasound - at 20 weeks to check your baby’s spine, limbs and organs
Cardiac scan – may sometimes be recommended at 23 weeks to check your baby’s heart
Growth scan - in the last 3 months, scans will usually be done every 3-4 weeks to monitor the baby’s growth and wellbeing, as well as the fluid around the baby.
Your doctor may also recommended extra scans if the baby is small for their due date (usually every 2 weeks) or very large (usually every 4 weeks). Sometimes, extra monitoring might also be needed to keep a check on your baby’s growth and wellbeing.
Some women also choose to have a non-invasive prenatal screening (NIPS) done in early pregnancy. This blood test, which can be done as early as 10 weeks, is used to identify the risk of a number of genetic abnormalities, including Down syndrome. While more women are choosing to have this test done, it can be expensive and is not currently covered by Medicare.
How is it done?
An ultrasound is done lying down on an examination table or bed. Firstly, some gel will be put on your tummy, this helps make the sound waves travel. A hand held device is then moved across the skin to pick up images of your baby. These will be projected on to a screen where measurements are made and the images are saved.
In early pregnancy, you will be advised to empty your bladder about one hour before the scan and then drink 2 glasses of water (without going to the toilet again before the scan). This helps your doctor or sonographer get a better view of your baby.
Sometimes, a vaginal ultrasound may be needed if a clear image isn’t possible on a regular ultrasound. For this type of ultrasound, a narrow probe will be placed in your vagina while images of your baby are being captured. A vaginal ultrasound is not painful and will not harm your baby.
Is it safe?
Ultrasounds have now been used in pregnancy for decades and there are no known safety concerns. Doctors and sonographers who do the ultrasounds have been trained to make sure that the scans are safe for you and your baby.
What are the different types of scans?
Standard ultrasounds make 2 dimensional images, however there are now 3-D and 4-D scans also being used. A 3-D scan lets your doctor see the width, height and depth of your growing baby. A 4-D ultrasound also creates a moving image – this scan is not done for medical reasons, but can be exciting to see. Fetal echocardiography is another type of scan that shows the size, shape, and structure of your baby’s heart.
When can I find out the sex of my baby?
Your 20 week scan is when you can usually ask to find out whether your baby is a boy or a girl. Although depending on the position of the baby it can sometime be difficult to tell. Most doctors and sonographers won’t guarantee the sex of your baby based on the results of this scan. If you choose to have a non-invasive prenatal screening done in early pregnancy this can more accurately tell you the sex of your baby, which may then be confirmed at the 20 week scan.
What happens if my ultrasound shows a problem?
If a problem is picked up on your ultrasound, a specialist doctor will usually be asked to check the ultrasound images. The doctor may advise you to have further tests to check the fluid or tissues around your baby for any abnormalities of the baby’s genes. Sometimes another type of scan called an MRI is also needed.
It is normal to feel anxious about scans and worry about the results. Remember that serious problems are not common, and most women with diabetes will have a healthy baby. However, if a scan does reveal a serious problem, support is available from your health professionals as well as specialist counselling and support services.
Thanks to Dr Tom Cade, Obstetrician from the Royal Women’s Hospital, Melbourne for reviewing this article.
Pregnancy is a very special time for all women, but worries and questions are normal. When you have diabetes there will be extra things that might worry you.
Pregnancy is a journey best shared, and support and connection with other women who have diabetes, is just as important as support from your family and friends.
Most women will connect with others who are pregnant at some stage – whether through friends and family, through their antenatal classes, or pregnancy and parenting groups.
Social media and popular pregnancy and parenting websites, have also opened up many opportunities for you to connect, and there’s no need to be alone.
You may find becoming part of a general group of pregnant women and mothers without diabetes doesn’t always meet all of your needs, or may in fact be difficult for you. As well as all the usual information about pregnancy and motherhood, you need specific information and support from those who ‘get you’ and the special needs of pregnancy when you live with diabetes.
