Once upon a time, women with type 1 diabetes were told they could never have children. Thankfully, today it’s common knowledge that a healthy pregnancy is quite possible.
Still, there are a lot of open questions and misconceptions. Here are nine important facts about pregnancy and T1D, clarified:
MYTH: Having type 1 diabetes can make getting pregnant very, very difficult.
FACT: The healthier your blood sugar levels are, the easier getting pregnant will be, but women with type 1 diabetes can have difficulty getting pregnant just like anyone else.
It’s easy to assume (and worry) that because your body struggles to produce insulin, it will struggle to become pregnant, too.
The truth is that whether or not you have type 1 diabetes, you may have difficulty getting pregnant because some women simply do. Consistently high blood sugars and a high A1C (3-month average) are the most likely way type 1 diabetes would make getting pregnant more challenging.
Research has found that women with T1D have slightly decreased fertility rates — especially in those with existing complications like retinopathy or neuropathy. Women with type 1 are more likely to have irregular menstrual cycles and delayed ovulation — but again, these are associated with consistently high blood sugar levels.
But for women without complications and reasonable blood sugar management, overall fertility rates have improved significantly over the past couple of decades thanks to better insulin and management options.
Fortunately, there’s something you can do about this: work with your healthcare team to improve your overall blood sugar management and bring your A1C down to a healthier level.
MYTH: You only need ‘super tight’ blood sugar management during pregnancy.
FACT: Your blood sugars and A1C level prior to getting pregnant can have a big impact on your baby’s development.
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 a woman with type 1 diabetes who wants to become pregnant is to spend at least 6 months preparing for pregnancy by maintaining an A1C below 7 percent, recommends Jennifer Smith, RD, CDE, pregnancy coach and coauthor of “Pregnancy with Type 1 Diabetes.”
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!
MYTH: You must use an insulin pump and continuous glucose monitor during pregnancy.
FACT: Women who prefer multiple daily injections can have very healthy pregnancies, too!
An insulin pump and continuous glucose monitor (CGM) are two tools that can certainly help many women achieve better blood sugar management before and during pregnancy — but it can be done with multiple daily injections (MDI), too.
The 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. If you aren’t willing to take an additional injection to bring a 160 mg/dL blood sugar down to 100 mg/dL, for example, then using MDI during pregnancy may not be the right choice for you. Pressing the buttons on a pump to receive those extra doses of insulin might be easier for you.
Another challenging aspect that comes with MDI is that none of today’s long-acting insulins have been studied for their safety in pregnancy. There is no reason to believe any of these insulins are harmful to a baby, either, but there just isn’t any data on it. Women have been using these insulins during pregnancy over the last decades with the outcome of healthy, beautiful babies!
If possible, every woman with type 1 diabetes should consider using a CGM before/during/after pregnancy to make healthy blood sugar levels more achievable. Trying to achieve this range without a CGM can mean pricking your finger to test blood sugar at least 10 to 15 times per day. A CGM will give you so much more information, support, and safety compared to constant finger pricks.
The same goes for using diabetes devices during pregnancy: there is no specific data available, but anecdotally they have been shown to be quite safe. Since high maternal blood sugars are proven to be dangerous, you are certainly erring on the side of caution by opting to use the best technology available.
MYTH: During pregnancy, your blood sugars need to be perfect.
FACT: Even during pregnancy, perfection isn’t possible.
There’s no arguing that the healthier your blood sugars are during pregnancy, the healthier both you and your baby will be, but that does not mean your blood sugars need to be perfect.
There are simply too many variables — especially during pregnancy — that make “perfect” diabetes management impossible.
However, this is why it’s so important to use a CGM during pregnancy. Your insulin needs will change often during pregnancy, which means you’ll have to work with your healthcare team to make frequent adjustments to your insulin doses for meals, corrections, and basal/background insulin needs.
Achieving tighter blood sugar levels is also largely the result of what you eat. As women with type 1 diabetes, you simply cannot afford to indulge in a pregnancy craving to eat a whole container of Oreos or half a loaf of bread. Learning how to work through those cravings and indulge in thoughtful ways — like one modest serving of dessert per day — will make it that much easier to keep your A1Cc closer to the desired level of 6 percent.
MYTH: You’ll have to be induced and deliver via Cesarean section because you have diabetes.
FACT: There are many factors that determine how your child will be born.
The sad fact is that women with diabetes are 5 times more likely to deliver a stillborn baby compared to women who do not have diabetes. However, it’s important to note that blood sugar levels, cigarette smoking, diabetic kidney disease were also likely factors in the population that produced that statistic.
