People with T1D can experience healthy pregnancies. You may just need to plan more in advance, keep a close watch on blood sugar levels, and take other steps during your pregnancy.
Women with type 1 diabetes (T1D) were once told that they could not have children. This was the basis for a whole generation of people not being able to watch the original 1980s movie Steel Magnolias, which featured a character with T1D who experienced issues related to pregnancy because of care standards at that time.
That is no longer the case, as it’s common knowledge that a healthy pregnancy is possible for those with this autoimmune condition. The common use of insulin pumps, continuous glucose monitors, rapid-acting insulins, and more advanced diabetes care has changed the landscape for T1D and pregnancy.
Diabetes management becomes an even more important part of life when you’re preparing for pregnancy and when you are expecting a child. That means close attention to blood sugar levels and many other aspects of diabetes care, and your healthcare team can help you navigate this significant moment in your life.
Consistently high blood sugars and a higher three-month average A1C raises the risk for more T1D pregnancy complications with T1D.
Research has found that women with T1D have slightly decreased fertility rates, especially in those with existing diabetes complications, including retinopathy or neuropathy. Women with type 1 are more likely to have irregular menstrual cycles and delayed ovulation because of consistently high blood sugar levels.
But for women without complications and blood sugars in the target range, overall fertility rates have improved over the past couple of decades, thanks to better insulin and management options.
Blood sugars during pregnancy
The American Diabetes Association’s (ADA) Standards of Care recommend that people with diabetes who are pregnany will want to aim for these blood sugar targets:
- a fasting glucose 70–95 mg/dL
- under 140 mg/dL an hour after eating
- under 120 mg/dL two hours after eating
Your healthcare team, including diabetes, pregnancy, and other professionals, are the best to consult and your personal goals for diabetes during pregnancy. They can best advise you on specific targets and perosnalized goals that are best for you.
Your diabetes management during the 6 months before getting pregnant can have a significant impact on the health of that growing fetus, because your blood sugar levels impact the health of your eggs.
While not all pregnancies are planned, one of the best things you can do as someone with T1D who wants to become pregnant is to spend at least 6 months preparing for pregnancy by maintaining an A1C below 7%, recommends Jennifer Smith, RD, CDE, pregnancy coach and co-author of the “Pregnancy with Type 1 Diabetes” book.
That way, by the time a pregnancy test turns up positive, the mindset of keeping your blood sugars mostly in the 80 to 150 mg/dL range will feel more natural — and it will boost your confidence for doing so when there’s a bun in the oven, too!
Many choose to use insulin pump technology for insulin delivery during their pregnancy, possibly using many different pre-programmed rates to fine-tune their diabetes management.
However, insulin injections through prefilled insulin pens or a syringe and vial can be just as effective as the technological choices.
Multiple daily injections, or MDI, are not off the table.
The main trade-off of using MDI to manage your diabetes instead of an insulin pump is that you’ll need to take many more injections per day. This might make you consider whether you’d prefer pressing the buttons on a pump to receive those extra doses of insulin throughout the day to stay in a tighter range versus taking an injection each time you want to lower your glucose level to that target range.
Your insulin needs
You can discuss this option with your healthcare team and check your health insurance coverage to determine what is most affordable for you.
Consider a CGM
If possible, everyone with T1D may want to consider using a CGM during pregnancy to better monitor blood sugar levels and keep them in target range. Research shows the benefits for those with T1D during pregnancy, and diabetes guidelines recommend target glucose levels before and during pregnancy — something CGM could be ideal for.
Trying to achieve this range without a CGM can mean pricking your finger to test blood sugar several times per day.
A CGM may give you so much more information, support, and safety compared to constant finger pricks.
Achieving tighter blood sugar levels is also largely tied to what you eat.
This 2023 research found that women with T1D may gain more weight during pregnancy, meaning it can be even more important to balance eating habits with potential weight gain during pregnancy. The researchers encourage lifestyle and eating habits that can help limit how much insulin is needed, to avoid adding weight during pregnancy.
As someone with T1D, it’s not recommended to indulge in a pregnancy craving of eating a container of Oreos or half a loaf of bread.
