Type 1 Diabetes and Pregnancy
The decision to start a family is exciting but it can also be overwhelming, even more so if you live with Type 1 Diabetes. Prior planning is extremely important. Women living with Type 1 Diabetes can have a healthy pregnancy and having a plan to manage your diabetes before, during, and after your pregnancy will ensure that you keep yourself and your baby healthy.
The CDC has a comprehensive guide on pregnancy and Type 1 Diabetes. Below are some key take-away points.
Before You Get Pregnant
- The American Diabetes Association (ADA) has a helpful planning checklist to utilize before you get pregnant. This is an excellent reference tool to learn how you can boost your health and get ready for pregnancy. Being in optimal health overall is imperative.
- Ensure that your endocrinologist and OBGYN are working together prior to conceiving. As a person living with Type 1 Diabetes, you are at increased risks for complications and health concerns. Consult with your OBGYN to ensure they are experienced with higher risk pregnancies and Type 1 Diabetes.
- Manage your blood sugar within healthy recommended ranges. This includes obtaining a certain A1C goal, minimizing variability (obtaining more stability and less glucose fluctuations), and maintaining a certain time in range goal before, during and after pregnancy. Many endocrinologists will recommend that you reach and maintain these goals for a few months even before becoming pregnant, so you and your body are ready for the challenges ahead. They may also recommend that you use a continuous glucose monitor (if you are not already doing so), in order to keep close track on your glucose levels throughout your pregnancy, to support your glucose management targets.
- Review your medicines. Some medicines and supplements may not be safe to use while pregnant. Speak with your health care team about current medications and supplements before you become pregnant. Do not make any changes to prescribed medicines without consulting with your doctor first.
Insulin needs change throughout pregnancy, possibly even week to week, depending on the phase and various hormonal changes. Be sure to talk to your doctor on a regular basis about changes to your insulin needs and how to manage your blood sugar carefully throughout the pregnancy. Endocrinologists typically speak with patients living with Type 1 Diabetes during pregnancy on a weekly or bimonthly basis in order to maintain target glucose goals throughout the duration of your pregnancy.
During your pregnancy, you and your doctors will adjust your diabetes management plan multiple times. It is of utmost importance that you trust your clinical team and feel free to reach out to them when needed.
Risk factors to consider
Blood sugar levels that stay high during pregnancy may cause your baby to grow too large (macrosomia) pre-birth. or harm the early development of organs and lead to birth defects.
Monitor diabetes related complications could worsen throughout pregnancy, such as high blood pressure, vision loss, and kidney disease.
Other risks to consider during pregnancy include:
- Preeclampsia – high blood pressure that can damage the liver and kidneys
- Insulin resistance – when insulin is less effective at lowering your blood sugar
- Macrosomia – a larger-than-average baby which can lead to a more complex delivery
- Birth defects that may affect your baby’s heart, brain, spine, kidneys, digestive system, limbs, and mouth
Create a birth plan
Creating a birth plan prior to the delivery is important to the patient’s and healthcare team’s readiness and managing expectations. Everyone on the healthcare team should be informed that the expectant mother has type 1 diabetes. If the patient has healthcare provider approval for wearing a continuous glucose monitor and/or an insulin pump, the delivery team needs to know what to expect. The provider responsible for pediatric care needs to know potential issues that could arise in a delivery of this type. If you are delivering in a hospital, speak with as many people as possible on the delivery team, upon arrival at the hospital about your diabetes. Having informed midwives and nurses that are up to speed with your needs will ensure the health and safety of you and your baby.
Speak with your doctor of your intended insulin delivery methods during labor and delivery as well. Include in your birth plan, whether you will manage your blood sugar levels during and after labor and delivery, or if you are happy for the doctors to do so. When packing a hospital bag, have several back-up supplies handy, including insulin, the hospital may not have the same exact supplies and medications that you are familiar with.
During and After Delivery
Your blood sugar levels may rise during labor, but they may drop just before you give birth or immediately after—regardless of whether you have a vaginal delivery or a Cesarean (C-section). Your doctor can help you plan for the insulin dose changes and monitoring throughout your delivery and after.
If you choose to breastfeed your baby, this offers many health benefits to both the mother and baby. For the mother, it can help reduce the risk of high blood pressure, ovarian cancer, and breast cancer. Breastfeeding also supports the baby’s nutrition to stay healthy, while reducing the risk of asthma, obesity, and severe lung disease. Having diabetes may delay your ability to produce breast milk at first, but it should improve over time. Breastfeeding is an energy-consuming activity, similar to physical activity, and can lower blood sugar. Keep low glucose supplies nearby and in reach when nursing.
With careful planning and attention to your medical needs and with the help of your clinical team, you can ensure that you and your baby stay healthy during pregnancy, during delivery, and after!