In recent years, obstetrics’ protocol for all pregnant women has evolved to inducing or delivering via C-section by 38 to 39 weeks. So if you’ve demonstrated tight blood sugar management throughout your pregnancy, and there are no concerns, you should be able to wait until you go into labor naturally, without pressure to undergo an early C-section.
Whether or not you have type 1 diabetes, your delivery plan is really more of a hope. At the end of the day, none of us knows how our baby will come into the world. You may need an emergency C-section for reasons completely unrelated to your diabetes.
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 both you and baby are as healthy and safe as possible on the big day.
MYTH: You will have a bigger baby because of your diabetes.
FACT: You could easily have a larger baby, and it may have nothing to do with your diabetes.
This is a frustrating one — and likely something you’ll have to hear or discuss constantly during your pregnancy, during ultrasounds and after your baby is born. “Macrosomia” is a term used to describe a baby that is larger than normal — defined as over 8 pounds, 13 ounces.
Yes, higher than normal blood sugar levels can lead to a chubbier baby. Even in T1D women with A1Cs in the low 6s and high 5s,
This is part of why women are often induced earlier than 39 weeks, but it can feel unfair at times, too. You may have non-diabetic friends whose babies weighed well over 8 pounds but were told their baby was normal.
When a woman with type 1 diabetes has a baby well over 8 pounds, she’ll likely hear something like, “Ah, well, that’s because of your diabetes.”
It can be frustrating and come with an unspoken sense of failure because your baby is chubby, despite being healthy in every other way. In this case, speak up for yourself. Don’t be afraid 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.
MYTH: You will struggle to produce breast milk because of diabetes.
FACT: You can absolutely produce adequate breast milk as a mother with type 1 diabetes.
Just like with fertility, women with T1D can struggle with breast milk production the way non-diabetic women do, too. But having type 1 diabetes alone does not mean you will inevitably struggle in this area.
“Yes, blood sugar levels can interfere with breast milk production, but that’s only likely if you’re well over 200 mg/dL (blood sugar level) for days and days,” explains Smith. “For a woman with type 1 diabetes doing her best to manage an A1C in the 6s or 7s, producing breast milk shouldn’t be a problem.”
It’s important to note, however, that producing breast milk will affect your blood sugar levels. 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.
Smith 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.
MYTH: You will pass type 1 diabetes onto your children.
FACT: There are many factors that determine your child’s risk of developing type 1 diabetes.
Thanks to TrialNet.org and the American Diabetes Association (ADA), there’s a great deal of research helping to determine different factors that affect the likelihood of type 1 diabetes in children with a parent who has the disease.
The ADA’s research has pinpointed certain factors that affect your child’s risk of developing type 1. For example:
- If you are a man with type 1, your child’s odds of developing it are 1 in 17.
- If you are a man with type 1 — and your baby was born before you turned 25 — your child’s odds of developing it are 1 in 25. If your baby was born after you were 25, your child’s risk is 1 in 100.
- If you developed type 1 diabetes 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 type 1 diabetes, your child’s risk is between 1 in 10 and 1 in 4.
TrialNet is testing children and siblings of people with type 1 diabetes 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 age 5, their likelihood of ever developing type 1 diabetes is extremely low.
For children who do test positive for autoantibodies, research studies are working to delay or prevent the full onset of the disease. Participating in TrialNet is free for any child or sibling of a person with type 1.
MYTH: Your pregnancy can be just like any other woman’s pregnancy.
FACT: Managing type 1 diabetes during pregnancy will likely be one of the most challenging things you do — but you can do it!
An insulin pump and a CGM can help, but they do not make pregnancy with type 1 diabetes simple or easy. No matter how you dress it up, managing this disease during pregnancy will be one of the most physically, mentally, and emotionally challenging things you encounter. It is a 24/7 job that comes with tremendously more pressure, stress, and variables than an ordinary day with type 1 diabetes.
But you can do it! Don’t let type 1 diabetes stop you from pursuing motherhood. Work closely with your healthcare team. Ask for help. Seek out other mothers with type 1 online, and take it one day at a time.
Ginger Vieira is a type 1 diabetes advocate and writer, also living with celiac disease and fibromyalgia. She is the author of “Pregnancy with Type 1 Diabetes: Your Month-to-Month Guide to Blood Sugar Management” and several other diabetes books found on Amazon. She also holds certifications in coaching, personal training, and yoga.