Pregnancy and T1D

Whether you’ve just started planning, or are looking ahead, gathering information is the first step to a safe and healthy pregnancy with T1D.

Many women choose to work with a team that includes an endocrinologist, primary care doctor, and an OB-GYN, preferably one who has experience with T1D pregnancies.

Creating a pregnancy plan is the next step. Most experts recommend maintaining an HbA1c at or below 6 percent before you conceive, and maintaining that range throughout your pregnancy. It’s also important early in the planning stages to consider wearing a CGM or Flash GM if you don’t already. These devices will provide additional insight into blood-glucose patterns, helping you maintain healthy blood-glucose levels.

With all the excitement, planning and well-intended advice from friends and family, pregnancy can also feel overwhelming. Take a deep breath. JDRF is here to help you experience a healthy and happy pregnancy.

It is natural for people with type 1 diabetes (T1D) to worry about the possibility of passing the disease on to their children.

Reassuringly, the disease does not develop in a majority of people with genetic risk factors. But that said, your child will have a greater risk of developing type 1 than the general population—on average, this risk is about fifteen times greater for someone with a relative who has the disease.

Besides having a parent with the disease, your child’s risk of inheriting type 1 can be additionally impacted by additional factors like:

• Gender
• Race/ethnicity
• Where you live (the disease is more common in countries further from the equator)
• How old you were when you developed type 1 diabetes
• The presence of diabetes-related autoantibodies in your body
• Whether one or both parents have the disease
• Your age when the baby is born (if you are carrying the baby)
• Having certain immune system disorders in addition to type 1

It is important to remember that one’s genetic makeup is not the only factor at play. In fact, 80 percent of people with type 1 diabetes have no family history of the disease.

If you have type 1 diabetes (T1D) and become pregnant, a birth plan is something you will want to consider.

Whether or not to have one and how in-depth to make your birth plan is a very personal choice, and you are the best judge of that. A birth plan is, in essence, a wishlist of how you would like your baby to arrive into the world. Sometimes this is an official document, and other times it is a discussion that you may have with your doctors and family members. Regardless of the formality, it can help the parents-to-be feel better prepared for the big day.

Of course, no one lives in a perfect world, and in reality, only few birth plans are followed fully. Yet, for  someone pregnant with type 1 diabetes, a big part of the birth process is diabetes management. It is important to discuss blood-sugar management with your medical team to plan how your blood-sugar will be managed from the time you arrive at the hospital until the time that you leave, and what you will do to ensure these plans are followed.

First, talk with your support team about what your ideal plan would be. Discuss your concerns about pain management, birthing options and using a midwife or doula. There are so many questions surrounding childbirth that you may want to get answers in advance, and the best way to figure out what options are right for you is by doing research and seeking information from your medical team.

Below are a few questions that may help you get started. You can build on this list as you and your partner develop your birth plan and generate your own questions:

•  Do I want to receive pain medication at any time during labour, or do I prefer to give birth naturally?
• Who will manage my type 1 diabetes during the labour and delivery (my partner, my doctor, someone else?)
• Will I be able to wear my insulin pump during labour and delivery?
• Do I want to breast-feed or formula feed?
• If my baby experiences a low blood-sugar level after delivery, what are my options?
• Who are the people I want present in the room during my child’s birth? Are there any restrictions on how many people can be there?
• If there is an emergency situation, who will make medical decisions on my behalf or my child’s behalf if I am unable to do so?
• After birth, do I have any plans for the umbilical cord and/or placenta, (which can be used for type 1 diabetes research), stored or encapsulated?

Bring your doctor into the discussion and explain your wants and needs. Work together with your medical team to plan for both an uneventful birth and one that may deviate from expectations.

Remain flexible and open to changing the plan to accommodate any emergencies. The most important end result is health for everyone, and the goal of your medical team is to help you achieve that.

First, ask your obstetrician or midwife if there is a hospital protocol in place for when someone with type 1 diabetes gives birth and more specifically, if there is a protocol for those who use insulin pumps and flash or continuous glucose monitors (Flash GMs and CGMs).

You will want to be aware of any protocols (such as removal of insulin pump, a certain type of insulin that must be used, an insulin drip that must be used, etc.) that do not align with your birth plan. This may require some pre-labour discussions to ensure you remain on current medications throughout the birth experience.

It is also important to discuss your plans for managing any change in insulin dose just prior to and immediately after birth. In addition, your obstetrician or endocrinologist will be able to help you plan for insulin dose changes immediately following birth, during your hospital stay, and once you go home.

Take a copy of these instructions and bring them with you to the hospital. Make sure your endocrinologist and obstetrician have a copy for their charts as well.

Having this information will serve as a great source of comfort if the hospital experience becomes hectic or other aspects of the birth process feel out of your control.

Most importantly, make sure that you and your healthcare team are in agreement about how your type 1 will be managed during and after the birth of your child.

You may be using a continuous glucose monitor (CGM) during the course of your pre-pregnancy and pregnancy months. This can be a very useful tool to help monitor the ever-changing insulin needs of a pregnant body, and may improve blood sugar management, leading to better health outcomes. However, the ability to use a CGM during the actual birth process depends on the delivery method and the individual hospital.

Check with your medical team to see if you will be able to keep your CGM on during labour. If you are having a C-section, your doctor may require that the sensor be removed before surgery. Other doctors may allow you to keep the sensor on. Ask your doctor about their protocol and where they prefer you to wear it (so it doesn’t get in the way) and be sure to voice your preferences.

With type 1 diabetes, even the best-laid plans can change at a moment’s notice. It is good to have a plan for how you’d like your child’s delivery to unfold, but remember, we can’t control everything! Whether or not the delivery goes exactly as planned, know that you are in good hands with your medical team throughout the birth process and in the exciting days and weeks that follow!

Your birth experience will be similar to those who do not have type 1 diabetes. However, one main difference is that your blood-sugar level will be monitored very closely throughout the entire birthing process. If you are not using a continuous glucose monitor (CGM), this means you may need to endure a lot of finger pricks.

This kind of close monitoring is required to ensure that your blood sugars remain within the target range as the physical and emotional stress of labour can potentially increase your blood sugar levels. If you do experience a high or a low during the birthing process, your medical team will give you the necessary amount of insulin or glucose needed to return your blood sugar to the target range.

If, in a worst case scenario, you were to experience a complication during your vaginal birth that would require a C-section, your consumption of food or drink may further complicate the delivery of your baby. This is why it is important that blood sugar levels are closely monitored during labour.

Although it differs slightly across individuals, your insulin requirements will drop dramatically either just before or immediately after you give birth. In fact, many return to their pre-pregnancy insulin requirements at this time. This is dependent on several factors, so your experience may differ from others who have given birth with T1D.