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If you or a loved one has type 1 diabetes, you may have wondered if pregnancy is safe. “My granddaughter was diagnosed with type 1 diabetes and just got married,” one myT1Dteam member shared. “Will she be able to have children?”
To help you better understand this important topic, we spoke with Dr. Avni Vora, an endocrinologist with Northwestern Medicine. Dr. Vora has extensive experience supporting people with type 1 diabetes, type 2 diabetes, and gestational diabetes before, during, and after pregnancy.
Keep reading to learn more about five facts regarding type 1 diabetes and pregnancy.
Managing blood sugar levels is essential when you’re pregnant because high blood sugar, also called hyperglycemia, can create risks and complications for you and your baby.
“When you have high blood sugars during pregnancy, your baby makes insulin in response to those blood sugars,” Dr. Vora said. “And that insulin can make the baby gain weight, leading to a baby that is larger than normal, which can make delivery more difficult.”
High blood sugar can also:
Dr. Vora emphasized the importance of glucose control during labor and delivery. “It’s really important to have strict blood sugar control at the time of delivery,” she said. “If a mother’s blood sugars are high, the baby makes insulin in response. After delivery, the baby is producing extra insulin but is not getting sugar from the mother anymore. This can lead to the baby actually having low blood sugar after delivery.”
Low blood sugar is called hypoglycemia. Potential complications of hypoglycemia in newborns include brain injury and seizures.
Although the potential risks and complications may sound scary, you can have a healthy pregnancy and deliver a healthy baby even if you have type 1 diabetes.
According to Dr. Vora, having type 1 diabetes shouldn’t affect your chances of getting pregnant as long as you have regular menstrual cycles and no other health issues. Before trying to conceive, she recommends taking steps to prepare.
“I think the first step, at least when it comes to diabetes, is trying to optimize your blood sugar control as much as possible before you try to get pregnant,” Dr. Vora said. One way your doctor can help you do this is with a hemoglobin A1c (HbA1c) test, which measures your average blood sugar over the past two to three months.
“If somebody comes to me with a high A1c, I say, ‘Let’s first work on getting your blood sugars under better control before you try to get pregnant,’” Dr. Vora said. “If your sugars are high going into pregnancy, it’s harder to keep them under control during pregnancy because of insulin resistance.”
Dr. Vora said blood glucose level targets vary depending on whether you are pregnant. She helps people adjust their medications before pregnancy, if needed, to help them prepare.
“The blood sugar goals for pregnancy are much lower than for people with diabetes who are not pregnant,” Dr. Vora said. “We are aiming for very tight control during pregnancy to reduce the risk of complications. We try to adjust the medicine prepregnancy to try to get towards those goals so that when you do get pregnant, it’s not as hard to adjust.”
Since diabetic retinopathy can get worse during pregnancy, Dr. Vora recommends asking your health care provider for an eye exam before you start trying to conceive. If you have retinopathy, she suggests getting an eye exam every trimester to monitor it. Over time, retinopathy can lead to blindness. Tell your doctor if you notice any vision changes.
If you are pregnant and did not take these steps to prepare, start a conversation with your diabetes health care provider. Ask your care team what you can do now to support yourself and your baby, whether you are in your first, second, or third trimester.
If you have lived with type 1 diabetes for a while, you and your health care provider have likely found ways to manage this chronic condition. Pregnancy can change that.
First, you’ll need to expand your care team. In addition to an endocrinologist for diabetes care, you’ll need an obstetrician, a doctor who cares for pregnant people and delivers babies. In early pregnancy, Dr. Vora said, you’ll likely see your obstetrician monthly for routine appointments. These visits will increase in frequency as you approach your delivery date and may include follow-up appointments after delivery.
You may also see a maternal-fetal medicine specialist. This type of provider has special training in high-risk pregnancies, which include those during pregnancy. In some cases, they can manage both your diabetes and obstetrics care. If so, you might see your endocrinologist less during this time.
“For me, it’s a mix,” Dr. Vora said. “If I have a patient who has a maternal-fetal medicine specialist that wants to manage their diabetes during pregnancy, I say, ‘OK, come back and see me after you deliver.’ I have other patients who stay with me throughout the whole pregnancy, and I typically see them every four to six weeks.”
Some find it helpful to enlist the help of a diabetes educator for support during pregnancy.
Once you are pregnant, you might need a higher insulin dose. Dr. Vora said this is because insulin resistance can increase during pregnancy.
“Some women need five to 10 times as much insulin than what they normally take due to the increased insulin resistance,” Dr. Vora said. “People with type 1 have an autoimmune disease that basically destroys the insulin-producing cells in their pancreas, so they are unable to make insulin. When the hormones raise their insulin resistance during pregnancy, they need a lot more insulin.”
