Pregnancy Overview — Before and After
Over 130 million women give birth each year and for women with type 1 diabetes, while the risks and challenges are of course magnified, the reality is that you can successfully navigate the before and after phases of pregnancy—it just requires a solid game plan and an incredible team. This will not be the spontaneous adventure it is for some, but rarely is that the reality for people living with type 1 diabetes (T1D). At the end of this road lies an even greater adventure, motherhood.
1. Before you get pregnant
The resources are not robust and in many cases you will have to be your own advocate—you will have to fight to maintain control of your body and your care, but if you work hard to be healthy, assemble the best team, seek the best information, you will be ready.
The key is getting blood glucose levels in range three to six months before conception. Your baby’s organs will be fully formed just seven weeks from your last period and high blood glucose levels increase risks to your baby. Additionally, a healthy body weight and exercise routine should be established before pregnancy. Prenatal vitamins with folic acid can be added beforehand as well (this may reduce the risk of your baby developing spina bifoda). This preplanning will give your baby the healthiest start possible.
2. Assembling your team, know your hospital
Find an ob/gyn who is experienced in caring for women with T1D if possible, and schedule an appointment to understand your care and delivery. Know the hospital where you will deliver and how they will approach diabetes management during delivery and time in the hospital. For example, some hospitals require you to disconnect a pump, many have a common protocol for all people with T1D, and others have never worked with a continuous glucose monitor (CGM). Know what to expect and how you will navigate.
Schedule a pre-pregnancy exam with your endocrinologist to check your A1C levels (target range is less than 7 percent), thyroid level and identify any potential complications, such as eye, nerve or kidney damage, heart disease or high blood pressure. Discuss changes to medication and insulin doses; in most cases you will need more insulin, especially in the last trimester.
If you don’t currently use a CGM, this is an ideal time to start. This tool will give you greater access to information as you navigate uncharted waters for your body, allowing you to react to blood glucose readings more immediately and efficiently.
Find other women who have successfully become mothers and join their group, whether online (like the Sugar Mommas) or in person. These women will be an invaluable resource, helping you trouble-shoot most every situation, offering advice and real life experience.
Talk to other type 1 women who have gone before you. This will ease the burden of trying to figure it out all on your own. Brooke Gibson, founder of the Type 1 Diabetic Sugar Mommas, a T1D mother’s support group in the San Francisco Bay Area, says that “finding other type 1 women who have become mothers, helps give others the confidence that they can have healthy babies.” T1D Sugar Mommas began as a Facebook group and has grown into a vibrant association of T1D women who are an invaluable resource for each other, helping trouble-shoot most every situation, offering advice and real life experience. Finding a network such as this can not only give you added confidence but it also can be a vital source of emotional support for the challenges you may be facing.
3. Baby on board
You are pregnant and while you require additional monitoring, your body will change just like every pregnant woman—you will experience highs and lows that have more to do with emotions than sugars, and your baby will grow, develop and move! What to Expect When You’re Expecting by Heidi Eisenberg Murkoff and Sharon Mazel provides tremendous resources both online and in your local community for pregnancy and parenting.
Think ahead about your delivery and the care for both you and the baby; select a pediatrician who is familiar with children of women with T1D or at a minimum is willing to learn more.
Continue to work with your team to maintain good control of your T1D and prepare for changes with each trimester. For example, insulin resistance is often higher in the third trimester; so constant blood glucose monitoring is paramount. High blood glucose levels will pass through the placenta to the baby, increasing the chance of birth defects, so diligence is not only important for you, but also for your baby. Put together a plan for your diabetes management to keep your blood glucose levels in range, which may include switching to a pump and CGM if you haven’t already.
4. Labor and delivery
Don’t forget to prepare for this moment with the usual birthing classes, hospital tours and preparations for heading to the hospital. In addition to the usual bag, make certain to include extra supplies, batteries for pumps and CGMs, chargers, medication and snacks. While you will be in a hospital, you don’t want any added complications (or to have to send your partner on an errand) due to malfunctioning equipment.
While many women have a complication-free vaginal birth, the odds of having an induced labor or C-section are increased for women with T1D. Know your hospital’s protocol for managing your diabetes—some will allow you to maintain control, but if you have a C-section you will most likely be handing over the reigns and put on an insulin IV drip.
After delivery, your blood glucose levels will drop as will your insulin needs. Work with your endocrinologist ahead of time to develop guidelines for cutting your doses. Expect to decrease insulin by at least a third and then further a day or two after delivery. Be prepared to manage your own insulin and eating after delivery, not the hospital staff.
5. Your baby is here
Although your baby will be at increased risk of hypoglycemia after nine months in an environment of heightened glucose, this should subside within a few days of birth. Your pediatrician will anticipate this and the baby will be carefully monitored.
If you plan to breastfeed, continue to pay close attention to your blood glucose levels, as hypoglycemia is common. If you need extra motivation, breast-feeding provides your baby with immune antibodies and can reduce your baby’s risk of developing type 1.
Like every new mother, you will experience moments of joy, anxiety, frustration, sleeplessness and overwhelming love. As you planned for your life before your baby, you must continue to plan for your new life, managing all of these emotions and experiences with T1D. Keep up the team approach, accept those helping hands, surround yourself with new mothers and remember to take care of yourself physically and emotionally. Also, take a moment to be proud of all you have accomplished.
For heavier reading: Guide to pregnancy.