Among the topics least talked about with type 1 diabetes (T1D) are abortion and miscarriage.
Adding T1D to either of these experiences can add a whole new layer of risk and worry.
Here, we’ll discuss what you need to know if you have T1D and are experiencing a miscarriage or having an abortion.
We also include testimonies from women with T1D about how the end of a pregnancy affected their mental health and blood sugars.
The short answer is “yes,” but the more complete answer is that people with well-managed T1D have no more risk for experiencing miscarriage than their peers without diabetes.
“Chronically high blood sugars at the time of conception make you twice as likely to experience a spontaneous miscarriage compared to a non-diabetic pregnancy,” explains Jennifer Smith, diabetes care and education specialist (DCES) at Integrated Diabetes in Wynnewood, Pennsylvania, and co-author of “Pregnancy with Type 1 Diabetes.”
“Yes, unmanaged blood sugars are a huge cause of early miscarriage, but well-managed blood sugars are not,” Smith says.
This is why people with T1D are heavily encouraged to achieve an A1C at or below 7.0 percent before intentionally conceiving.
To clarify, having the occasional high blood sugar around the time of conception does not cause miscarriages.
What Smith is describing is the negative impact of long-term high blood sugar levels and persistently high A1C levels during the months leading up to and during the beginning of your pregnancy.
“If you’re going to miscarry due to unmanaged diabetes, it will likely happen very early, in the first 8 weeks of pregnancy,” she says.
“It’s important to remember, though, that for most women with reasonably healthy blood sugar levels, it’s 99 percent likely that your diabetes was not the cause of your miscarriage,” Smith adds.
“Early miscarriage usually means… something was not quite right in that developing fetus, and your body ends the pregnancy because it knows it’s not healthy and not viable. This is the most common cause of miscarriage, and it also applies to women with well-managed type 1 diabetes,” she says.
If you consider what we know about how persistently high blood sugar levels can damage nerves and blood vessels throughout your eyes, kidneys, fingers, toes, etc., then it isn’t hard to see why it can
The health of your uterus is just as affected by those long-term high blood sugar levels.
High blood sugars also contribute to congenital conditions that can develop in the first trimester.
“When you become pregnant, during the first trimester the cells of that fetus are dividing and forming first into heart cells, arm and leg buds, ears and eyes, the mouth palate, and external genitalia,” Smith explains.
The next trimester includes the forming of the brain, spinal cord, and more.
“This is why women with diabetes are told their pregnancy faces a higher risk of birth defects — because persistently high blood sugar levels can interfere with the healthy development of every part of that fetus’s development,” Smith says.
If you look into any forum discussion about the effects of a miscarriage or abortion on blood sugar levels, you’ll likely find a huge variety of experiences. There are two reasons for this.
“It’s about hormone levels,” Smith says, adding that estrogen and progesterone levels are changing quickly as soon as you become pregnant.
“First, how far along was the pregnancy before [it] was dissolved via miscarriage or abortion?” she says.
“If you only got to that 4- or 5-week mark of pregnancy, you’re just starting to see changes in insulin needs as progesterone levels rise, so you may find a quick dip in your insulin needs after a miscarriage or abortion if you had made adjustments in your insulin doses as those hormones come crashing back down to normal levels.
“If you’re in the late first trimester, you may not notice a big change in insulin needs because that’s a common point in pregnancy when insulin needs drop due to heightened insulin sensitivity,” Smith says.
This means your insulin needs at this point could’ve come back down to your nonpregnant insulin needs, thus you wouldn’t notice a big difference if the pregnancy ended around this stage.
Smith recommends writing down your nonpregnancy insulin doses so you have something to compare to that helps you fine-tune back to your normal doses after pregnancy.
“There’s also a big difference in how quickly the pregnancy was dissolved,” Smith adds. “If you miscarried at home, that process is less abrupt and the effects on your diabetes will be more gradual.”
For example, if your miscarriage or abortion required a dilation and curettage (D&C), an abrupt procedure to clear the body of the pregnancy, it can lead to very abrupt changes in your insulin needs, too — especially if you had adjusted your doses for the pregnancy.
A D&C is a medical procedure that removes tissue from the inside of the uterus. It’s used for a wide range of reasons, including miscarriage, abortion, and hemorrhaging.
“At the end of the day, there is no one-size-fits-all plan of how these events impact your blood sugar levels. Just like a woman’s menstrual cycle, there are so many variables happening with each and every woman’s miscarriage or abortion,” Smith says.
“You also have to consider the emotional stress you’re going through at the time, and the weeks afterwards,” Smith says. “If you’re sad and depressed, if you’ve changed your normal routine around exercise and food, these can all have a sudden impact on your diabetes.”
Regardless of whether you were trying to get pregnant or not, experiencing a miscarriage or abortion can be a stressful event in your life.
Don’t underestimate the impact of stress on your blood sugar. Higher stress levels increases cortisol levels, which means your liver is releasing more glucose, meaning you’ll need more insulin.
Even the most subtle stress can call for an increase in your background insulin needs.
Both experiences can come with feelings of failure, shame, fear, worry and guilt. If you’re struggling with these emotions, reach out for help from friends, family, your healthcare team, or professional counselors.
If you find yourself having trouble working through your emotions, reach out for help from friends, family, your healthcare team, or a therapist or counselor. Your doctor can give you a referral to a therapist or counselor.
“You cannot compare what happened to your friend’s blood sugars or someone’s experience on Facebook,” Smith says. “There are just too many details that can make the impact it has on your body and your blood sugars completely different.”
“Yes, I had an elective abortion at 26 (I’m now 50) I was 12wks. Please whatever you do make sure you inform whomever is taking care of you what you are doing. As women we sometimes keep silent for fear of judgment. I know, I’ve been there. I told no one. Got sick from the meds and severe nauseated. Couldn’t eat, too weak to check sugar, went into DKA. I nearly died.”
“I had to have a D&C for a miscarriage, which is basically the same thing, or at least a similar procedure. I think my blood sugars went up just a little bit, but nothing high enough to cause any trouble.”
“I had a termination at 7 weeks, it didn’t have much of an effect on my sugars, I was battling a crippling kidney infection and near failure at the time though. The stress and emotion after affected my sugars though. It wasn’t a wanted termination, it was the only option to protect me. I had a few spikes while hormone levels settled down.”
“My baby had development complications due to my diabetes and I chose to have a ‘termination’ at 26 weeks. I could have continued with the pregnancy for the same outcome but once the baby left me it wouldn’t have survived! It was the most difficult decision I’ve ever had to make in my life!”
“Still one of the hardest things to talk about for me, I had complications and had to have one. It did mess up my sugars for the day but I was fine the next day. Emotionally not so much.”
“I terminated at 16 weeks. Because I was fairly far along my insulin needs had increased substantially. They decreased to a normal level immediately following surgery.”
“I had a miscarriage, my sugar was off for about 4-6 weeks after my D&C due to the hormones changing and such which I’d assume would be similar in the event of an abortion.”
“I had a miscarriage and the procedure is the same. Elective abortion and miscarriage are both taken care of as an abortion procedure. My blood sugars were wacky for a couple weeks as the hormones from my pregnancy were coming down. If you are getting the surgery which I highly recommend, make sure they schedule it in the AM.”
“I had an abortion at 6-7 weeks. Blood sugars went a little wild with the hormones given before the procedure but only lasted a couple of hours on the day. After that, I had a spike here and there but nothing major or treatment resistant. Just until my hormonal levels went back to normal.”
“I had a miscarriage in 2019, my sugars were wonky for about 2 weeks after. Just lots of highs and lows, not really any in between.”