The importance of preconception counseling when planning a family with T1D

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Samantha Markovitz, NBC-HWC

Family planning plays a crucial part in many people's lives, but the importance of preconception counseling for women living with type 1 diabetes (t1d) truly can't be understated.

Women with t1d are absolutely capable of having healthy, happy pregnancies, thanks to the individualized care and support of a team of medical professionals. Expectant mothers simply need to take a more thoughtful approach to some situations.

Like most things with t1d, navigating pregnancy requires diligent preparation beforehand, which is where preconception counseling comes in. If you're looking to add to your family in the future, here's what to know.

Starting a family with T1D

For decades, women living with t1d were told that their dreams of having a family might not be possible due to the risks that diabetes can cause for both mother and baby. While it's true that there are some inherent risks involved with a t1d pregnancy, as the National Institutes of Health outlined, it's now known that focusing on specific aspects of care and monitoring can greatly increase the likelihood of safe and healthy pregnancies. Many women living with t1d have given birth to healthy, happy babies!

While the nine months of pregnancy are often the focal point, what happens before can be equally as important. Proactively seeking advice and insight from your trusted endocrinologist and OB/GYN is a great place to begin. While you'll likely build out your medical team to include more multidisciplinary experts (like a perinatologist, also known as a maternal-fetal medicine specialist), sitting down with your current providers is a simple first step on this journey.

These professionals can help set you up for success. Nearly half of all pregnancies are unplanned, according to the Centers for Disease Control and Prevention, which makes it even more crucial for women of reproductive age to be empowered with this information, regardless of when (or if) they decide to have children.

Your checklist for proper preconception care

When you set out to begin the journey to a healthy pregnancy with diabetes, your providers may stress the importance of preconception counseling. They'll likely educate you about potential risks and the diligent efforts required to get to the positive end result. The doctor should also listen to you, answer your questions, and develop a plan for you to prepare for what comes next.

Here are some important steps to take when preparing to start a family:

  • Work toward (and maintain) in-range blood glucose levels. The American Diabetes Association (ADA) generally recommends that women planning a pregnancy with t1d aim for an A1C of 6.5%. The ADA noted that women with an A1C of that level are no more likely to have a baby with a birth defect than women without diabetes.

  • Leverage tools to support your glycemic goals. Newer diabetes technology like continuous glucose monitors (CGMs), insulin pumps, and smart insulin pens can help you to safely monitor your blood sugar and spend more time in your target range. Work with your medical team to acquire these tools and make the most of their ability to safely assist you with reaching your preconception targets.

  • Draft your medical dream team. Since you'll be working closely with your medical team during pregnancy, you'll want to make sure that you're comfortable with each of your providers. Clinical expertise in managing t1d pregnancies and a good bedside manner are two key traits to seek out. You should feel comfortable with — and confident in — the experts you add to your team.

  • Review your medications and make necessary changes. Some medications and supplements you currently take may not be safe for pregnancy. Have your doctor or pharmacist look over your medications and work together to make safe substitutions or eliminations prior to conceiving. This is also a good time to make sure you have a plan and any necessary prescriptions for severe hypoglycemia, which may be a frequent occurrence during the high insulin sensitivity period of the first trimester.

  • Add in prenatal vitamins and supplements. Ask your doctor about their specific recommendations for your unique needs when it comes to important nutrients like folic acid, B6, and zinc. You're likely focused on maintaining a healthy diet, which is great, but you'll likely need to add a supplement to ensure your growing baby gets all the nutrition they need.

  • Take the time to reset (or establish) healthy habits. Eliminating alcohol and cigarettes is also important in living a healthy lifestyle leading up to pregnancy. In addition to eating a balanced diet, getting regular physical activity and safely maintaining a healthy weight can help support the process of starting a family.

A note for dads-to-be with T1D

There tends to be more information focused on women with t1d who are planning to start a family, due to the intense demands of pregnancy with diabetes. However, men's t1d health is also important to support healthy sperm production, as JDRF explained. Consistent out-of-range blood sugar can cause issues with erectile function, sperm count, and sperm health. Talk to your doctor about any questions or concerns you may have and know that you have the support of your medical team during this special season of life as well.

Worth the work

People living with t1d are used to working hard and building resilience through living with the condition. It can often feel tiresome and unfair to have to work so hard to safely do what your peers seem to do without as much effort. But on the plus side, the extra monitoring and support mean that you'll get special insight into the miracle of life.

Imagine a future where you've made it through the other side of the process — and know that your hard work will be worth the effort!

Keep in mind that mobile apps can also help with tasks associated with preparing to start a family with t1d. Looking for a list of the diabetes community's favorite apps? Explore the Edgepark Health Insights blog for a rundown of helpful applications that can benefit your daily management efforts.

Samantha Markovitz, NBC-HWC

Bio: Samantha Markovitz, NBC-HWC is a Mayo Clinic-trained National Board Certified Health and Wellness Coach and the author of “Type 1 Diabetes Caregiver Confidence: A Guide for Caregivers of Children Living with Type 1 Diabetes.” Drawing from her own experience in living with T1D, Samantha is dedicated to empowering individuals and families to live well and thrive while managing health challenges and achieving their goals.

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