Use effective birth control until:
- You want to have a baby.
- Blood glucose levels are in the target ranges.
Conversations about sexual activity and pregnancy prevention need to start in the early teenage years with your child’s pediatrician, family doctor, or endocrinologist.
When you decide you want to get pregnant, but before you stop using birth control, tell your healthcare provider. You will need to meet at least monthly to establish tight blood glucose management, make a nutrition plan, and address additional health issues that may complicate pregnancy. Generally this requires a team, including a diabetologist, a registered dietitian, a CDE (often a nurse or nurse practitioner), and an obstetrician. Be sure to find an OB who is used to treating a person with type 1 diabetes—many treat women with gestational diabetes, but this is very different than treating someone with pre-pregnancy type 1 diabetes. Additionally,you should have a retinal exam performed by your eye care provider to be sure your eyes are in good shape for pregnancy (see details below).
It’s a good idea for both you and your partner to meet at least some subset of the diabetes team. Pregnancy is a challenge on its own; add it to type 1 diabetes and the complexity increases. You will need a support system both before and after the baby is born. Your partner should be ready to give glucagon if you have a severe low blood glucose reaction. Your partner can also help with shopping and meal preparation to be sure mother and developing baby have the right food choices for a healthy pregnancy.
Blood Glucose Management
Women should have an A1C <6.5% before pregnancy and <6% during pregnancy.
Sounds impossible? It isn’t. Even women with high and erratic blood glucose levels can reach and maintain these targets before and during pregnancy. In a way the harder part is after pregnancy, when life is complicated by the presence of a baby. Too often women revert to their old habits, with a higher A1C. This is understandable but not desirable because it is good management over a lifetime that leads to long-term health with type 1 diabetes.
High blood glucose crosses the placenta into the baby’s circulation and triggers the baby’s pancreas to secrete extra insulin, which can create a lifelong abnormality in how they respond to the food. It is important to keep high blood sugar spikes down as well as reduce your A1C.
A flexible insulin plan—multiple daily injections or an insulin pump—is recommended during pregnancy. Both are equally effective in pregnancy; however, some providers prefer pumps. If you are going to switch to an insulin pump, do so well before you go off birth control.
Some insulins are Category C (risk to fetus not ruled out), so your doctor may have you switch to a different insulin.
Nutrition During Pregnancy
Meet with a CDE and a registered dietitian to review carbohydrate counting, dining out, and incorporating snacks as needed. If needed, losing excess weight before pregnancy can reduce the risk of a range of obesity-related pregnancy com- plications. Be consistent with meal and snack times to help smooth out the peaks and dips in blood glucose levels.Take folic acid supplements to reduce the risk of birth defects, and make sure you are getting enough calcium and vitamin D.
Diabetes Complications and Pregnancy
Pregnancy will put your body under significant stress. If you have diabetes com- plications or are at increased risk, you may need to take extra care when plan- ning for a pregnancy. However, with most complications, mother and baby will be fine. It is simply important to be aware of any areas of particular concern.