The Complete Guide to Pregnancy Planning with Type 1 Diabetes
The definition of “right time” to plan for a baby varies from family to family. All parents-to-be strive for financial and emotional readiness. But when type 1 diabetes is part of the family-planning scenario, you have a few extra things to consider. Pregnancy with type 1 diabetes (T1D) can directly impact the health of the child and the mother and having type 1 diabetes well-managed at conception is key to this.
What to Consider Prior to Pregnancy
Pregnancy is both a physical and an emotional journey—it’s no wonder women with type 1 diabetes who are pregnant have many questions and concerns. That is why preconception planning is absolutely crucial. Having said that, some pregnancies are unplanned. It is important to speak with your doctor and diabetes care team and get the guidance that you need to have a healthy pregnancy with T1D as soon as you know you are pregnant.
How soon should you start preconception planning? Working on the following goals for a few months in advance of conception can make the whole process easier and less stressful:
Keep Your A1c Levels Regular
It’s never too early to be working toward your hemoglobin A1c (A1c) goal. The A1c is a benchmark for type 1 diabetes management that many doctors and hospitals use to measure your average blood sugar over a 2-3 month period. Many endocrinologists recommend that women aim to achieve and maintain their A1c goal for a few months before becoming pregnant.
The American Diabetes Association recommends that women who are planning a pregnancy with type 1 diabetes aim for an A1c as close to the target for pregnancy (A1c <6.0%) as possible without significant hypoglycemia.
Because a baby’s major organs develop within the first 8 to 12 weeks of a pregnancy, it’s best to keep your blood sugar more tightly managed before conceiving. Persistently high blood glucose levels dramatically increase the risk of abnormal development of your baby. Work with your physician and diabetes educator to achieve the best blood glucose level you can. Discuss whether it might be time to consider an insulin pump and/or a continuous glucose monitor (CGM).
Assemble Your Diabetes Care Team Roster
Now is a good time to connect with your medical team and clue them in to your plans. You will also need a medical examination by an endocrinologist before your pregnancy. This will allow the doctor to check your blood pressure and immunity to rubella and chickenpox, run blood tests and conduct a complications screening (particularly for your eyes and kidneys).
If you aren’t happy with how your team manages your type 1 diabetes care, this is an opportunity to find a doctor who will work with you and understand your needs. Once you are pregnant, you will spend a lot of time consulting with your doctor and tweaking your management plan, so make sure you have a team you both trust and feel comfortable baring it all to (emotionally and physically!).
Consider adding an OB/GYN specializing in high-risk pregnancies and a dietitian to your team, as a pregnancy with type 1 diabetes is a delicate balance of food, insulin and the needs of your growing child that will benefit from a full team. There are also endocrinologists who specializes in assisting pregnant women who have diabetes, consider adding one to your team. You will feel much more confident and prepared during your pregnancy if you have assembled a trusted, multidisciplinary team in advance.
After preconception appointments and counseling, your head will probably be swimming with all of the information you receive. You may feel overwhelmed and even a little distressed. Take your time to digest the information. Talk about your concerns with your partner, and lean on one another as you move toward these goals. Even without type 1 diabetes, this is an important time to prepare both emotionally and physically.
Update Your Medication Regimen
Some medications and supplements are not considered safe during pregnancy. You will want to have an extensive talk with your healthcare provider about each medication and supplement prior to conception. If you are on any medication that prevent cardiovascular disease such as blood pressure and cholesterol, please consult with your healthcare provider before altering your medication routine.
Discuss medication dosages with your doctor so that you understand which medications might be required during pregnancy and how much you should take. Be prepared for an increase in your insulin dose during pregnancy.
In order for your insurance company to cover these increased requirements, your doctor will have to regularly update your prescriptions and you will have to ensure that your pharmacy receives them in a timely manner. It is important to think ahead about these situations. You will have better things to do than battle with your pharmacy and insurance companies while you are pregnant.
Don’t Forget Prenatal Vitamin and Mineral Supplements
Folic acid, zinc and B6 are all important for conception and development of a healthy child, but different women have different needs. Ask your physician about how much of each vitamin and mineral to take in supplement form, and if he or she would recommend additional vitamins.
IMPORTANT NOTE: If you do not already have a glucagon kit, now is the time to get a prescription from your doctor, purchase one, and familiarize yourself and your family members with how and when to use it.
Steps for Dads-to-Be with Type 1 Diabetes
For couples planning a baby in which the dad-to-be is living with type 1 diabetes, it’s important that his health is optimized to ensure healthy sperm production. Though the woman’s fertility may be more of a focus, men with type 1 diabetes need to be aware of the impact their type 1 diabetes may have on their ability to successfully conceive. Poorly managed blood sugar can impact erectile function, sperm count and sperm health. Every man has the right to talk with their doctor about his fertility concerns. Don’t discount or avoid these issues when planning to start your family.
For Moms-to-Be: Preparing for Conception
Once you and your partner have decided to “go for it” and try to get pregnant, you may feel heightened levels of excitement and anxiety. Having type 1 diabetes during pregnancy means you will need some extra monitoring as compared to your peers who do not have diabetes. This might not always feel fair. Be sure to remind yourself that the end goal remains the same for all: a healthy baby and a healthy mother.
As you move toward pregnancy, here are a few ways to prepare your body for a baby:
Know Your Cycle
Pinpointing when you ovulate each month is the single most helpful task in improving your chances for conception. There are many ways to do this, from watching the calendar, to taking your body temperature, to purchasing an ovulation predictor kit or using a fertility app. Bookstores and websites offer a wide variety of options to help you better track your menstrual cycle and sexual activity.
How you choose to track ovulation is less important than simply making the choice to track it. Don’t let conception become an intimidating science experiment. Try to keep this aspect of conception from dominating your thoughts. Be sure to relax and enjoy this special time and the process involved.
Get Your Weight in the Target Range
Being overweight can make conception difficult and increase the risk of pregnancy complications, such as preeclampsia. Extra weight can raise a woman’s insulin resistance (a condition in which insulin becomes less effective at lowering blood-sugar levels). It is common for women with type 1 diabetes, even those within normal weight range, to experience some level of insulin resistance during pregnancy.
Eat a Healthy Diet
Follow a balanced and healthy diet that includes whole grains, fruits, vegetables and low-fat dairy products and reduce your intake of unhealthy and high-fat foods. This can help you meet your target weight and help manage your blood sugars, which may improve the chances of conception.
Ask a registered dietician (R.D.) for recommendations about caloric and carbohydrate intake during the conception phase, and specifically ask questions about managing T1D while eating a balanced diet. Finally, don’t forget to stock your pantry with healthy snacks based on their recommendations.
Exercise and physical activity is just as important for women with type 1 diabetes who are trying to become or are already pregnant as it is for women without type 1 diabetes. A good exercise program gets your body in the best shape possible for the demands of carrying a baby.
Regular exercise can also improve your blood-sugar management, which may enhance your chances for conception. (And it can help lower stress, which is a plus!) See a fitness professional before you begin a new exercise routine. You must also take extra care to monitor blood sugar levels to avoid the negative consequences of low blood sugar levels.
Eliminate Alcohol Consumption and Smoking
According to the Centers for Disease Control, both alcohol and smoking during pregnancy can have detrimental effects on the baby, so it is highly recommended that both be discontinued prior to attempting to conceive.
With all these considerations in mind, it’s also important to go easy on yourself as you prepare for conception. While you can strive to do everything right, in this process, there is no such thing as perfection. So, remember to acknowledge all the hard work you are putting into this and be kind to yourself along the way.