Instead, you can work with your healthcare team and a T1D-pregnancy nutritionist to coordinate your eating plan and help you learn to work through pregnancy cravings.
This might include having 1 modest serving of dessert per day, or finding creative, healthy snacks to indulge in during those moments of craving. For example, low carb cold veggies with a healthy dip or spread that won’t dramatically affect blood sugar levels.
High blood sugars before and during pregnancy
In this
But well-managed diabetes can just as easily mean a healthy, happy pregnancy.
In recent years, obstetrics’ protocol for all pregnant people has evolved to inducing or delivering via C-section by 38 to 39 weeks.
So, suppose you’ve demonstrated tight blood sugar management throughout your pregnancy, and there are no concerns. In that case, you should be able to wait until you go into labor naturally, without pressure to undergo an early C-section.
Or you may go into labor at 35 weeks before anyone has even begun discussing inducing labor or scheduling a C-section.
There are so many variables that affect how a baby is born. The most important thing is that you and the baby are as healthy and safe as possible on the big day.
At the end of the day, no one knows how a baby will come into the world. You may need an emergency C-section for reasons utterly unrelated to your diabetes.
If you do need induced labor or a C-section, it remains just as important for close blood sugar management during labor. This means a CGM or a hospital monitor can be key tools during this delivery process, especially if you haven’t been able to eat or drink anything in advance because of the induced delivery.
Knowing what to expect
Breakthrough T1D, formerly known as JDRF, is one of the leading resource centers for information about pregnancy and diabetes. The organization has led research on this topic for decades, and the current clinical guidelines are primarily based on that research.
This resource guide may be helpful for those planning or going through pregnancy with T1D.
Higher blood sugar levels can lead to a chubbier baby. Even in T1D women with A1Cs in the low 6s and high 5s, your baby can be a little chubbier because your blood sugars are still inevitably a little higher than someone without diabetes.
However, there is no guarantee you will have a larger baby. And if you do, there’s no 100% guarantee it will be a result of anything tied to diabetes.
This can take a mental health toll, too.
Don’t be afraid to speak up for yourself. If you need to, remind your doctor that you’re doing the very best you can to manage blood sugar levels in a body that doesn’t manage them on its own.
Just like with fertility, people with T1D can experience lower breast milk production the way people without diabetes do, too. But having T1D alone does not mean you will experience this issue.
Producing breast milk will affect your blood sugar levels, and research does show that breastfeeding parents with T1D make breast milk that has higher glucose levels in the milk compared to those breastfeeding without diabetes.
After your baby nurses, your body will burn a significant number of calories in order to replenish your milk supply in time for your baby’s next feeding. This is similar to going for a short power walk — and it can lower your blood sugar.
Some diabetes guidance recommends working with your healthcare team on a plan that reduces fast-acting insulin doses for meals eaten shortly after nursing, or eating a small snack of 10 to 15 grams of carbohydrates after a nursing session to prevent oncoming low blood sugars.
Diabetes has genetic links and can be passed down in families.
However, that is not guaranteed. There are many risk factors for T1D, an autoimmune condition.
The ADA’s research on genetics and diabetes describes certain factors that may affect a child’s risk of developing T1D, including:
- If you are a man with T1D, your child has a 5.8% chance of developing the condition.
- If you are a man with T1D and your baby was born before you turned 25, your child’s odds of developing it are 4%. If your baby was born after you were 25, your child has a 1% chance of developing it.
- If you developed T1D before age 11, your child is twice as likely to develop type 1 diabetes at some point in their life.
- If both you and your spouse have T1D, your child’s risk is between 10% and 25%.
TrialNet is testing children and siblings of people with T1D across the country for autoantibodies that indicate whether your immune system is attacking itself. Their research has found that if a child has no autoantibodies or just 1 autoantibody before turning 5 years old, their likelihood of ever developing T1D is extremely low.
You can have a healthy, happy pregnancy with type 1 diabetes.
Having this autoimmune condition does mean that managing blood sugar levels before and during pregnancy is even more important. It can play a big role in your own health and pregnancy, as well as your baby’s health.
You can discuss different aspects of pregnancy planning and management with your diabetes and healthcare team, including the possible use of a CGM to keep blood sugars in range.