Pregnancy can present many new challenges for women — especially those living with preexisting conditions. For instance, expectant mothers with type 1 diabetes (T1D) will have to monitor their glucose levels even more closely and ensure they're getting the right amount of insulin.
Fortunately, it's absolutely possible to combine type 1 diabetes and pregnancy. It may add an extra layer to daily challenges, but the reward for careful preparation, tight diabetes management, and direct communication with medical professionals is well worth it — at least in this mom-of-two's humble opinion!
Here are five tips that can help you successfully navigate the biggest considerations around type 1 diabetes and pregnancy.
1. Prepare with a carefully tuned baseline
If there's one thing I learned during my previous pregnancies, it's that preparation is key. A great way to get started in this regard is cultivating a relationship with your OB-GYN before getting pregnant. Talk to them about your A1C levels, glucose time-in-range, exercise regimen, current weight, and any medications that may impact the process. Focusing on the variables you can control before getting pregnant will ensure the best baseline for you and baby when the time comes.
This is also a good time to ask about your doctor's experience with previous T1D pregnancies, how T1D-specific risks can be minimized, and what the mechanics of labor and delivery with T1D look like. The more information you can gather upfront, the less chance of surprises later (when emotions will inevitably be higher).
2. Leverage technology
My doctors were very honest, emphasizing that preconception A1C levels shouldn't just be good but stellar — essentially mimicking the readings of a mom who doesn't have diabetes — to avoid any complications. To really dial in the settings, I used an insulin pump and continuous glucose monitor (CGM) throughout both of my pregnancies, and I couldn't recommend them enough.
Even though pregnancy is nine months, my insulin needs and glucose patterns changed almost weekly. I took time to review my previous day's CGM graph every morning and made adjustments as needed.
By the end of both pregnancies, my insulin needs had increased dramatically (which isn't uncommon for T1D pregnancies), so I was thankful for the ability to update ratios and sensitivity factors directly on my insulin pump. Even if these devices aren't part of your standard diabetes management suite, it's worth having a conversation about implementing them during pregnancy.
3. Understand the risks
According to various medical studies, including one published in Reviews in Obstetrics & Gynecology, patients with T1D pregnancies are at higher risk for hypoglycemia, diabetic ketoacidosis, retinopathy, nephropathy, preeclampsia, and preterm labor. Being aware of these risks and understanding the symptoms is a great step toward mitigating them.
One risk that may not be on your radar is gestational diabetes. This is a form of diabetes that occurs only during pregnancy. According to the American Diabetes Association, approximately 10% of otherwise healthy women in the U.S. are diagnosed with gestational diabetes during pregnancy. To test for this, women must consume a sugary drink and have their glucose levels closely examined. While important, all of my fellow mom friends who don't have T1D have told me they dread this test, which is normally performed between 24 and 28 weeks gestation, the Centers for Disease Control and Prevention noted.
Don't be afraid to have straightforward conversations with your team of doctors throughout all phases of your pregnancy. Ask questions and discuss any abnormalities, no matter how small. You deserve to be fully informed, and your healthcare team is there to help!
4. Build relationships with other moms living with T1D
If there's one thing I could change about my previous pregnancies, it would be my support posture. Before getting pregnant, I only had one real-life friend that had navigated a T1D pregnancy, so I relied heavily on internet friends and stories.
It would have been so nice to have a lifeline — someone to call with real-time questions and concerns, who had experienced it all before. Every pregnancy is different, but just talking through the extra tests and preparing for labor and delivery with other mothers living with type 1 diabetes is a great way to decrease any mental stress.
5. Plan for the "fourth trimester" with diabetes
During the course of my previous pregnancies, there was a lot of talk about, well, type 1 diabetes and pregnancy. But don't forget to prepare yourself — diabetes included — for postpartum.
I've heard some moms refer to this time as the "fourth trimester," and in my experience, that's a great description. In the midst of learning to breastfeed, surviving on very little sleep, and soaking in all the snuggles, you'll also need to consider how these activities affect your T1D.
I actually delegated some of this to my husband, who would notice that I was always going low during the nighttime feeding and made a suggestion to lower the basal rate for that time period. He also was great at carrying lots of healthy snacks and being ready with backup diabetes supplies since I was focused on the baby supplies!
As with most things, communication and cooperation are crucial during this time. With a solid support network and direct line to your healthcare team, navigating type 1 diabetes and pregnancy can be another exciting chapter in your journey.