By Kendra Perley
Expecting a baby is an exciting time, but it also comes with its fair amount of nervousness and worry. These feelings are amplified if considering a pregnancy as a woman living with type 1 diabetes (T1D). Unlike Type 2 diabetes, type 1 is caused by an autoimmune reaction that destroys the cells in the pancreas that make insulin, called beta cells. This can take place for months or even years before any symptoms appear and a person is diagnosed with type 1 diabetes. Researchers do not know what causes type 1 diabetes, and it currently cannot be prevented or cured, only treated.
Type 1 diabetes is a serious chronic illness that comes with a host of complications if the disease isn’t managed properly. Poorly-managed diabetes increases pregnancy complications of both the mother and child, including miscarriage and still birth, birth defects, high blood pressure and preeclampsia, and preterm labor and premature birth.
While these risks and complications are serious and scary, women with T1D are able to have healthy pregnancies and babies. If a woman with T1D is considering pregnancy, she will work closely with her diabetic care team to tightly control her blood sugars and monitor her baby every step of the way. Taken from my own experience with two T1D pregnancies, below is what a woman with type 1 diabetes may expect during her pregnancy.
More frequent appointments with her endocrinologist
Pregnancy does a lot to a woman’s body, most of it unseen. A surge of pregnancy hormones impacts blood glucose levels, requiring frequent adjustments to a T1D woman’s insulin intake. As a pregnancy progresses, insulin resistance increases, requiring more insulin to maintain optimum blood sugar levels. Frequent meetings (once a month or every couple of weeks) with an endocrinologist allows a care provider to have a pulse on a pregnant T1D woman’s blood sugars and make any adjustments necessary to reduce blood sugar swings. It is important to make it to these appointments and to reach out to your doctor if any issues or concerns arise between appointments.
See a maternal fetal medicine doctor
Along with a traditional obstetrician, a pregnant T1D will most likely be referred to a maternal fetal medicine doctor (perinatologist), who specializes in what is considered “high-risk pregnancies.” No matter how well a woman’s diabetes is controlled, having a perinatologist/MFM on her care team ensures the health and safety of both mom and baby. Perinatologists have experience working with pregnancy and diabetes, and will conduct more ultrasounds of the baby to ensure proper growth and detect any potential defects.
Maintain control of her blood glucose levels before and during her pregnancy
As someone living with type 1 diabetes knows, maintaining a steady blood glucose level helps reduce the risk of complications such as neuropathy, diabetic retinopathy, kidney damage, and amputation. When considering a pregnancy, a woman’s endocrinologist may suggest she maintains a hemoglobin A1c of 6.0% or lower to reduce complications to mom and baby. This is why making it to every endocrinology appointment is so critical. Additionally, an expecting diabetic woman will need to control her glucose levels during labor and the birth. If her blood sugars are raised during labor, this causes high blood sugars in her baby, making the baby’s body produce extra insulin to regulate their own blood sugars. This can lead to the baby becoming hypoglycemic after the birth. Wearing a continuous glucose monitor (CGM) provides additional insight into blood-glucose patterns, helping people with T1D maintain healthy blood-glucose levels. If a woman doesn’t already wear one, she should strongly consider it before her pregnancy.
Deliver her baby before she reaches 40 weeks gestation
Most women will go into labor around 40 weeks gestation. However, many doctors will suggest a diabetic woman be induced for labor before she reaches 40 weeks for the health and safety of both mom and baby. This is due in part to keep the baby from growing too large (macrosomia) which is common for babies of diabetic mothers, and also because the placenta may deteriorate at a faster rate than a healthy woman, possibly increasing the likelihood of stillbirth.
While these expectations may seem daunting to a woman with type 1 diabetes who is considering a pregnancy, know a healthy pregnancy and delivery is possible. Many T1D women have worked hard to have tight control over their blood sugars and follow their doctor’s recommendations to have healthy and successful pregnancies and babies. It requires commitment and diligence, but it’s more than worth it when holding your baby in your arms.
*Kendra is not a medical professional, and does not offer any medical advice. The expectations of a diabetic pregnancy listed above were formed from her experience with two diabetic pregnancies and may not be the experience of others. A woman who has T1D and considering a pregnancy should work closely with her medical provider to ensure the health and safety of herself and her baby.