Type 1 Diabetes and Pregnancy: Things to Consider

Kelsey Bonilla Health Guide
  • Pregnancy Tracker: 28 weeks

    Size of the Baby: About 15 inches long!

    Biggest Obstacle: Balancing a busy work schedule with all my healthy habits.


    I've completed seven months of pregnancy Thursday. I'm officially beginning the third trimester and transitioning into "anticipation mode." I'm feeling healthy and strong with a lot on my mind as we attend our child birth classes, have more frequent doctor's appointments, plan a baby shower, and generally prepare for the birth of our first child!


    Yesterday we had a regular check-up appointment with one of my OBs. After starting our classes last week, I had a lot of questions about how my labor and delivery will (hopefully) go. The doctor we met with yesterday is the young, female counterpart to my wonderful, experienced, male doc. Dennis and I picked her brain for nearly half an hour!

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    She calmed some of my concerns and dispelled a couple myths that I'd be carrying around for several months. First of all she said that not all diabetics are at risk for having large babies. Most of the literature on diabetes and pregnancy lists macrosomia (excessive birth size) as the most prominent complication. My doctor explained that this is true because the vast majority of women who have pregnancies complicated by diabetes have either type 2 or gestational diabetes. These types tend to occur in women who are obese and/or have high insulin levels, which in turn results in excessive weight gain for baby.


    Type 1 diabetics, on the other hand, are at risk for mascular conditions that can lead to underweight babies.


    Thus, for women with type 1, our babies can fall anywhere on the spectrum of size. Hopefully, my risks will "cancel" each other out and I'll have a normally sized, healthy baby!


    We asked other questions, mostly regarding what they anticipate for my labor and delivery. Obviously, there are many considerations to delivery that one cannot know until the time arrives. Even without diabetes added to the mix, labors differ widely from woman to woman.


    In my case, the presence of diabetes means that my doctors do not want me to necessarily carry the baby for a full 40 weeks. Apparently, type 1 diabetics have a higher than average risk for still birth. Although, with the intensive blood glucose management that is the norm today, this risk is very low. Nonetheless, the risk goes up the longer the pregnancy lasts.


    My doctors often choose to induce labor in the 38th or 39th week to mitigate the risk for still birth.


    Inducing early (though after I'm "full term") brings up other issues, particularly pulmonary maturity for the baby. Sometimes they perform an amniocentesis to ensure the baby's lungs are mature and ready for delivery.


    So, from what I can tell, it's rather unlikely that the baby will be delivered on or around my due date of January 8th. We could very well be having a New Year's baby!


    As I've been reading about pregnancy, labor, and delivery, I have been exposed to many different theories and philosophies. Some women embrace a natural birth while others happily forgo the full experience in favor of a less painful delivery. I see the benefits of each of these concepts. However, the conclusion I've come to is that as a type 1 diabetic with a high-risk pregnancy, my options are somewhat limited. Obviously, I'm a fan of modern technology because I wouldn't be alive without a huge amount of medical intervention in my life. I should focus on becoming educated while being open to whatever my doctor believes will give us the best chance at delivering a healthy baby.


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    After our fruitful talk with the doctor, I waited for the nurse to return to administer my flu shot. Typically I lay down for shots (as I do when my blood is drawn) because I have a tendency to faint. However, I decided that, since I'm about to have a baby, it's time to toughen up a bit. I sat up straight, with sweaty palms, turned away and the shot was completely painless. According to most recommendations pregnant women and individuals with chronic illnesses should get a flu shot.


    If you have diabetes or are pregnant, or both, don't forget your flu shot!

Published On: October 19, 2007