If you use an insulin pump, you may need to do more manual insulin entries to keep your sugars under control. Although a continuous glucose monitor (CGM) can help by providing immediate updates, it can also be more work than usual. It’s important to continue to enter carbohydrates into the pump on time to cover your meals.
“We can take the continuous glucose monitor data and send it to the pump, and the new automated pump systems will help adjust between meals,” Dr. Vora said. “In the United States, all the current available pumps are not approved for use in pregnancy. The glucose targets for the automated insulin pumps are higher than what we want for pregnancy. You might have to manually give yourself more insulin to get your sugars down. So, it will require more attention to keep sugars at pregnancy goals.”
Dr. Vora noted that insulin pumps can still be used during pregnancy because control may still be better on a pump than off. She explained that she discusses how someone might use a pump differently — for example, using manual mode instead of auto mode — during preconception discussions.
When the big day finally arrives, your obstetric care team will closely monitor your blood sugar levels to protect your baby from being born with low blood sugar.
“The standard of care is to put people on an IV insulin drip,” Dr. Vora said. “Your team can monitor your blood sugars every hour and adjust the drip based on what the blood sugar is doing.” She said insulin pumps and injections are not ideal for this scenario because the insulin is absorbed into the subcutaneous fat first, which can delay its effects. “IV insulin goes straight to the veins, so it kicks in very quickly,” she added.
Your care team will likely stop the insulin drip after delivery. Dr. Vora explained that insulin resistance decreases dramatically after giving birth. Most people, regardless of their type of diabetes, won’t need insulin right away, but it’s essential to receive continued care.
“We often recommend that anyone with type 1 diabetes see an endocrinologist while in the hospital to determine postdelivery insulin needs,” Dr. Vora said. Although people with type 1 diabetes generally can’t go without insulin or risk going into diabetic ketoacidosis (a serious diabetes complication in which the body doesn’t have enough insulin), Dr. Vora said the period immediately after giving birth can be an exception.
“Sometimes, in the first 12 to 24 hours after delivery, women with type 1 don’t always need insulin,” Dr. Vora said. “They may be running really steady or even sometimes running a little bit low.”
Dr. Vora explained that some health care providers induce labor in people with diabetes. “Most of my patients get induced by 39 weeks,” she said. “When you’re worried about the quality of the placenta, you don’t want to go too far beyond 40 weeks.”
Your obstetrician might also induce labor if they’re concerned about the size of the baby and want to avoid a high-risk delivery. “They monitor the baby’s size with ultrasound,” Dr. Vora said. “If the baby is large, they may choose to deliver early. There is a very low threshold for considering early delivery to try to reduce the risk of complications to the mother and the baby. Most women [with diabetes] get induced at 39 weeks, but sometimes even sooner if they’re concerned about any potential complications.”
Most experienced moms might not describe the postpartum period as relaxing, but people with type 1 diabetes can ease up a bit when it comes to controlling blood sugar levels after delivering a healthy baby.
“One benefit of the postpartum period is that there’s not as much urgency because we’re not worried about harm to the baby,” Dr. Vora said. “A week or two of mildly uncontrolled blood sugars in a woman postpartum is not going to cause any major long-term harm to health.”
You may find that you face new challenges when managing your blood sugar levels after giving birth. “Your body goes through so many changes, like weight changes and hormone changes,” Dr. Vora said. “All those things can affect your blood sugars.” Breastfeeding can affect it, too.
Dr. Vora explained that breastfeeding causes you to lose calories through breast milk, so you might need less insulin at first. When you stop breastfeeding, you might need more insulin. You and your health care provider should work together to manage your blood sugar levels during this time.
“We have a little bit more time to figure out what people need after delivery, so we can be a little bit less aggressive in terms of where we need the sugars to be,” Dr. Vora said. “But all those body changes that happen after delivery, in addition to breastfeeding, can require frequent adjustments.”
You’ve worked hard for nine months to bring a new life into the world. Try to enjoy this time, and continue caring for yourself while you care for your baby. Dr. Vora acknowledged that being sleep-deprived and grabbing carbohydrate snacks in the middle of the night might be your new normal, and that’s OK. “I generally tell my patients to do their best,” she said. “The newborn period can be really tough. You just manage as best you can.”
If you’re at the start of your pregnancy journey (the first trimester), Dr. Vora offers this advice and reassurance: “Do the best you can. As long as you try to stay vigilant and keep up with your health care visits, most babies do OK.”
On myT1Dteam, the social network for people with type 1 diabetes and their loved ones, more than 3,000 members come together to ask questions, give advice, and share their stories with others who understand life with type 1 diabetes.
Have you given birth while living with type 1 diabetes? Are you thinking about pregnancy? Share your experience in the comments below or on your Activities page.
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Avni Vora, M.D.
is a board-certified endocrinologist with a focus on diabetes management, particularly during pregnancy.
Learn more about her here.
Suzanne Mooney
writes about people, pets, health and wellness, and travel.
Learn more about her here.
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