Pregnancy and Type 1 Diabetes

Pregnancy and Type 1 Diabetes is a topic that doctor’s recommendations have significantly changed over the years.

Back when my mother had me(1960’s), doctors frequently told women with Type 1 Diabetes that they couldn’t have children as it was much too risky for them and their babies.

When I had my children(1980’s) some diabetic women were advised against having children and others were closely monitored (sometimes in hospital) throughout their pregnancy.

Thankfully there are not so many discrepancies between doctors nowadays and women can take control of their own Diabetes management and with good prenatal care deliver healthy babies.

As with any pregnancy you want to begin as healthy as possible so it is important to try to maintain your target Blood sugar and A1C levels before becoming pregnant.

This will aid in having an easier time conceiving and healthier pregnancy and baby post-delivery.

Preconception Care

Naturally, any woman wishing to become pregnant wants to give her child the best possible start in life. This is no different for women who have Type 1 or Type 2 Diabetes.

The ideal outcome is of course a healthy, full-term pregnancy and the safe arrival of a healthy, happy baby.

Having diabetes means there are heightened risks for both mother and baby which makes proper diabetes management essential.

For a diabetic controlling blood glucose level is a daily struggle but for a pregnant woman, those pregnancy hormones can really make that balancing act much more difficult.

This makes it essential to discuss your desire to become pregnant with your Diabetes Management Team so they can help you achieve optimal blood glucose and A1C levels before and during pregnancy.

Know the Risks

Having diabetes puts women at a higher risk of miscarriage and the possibility of having a baby with birth defects.

Risks to the Mother:

• higher risk of miscarriage
• increased worsening of diabetes caused retinopathy (damage to the retina)
• increased worsening of diabetes caused kidney damage or failure
• more difficult vaginal delivery requiring special maneuvers or the use of forceps or suction (due to baby’s weight)
• higher chance of Cesarean delivery
• gestational hypertension and pre-eclampsia (high blood pressure and significant swelling)
• excess amniotic fluid possibly causing premature labor

Risks for the Baby:

• defects of the heart, kidneys, urogenital tract, brain, spinal cord, and backbone (especially if diabetes is not properly managed in the first 3 months)
• above average birth weight (> 4 kg or 9 lbs) or possibly low birth weight or stunted growth
• premature birth
• delayed lung maturity
• hypoglycemia at birth (especially if the mother’s diabetes was poorly managed in the weeks before birth)
• jaundice
• calcium deficiency
• malfunction in the production of red blood cells
• perinatal death

These complications are highest when the mother is not controlling her diabetes.

With today’s’ much-improved diabetes management techniques and insulin, these risks are significantly lower in women with properly managed diabetes.

However, these risks are elevated in women with poorly controlled diabetes. Episodes of ketosis, ketoacidosis, or hypertension during pregnancy increase the risk.

How to Reduce the Risks

The most important thing any diabetic mother-to-be can do is try to get your blood glucose levels into the healthy range.

It is optimal if you can do this before conception and try to maintain these levels throughout pregnancy.

Increase the frequency with which you check your numbers.

Excessively high blood sugars (hyperglycemia) can cause the baby to grow too rapidly (Macrosomia) or can cause damage to the developing organs (which are developed by week 7).

Doctors recommend having your blood glucose in the range 3 – 6 months before conception.

Your Diabetes Management Team will work with you to not only determine your optimal range but also a recommended treatment plan to get you there.

If you are not already using a CGM (continuous glucose monitor) or an insulin pump this would be something to discuss with your doctor as it may make it easier to reach and maintain optimal blood glucose numbers.

Your doctor will likely recommend either a prenatal vitamin that contains Folic acid or he may recommend 1 mg daily for several months before pregnancy.

Make sure you have a good doctor who is familiar with Type 1 Diabetes and pregnancy and see him/her often. Regular prenatal care is imperative to a successful outcome.

Management

According to Wikipedia “high blood glucose levels are harmful to both mother and baby. Experts advise diabetics to maintain blood sugar levels as close to the normal range as possible for 2 -3 months before planning a pregnancy. Only through properly managing blood glucose levels before and during pregnancy can the risks be reduced for mother and child.

It is for this reason that you must work with your team of Diabetes experts that includes:

• diabetes nurse educators
• dieticians
• obstetricians
• endocrinologists/internists

They will work with you before and during pregnancy which will help ensure a healthy pregnancy and successful delivery.

Labor and Delivery

Statistics have shown that diabetic (Type 1 or Type 2) who go past 38 weeks gestation are at an increased risk of stillbirth and other complications.

It is for this reason that pregnant diabetic women are either induced or scheduled for cesarean delivery.

If you have managed your blood sugar levels optimally throughout your pregnancy and there are no other concerns your doctor may allow you to go into labor naturally.

Diabetic or not none of us knows for certain how our babies will arrive in this world. Even the most well-planned delivery plan can go awry and an emergency c-section required not related to diabetes at all.

The most important thing is the safety of both mother and baby during delivery whatever the method.

Postpartum

Having Diabetes does not mean you will have difficulty producing milk.

In some cases where the mother’s blood sugar levels have been high for several days, she may have some difficulty.

However, if you maintain your levels as close to the optimal range as possible you should not experience difficulty producing milk.

Keep in mind that producing milk will affect your blood glucose levels. Your body will burn significantly more calories while it makes more milk in time for your babies’ next feeding.

Work closely with your healthcare team to develop a plan that reduces fast-acting insulin doses for meals eaten shortly after nursing. Eating a small snack of 10 to 15 grams of carbohydrates after nursing may help prevent low blood sugars

Conclusion

With today’s medical technology there is no reason to fear Pregnancy and Type 1 Diabetes. Diabetic women all over the world are delivering healthy and happy babies.

Talk with your Diabetes Management Team as soon as you are thinking about becoming pregnant.

They will help you get your numbers within the target range and devise a plan to help you maintain those levels.

Understand that pregnancy hormones may make your blood glucose levels more difficult to balance requiring more frequent checks.

By working with your healthcare team and diligently monitoring your blood glucose levels you can reduce the risk of complications to both yourself and the baby.

There may be an increased necessity for either early induction or cesarean delivery. Remember the safety of both you and the baby is much more important than the method of delivery.

Producing milk and nursing your baby will affect your blood glucose levels. Work with your team to develop a plan that works for you.

This helps you understand that it is very possible by working closely with your team you can experience a healthy and happy pregnancy regardless of whether or not you have diabetes.