Preparing for Pregnancy With Type 1 Diabetes
A certain amount of thought and care should go into planning a pregnancy, especially when you have a type 1 diabetes. However, there have been many medical advances that have made pregnancy with diabetes less risky if you are properly prepared. Here’s what you need to know about planning your pregnancy.
Planning pregnancy with type 1 diabetes
One of the biggest factors that reduces the risks associated with a pregnancy with type 1 is stable blood glucose for at least three to six months prior to conception. Ideally, prior to pregnancy your target blood sugar should be 60-119 mg/dl prior to a meal and 100-149 mg/dl after a meal, according to the American Diabetes Association (ADA). This is done with a combination of healthy lifestyle adjustments and medications.
A preconception checkup
You should visit with your doctor or midwife to help identify areas that need to be addressed, ideally prior to conception. This might include your weight, your A1C, and any other chronic conditions. You may also want to check for other complications that frequently go along with type 1, including kidney, eye, nerve, and thyroid functioning. Your partner should also consider having a checkup or making lifestyle changes to provide your future pregnancy with the best start possible.
Consider an insulin pump
You may also wish to consider an insulin pump, if you haven’t already made the switch. While the pump may be helpful at stabilizing your blood sugars prior to pregnancy, it can be really helpful once you’re pregnant and your needs rapidly change. Your doctor can also help you identify medications that may need to be changed once you are trying to conceive or once you are pregnant. Not all medications can be safely continued in pregnancy, but most have an alternative form that can be used safely.
Additional care providers
Once you are pregnant, you may want to consider some additions to your team of care providers, including an endocrinologist who has worked with pregnant women with type 1 before and potentially a maternal fetal medicine specialist (MFM), a doctor specializing in high risk obstetrics. While they may not provide your routine prenatal care, they will be a part of the team to consult with your primary physician and help advise you along the way, particularly if complications arise.
Consider a continuous glucose monitor (CGM)
In the first trimester, you may find that you have more episodes of low blood sugar. This is sometimes caused by your body producing its own insulin again. Either way, your partner should know what the signs of low blood sugar look like and what to do. Many mothers-to-be also decide that using a continuous glucose monitor (CGM) is a good thing. While many insurance companies may fight it, it’s usually not the case in pregnancy due to the greater risks associated with low blood sugar.
Towards the end of your pregnancy, you may also be asked to do fetal monitoring. This might simply be additional ultrasound exams, or it may be a non-stress test, where you are on a contraction/heart rate monitor and press a button to indicate when baby moves. There is also a bio-physical profile exam that can be done to check in on the baby and the placenta to ensure both are healthy.
Concerns about birth
Most people with type 1 diabetes will not go over their due date, either due to natural labor onset or because the provider suggests an induction of labor or scheduled cesarean birth due to potential medical risks or complications, like macrosomia. Even if your baby is large, chances are good that the outcomes will be the same. Other than this, the process is the same as you learned about in childbirth class.
After the birth
Once your baby is born, he or she will have their blood sugar checked. It is common that they will have low blood sugar after birth. If they are not immediately breastfeeding, you can suggest that expressed colostrum or sugar water be given via syringe or finger, rather than a bottle, to prevent the disruption of breastfeeding. This can be done while the baby is skin to skin.
Returning to normal management
The long-term management of your diabetes will revert to your regular endocrinologist about six weeks after the birth of your baby. Until this time your pregnancy care team will help you cope with the hormonal fluctuations and the effects that has on your blood sugar and needs for medication.
Don’t feel afraid or overwhelmed
While the prospect of being pregnant may seem overwhelming, the good news is that with some planning and the watchful eyes of your team, it is possible to have a safe and healthy pregnancy and birth. Be sure to start well in advance of your planned conception for the best outcomes. Ask questions and don’t be shy about speaking up if you have concerns. It’s great practice for parenthood.