Staying on track with your diabetes during pregnancy can be hard work, from pre-pregnancy through to becoming a mum. Alongside this you may have worries, fears and questions that relate to your diabetes, your baby and your own health, and women who haven’t lived with diabetes can’t fully understand these things.
Someone like me
If you compare your experiences with women who don’t have diabetes, it is easy to feel like an outsider, or that you’re alone. On the other hand, connecting with women who have diabetes, can offer you fantastic support as you go through pregnancy and into motherhood. Sharing information and stories offers you reassurance and can benefit everyone.
The kind of support that best suits you, is up to you – some women prefer face to face support while others like online support networks.
Ask your diabetes team, endocrinologist or obstetrician about connecting with other pregnant women with diabetes in your area. If you attend a specialist diabetes in pregnancy service – the waiting room can also be a great meeting place and even an informal support group! Otherwise contact the Diabetes Australia agent in your state or territory to find out what’s available locally. Some states have pregnancy planning seminars where you can also network with others.
You can also look for support via the online diabetes community including places like:
*Diabetes Can’t Stop Me www.diabetescantstopme.com
*The Type 1 diabetes network http://t1dn.org.au/
*Note: these are external links and the content is not endorsed and approved by Diabetes Australia.
Alongside your own knowledge of managing your diabetes, the right information and support from health professionals, as well as support from your loved ones and other women with diabetes, helps you to stick with the effort needed to manage your diabetes during the entire journey. A listening ear offers you understanding and reassurance which helps increase your wellbeing and helps you enjoy this very special time of your life.
This article was written by Helen Edwards, Diabetes Blogger, Advocate & Consultant.
Pregnant with diabetes app
The Pregnant with Diabetes app has been developed for pregnant women with diabetes, and women with diabetes who are planning a pregnancy.
The original version developed by the Centre for Pregnant Women with Diabetes in Copenhagen, Denmark has been adapted to reflect Australian guidelines.
The app is endorsed by the Australasian Diabetes in Pregnancy Society (ADIPS) and can be downloaded from app stores free of charge.
The information covered in the app is suitable for women with gestational, type 1 and type 2 diabetes and covers topics such as: how to plan for pregnancy, blood glucose levels, pregnancy weight gain, diet and carbohydrate intake, physical activity and insulin dosing.
The CONCEPTT study is underway to find out whether real-time continuous glucose monitoring (RT-CGM) can have benefits for women with type 1 diabetes who are pregnant or planning a pregnancy.
RT-CGM devices feature technology which displays glucose levels when a measurement is taken every few minutes. It is hoped that this technology will help women achieve glucose levels in the target range for pregnancy without too many hypos, and help improve pregnancy outcomes.
The study is taking place across the US, Canada, UK and Europe and it is expected that the results will be available soon.
Source: BMC Pregnancy and Childbirth
A DVD provided by GPs and local diabetes teams to UK women with diabetes has been shown to be helpful in encouraging planning and preparation for pregnancy.
The 45 minute DVD focuses on the importance of planning for pregnancy and includes a pre-pregnancy checklist.
Women who watched the DVD before pregnancy had a lower HbA1c (6.9% vs. 7.8%) at their first clinic visit and were more likely to take folic acid before pregnancy (81% vs. 43%) compared to those who hadn’t watched it.
Many women who watched the DVD also reported making positive pregnancy planning decisions, such as contacting a healthcare professional for pre-pregnancy care or making lifestyle changes. This study suggests that simple resources to increase awareness about pregnancy planning among women with diabetes can be helpful.
The following NDSS resources are available to Australian women with diabetes:
Source: Primary Care Diabetes
Will the occasional high blood glucose level have any effect on my baby?
Your diabetes in pregnancy team will discuss target blood glucose levels for pregnancy with you.
Most women find that they will occasionally have blood glucose levels outside the target range. If your HbA1c (a test which reflects your average blood glucose levels over the past 10-12 weeks) is within your recommended target range during pregnancy, occasional blood glucose levels above target have not been shown to cause harm to the baby.
If you are finding that your blood glucose levels are regularly outside the target range, contact your diabetes health professionals for advice and support.