Pregnancy

Pregnancy is a transformative and exciting journey, but it can also come with unique challenges for individuals living with type 1 diabetes. With proper care, planning, and support, a healthy pregnancy is within reach. It's crucial to maintain blood glucose levels in the pregnancy range to reduce the risk of complications for both you and your baby(ies) . Understanding these risks and how to manage them can empower you to increase your chances of having a healthy pregnancy.

When a person with type 1 diabetes is pregnant, they and their baby might face some challenges. These challenges can include:

• High blood pressure: This means the blood moves through the body with a lot of force.
• Eye problems (retinopathy), kidney problems (nephropathy), and nerve damage (neuropathy).
• Babies might grow bigger than usual, be born too early, or have other health issues.

Here’s some advice for pregnancy with type 1 diabetes:

• Visit a diabetes provider before trying to have a baby, your provider may suggest you start using diabetes technologies like a Continuous Glucose Monitor (CGM), a special insulin pen, and/or insulin pump. They may also suggest you switch to a different type of insulin. They may stop certain medications that you are taking prior to conception because they are not safe to use during the pregnancy itself.
• Visit a diabetes provider as soon as you are aware of the pregnancy and continue to follow with the diabetes team throughout the pregnancy and post-partum period.
• Visit an obstetric (OB) provider with experience in diabetes throughout the pregnancy. Individuals with diabetes get more specialized OB care and monitoring throughout the pregnancy than pregnant individuals without diabetes.
• Eat healthy: Try to have about 175 grams of carbohydrates each day (divided over the day) and eat healthy fats.
• Weight gain during pregnancy:
• Aim to achieve the amount of pregnancy weight recommended by your provider. It will vary depending on your weight at the start of the pregnancy.
• Gaining extra weight, over what is recommended based on your starting pregnancy weight, can negatively affect the baby’s size. Therefore, it can be helpful to work with a registered dietician nutritionist throughout pregnancy.
• Exercise: Aim to move around every week with moderate-intensity aerobic activity. Talk about this with your OB team first.

Understanding Blood Sugar and Diabetes Technology Use in Pregnancy:

Before eating and overnight, aim for sugar levels of 70-95 mg/dL and 2 hours after eating, aim for 100-120 mg/dL. For those with type 1 diabetes, the goal is to have an average sugar level of 115-120 mg/dL and stay in the right range most of the time to keep the parent and their baby healthy. High sugars can make babies grow bigger than they should or cause other health issues for you or your baby. Studies show that keeping sugar levels in the optimal range more often can lower the chance of health problems.

We are still learning how CGMs (devices that check your sugar every five minutes) can help pregnant individuals reach glucose goals and improve their quality of life. During pregnancy, CGM sugar levels should be between 63-140 mg/dL. If you keep your sugar levels between 63-140 mg/dL 70% of the time or more, it may help avoid many health issues for your baby. 

Sometimes it’s hard for people to keep their sugar levels as low as is recommended, especially during pregnancy. Individuals with type 1 diabetes have to use insulin to help manage the sugar levels. Some people give themselves insulin shots multiple times every day. In those cases, a connected insulin pen can be helpful in pregnancy as it generally comes with a phone app that can calculate insulin doses for you based on your sugar level and carbohydrate consumption. Some people give themselves insulin through an insulin pump. Hybrid closed-loop insulin pumps are pumps that work with your CGM to give you insulin when you need it. These pumps may also be helpful during pregnancy for some individuals, but more research is needed. Regardless of what you and your provider choose for your mode of insulin delivery (regular shots, connected insulin pen, insulin pump, hybrid closed-loop system), insulin doses will change a lot during the course of the pregnancy. Work with your diabetes team to adjust dosing on a regular basis.

Discuss with your provider which diabetes technology(ies) are right for you and will best help you to manage the sugar levels throughout the pregnancy. Remember, keeping sugar levels just right is very important for the health of the parent-to-be and the baby, and experts are working hard to find the best ways to manage it. You are not alone in your pregnancy journey as a type 1. There are so many resources to help you and your baby stay healthy!