There are over 130 million births annually, and while the dangers and obstacles are exacerbated for women with type 1 diabetes, it is possible to effectively navigate the preconception, pregnancy, and postpartum periods provided you have a good strategy and a great support system. While it can be challenging, the path is worth the reward. Here is how you can plan for the pregnancy journey with type one diabetes.
Before Becoming Pregnant
The aim is to have normal blood sugar levels three to six months before trying to conceive. Only seven weeks after your last period will your child's organs be completely formed, and regularly high blood glucose levels before and during pregnancy can increase hazards to the baby. Preconception health measures include maintaining a healthy weight and regular exercise. Supplementing your preconception diet with folic acid-rich prenatal supplements may help reduce the risk of your baby developing Spina Bifida, a spinal disease that is one of the most common birth defects associated with diabetic pregnancy. With this kind of preparation, you can offer your child the best possible start in life.
Assemble Your Team
If you can, make an appointment with a gynecologist who has expertise treating women with type 1 diabetes so that you can learn more about your options for pregnancy and delivery. Get to know the hospital where you want to give birth and learn about their diabetes management policies and procedures. Some medical facilities have strict rules about how to manage diabetes during your stay in the hospital - such as disconnecting pumps in advance of delivery. Also be aware that certain hospitals follow the same procedure for all type 1 diabetics, while others have their own specific rules, and some may have never even worked with a patient using a continuous glucose monitor (CGM). Do your research in advance so that you have a clear idea before walking in and can set expectations.
Schedule a pre-pregnancy assessment with your endocrinologist to evaluate your A1C levels (goal range is less than 7 percent), thyroid level and detect any potential issues, such as nerve, kidney, or eye damage, high blood pressure, or heart disease. Talk to your doctor about adjusting your insulin and other medicine doses, too. You will likely need extra insulin, particularly in the third trimester, when insulin resistance can be higher.
While Pregnant
You are expecting a baby, and while you will need extra care, you can expect your body to go through the same changes that every pregnant woman does. Your blood sugar will rise and fall for reasons other than nutrition, and your baby will grow, develop, and move, just like it does for every pregnant woman.
Maintain tight control of your type 1 diabetes with the help of your care team, and get ready for adjustments each trimester. Maintaining a healthy blood sugar level is crucial for both you and your unborn child. If you have not already switched to using a pump and a CGM, this is a good time to consider making that change.
Labor and Delivery
Prep for this moment with hospital tours, birthing classes, and having a dedicated ride planned for when you need to go to the hospital. Have a supply bag ready to go that contains supplies, batteries for pumps, chargers, medication, and snacks. Keep in mind that induced labor or C-sections are higher for women with type one diabetes, which likely means being put on an insulin IV drip.
After delivery, your glucose levels will drop as will your need for increased amounts of insulin. Talk to your endocrinologist ahead of time about how and when to cut your doses. Expect to manage your own insulin and eating post-delivery, as the hospital staff will only be able to help so much.
Your New Bundle of Joy
Newborn babies birthed by mothers with type one diabetes have a higher chance of hypoglycemia initially after birth but usually subsides within a few days of birth. Pediatricians are well aware of this and will monitor your baby closely in these first few days.
If you plan to breastfeed, closely monitor your blood glucose levels, as hypoglycemia can be prevalent. The good news is that breastfeeding provides immune antibodies to your baby and can lower the chances that your baby develops type 1 diabetes.
Like any new mom, you will undoubtedly undergo times of happiness, frustration, worry, exhaustion, and unconditional love. As you plan for your life after you give birth, you need to remember that managing all of these emotions doesn’t have to be squarely on your shoulders alone. Stick with your team, accept help, talk with other new mothers and invest in a little physical and emotional R&R. Also, be proud of yourself - if you can do this, you can do anything.