Type 1 Diabetes and Pregnancy

Women with type 1 diabetes can have a healthy pregnancy. A diabetes management plan, ideally from before pregnancy until after the birth, helps keep mother and baby healthy.

Before pregnancy

• Blood sugar. Many doctors recommend reaching your A1C goal, and staying there, for a few months before becoming pregnant.
• Medicines. Some medicines and supplements are not safe in pregnancy. Go through each one with your health care team before you get pregnant, and do not stop a prescribed medicine without talking to your doctor first.

Your care team

You and your doctors will adjust your diabetes management plan during the pregnancy. If they are not already on your team, consider adding:

• an endocrinologist, a doctor who treats hormone conditions, diabetes among them; you may want one who specialises in pregnant women with diabetes;
• an obstetrician, a doctor for pregnant women; diabetes may make yours a high-risk pregnancy, and some obstetricians specialise in those;
• a diabetes educator, who can help you manage diabetes during pregnancy.

During pregnancy

• Keep A1C on target. Blood sugar that stays high in pregnancy can make the baby grow too large or cause birth defects.
• Know the risks. Watch for diabetes complications that can worsen during pregnancy, such as eye problems and kidney disease. Other risks include preeclampsia (high blood pressure that can damage the liver and kidneys), insulin resistance (insulin working less well to lower blood sugar), miscarriage, macrosomia (a larger than normal baby, which can make delivery harder), and birth defects affecting the baby's heart, brain, spine or organs.
• Expect insulin needs to change. Low blood sugar is common in women with type 1 diabetes. Ask your team how much insulin you need, and how often.
• Consider a continuous glucose monitor (CGM). It shows your blood sugar patterns, which helps you stay in range. Ask your doctor whether one is right for you.

Planning the birth

Questions to ask:

• If you deliver in hospital, what is the procedure for women who wear an insulin pump?
• Can you keep your CGM on during labour and delivery?
• Who will manage your blood sugar during and after labour and delivery?
• What diabetes supplies should you pack in your hospital bag?

Blood sugar may rise during labour, and it may drop just before or right after the birth, whether the delivery is vaginal or by caesarean section. Your doctor can help you plan insulin changes and monitoring through the delivery and after. You can wear your insulin pump or CGM during delivery.

After the birth

• Your baby. Babies are watched closely after birth. A baby whose mother has diabetes can have a drop in blood sugar at birth, so yours will get extra blood sugar tests in the first few days.
• Family risk. Having a family member with type 1 diabetes raises a person's own risk. Ask your doctor about screening for your newborn, watch your child for signs and symptoms of type 1 diabetes, and know that there are tests for early-stage type 1 diabetes before any symptoms appear.
• Breastfeeding. Women with type 1 diabetes can breastfeed, which can lower a baby's risk of asthma, obesity and type 1 diabetes. Diabetes may delay your milk coming in, but that should improve. Breastfeeding uses a lot of energy, especially while you recover from the birth: check for low blood sugar before and after breastfeeding or pumping, drink extra water, and ask your doctor whether all your diabetes medicines are safe while breastfeeding.

Sources

• Centers for Disease Control and Prevention, "Type 1 Diabetes and Pregnancy." https://www.cdc.gov/diabetes/about/type-1-diabetes-pregnancy.html
• Two stock photographs of pregnant women are not reproduced here.