Pregnancy With Type 1 Diabetes

Forty five years ago when I was diagnosed with type 1 diabetes I was clearly told I couldn’t have children. I didn’t. Today, thankfully that advice is no longer given. And while a woman with Type 1 diabetes needs to take precautions, she can absolutely, and safely, have a healthy baby.

I sat down for an interview with Ginger Vieira, co-author,with Jennifer Smith, of the recent book, Pregnancy with Type 1 Diabetes: Your Month-to-Month Guide to Blood Sugar Management.

What will people find in the book?

As much information as you possibly need to understand why your blood sugars fluctuate during pregnancy and how to adjust your insulin management to keep your blood sugars as close to non-diabetic levels as possible. Also the book covers preparing for pregnancy, months one through nine of your pregnancy, delivery, and postpartum, including the challenges of breastfeeding for a woman with type 1 diabetes.

My co-author Jenny is also my diabetes pregnancy coach. As a certified diabetes educator, woman with type 1 diabetes and mother, she knows this journey inside and out.

What makes pregnancy for a woman with type 1 diabetes challenging?

Let’s face it, a normal day with type 1 diabetes is challenging, balancing an autonomic system your body ought to balance on its own. And we’re only given insulin to do the job, while a non-diabetic body uses several different hormones to balance blood sugar.

Add pregnancy to that mix and you add the insane pressure of, “Every decision you make impacts the human life growing inside of you!!!” And now you have to balance your blood sugars with constantly shifting pregnancy hormones. Plus those hormones impact your insulin needs in ways that are constantly changing and evolving.

Also, there is never a break. Even when you’re sleeping it’s crucial to ensure your blood sugar is as close-to, or within, the non-diabetic range as possible.

The higher your blood sugars are during pregnancy the greater the risk of complications for mom, birth defects in your baby and having a bigger baby. A bigger baby is the result of your baby getting way more sugar from your blood while you’re pregnant than from a non-diabetic mom’s blood. This also makes the baby more prone to getting diabetes in its lifetime.

Was your doctor concerned about your becoming pregnant?

Nope! Not one bit. But if you can plan your pregnancy then you definitely want to do that with your doctor. One particular thing to be aware of is if you have pre-existing complications, for instance in your eyes (retinopathy), pregnancy can exacerbate that condition. So your healthcare team, including your eye doctor, will really be able to care for you best if everyone knows you’re thinking about getting pregnant.

What do you think could be improved regarding how health professionals work with pregnant women with type 1 diabetes?

One of the weakest parts of my healthcare experience was during delivery/c-section/postpartum because the healthcare team and the hospital seemed to be terrified of giving me too much insulin and causing my blood sugar to go too low. As a result, during my first pregnancy, I actually sneaked giving myself extra injections of insulin so I could maintain healthy blood sugar levels. This shouldn’t be necessary. I think the overall understanding and education of what a type 1 woman needs during this part of pregnancy really needs an update and a deeper educational protocol. My advice to any pregnant woman reading this is: don’t be afraid to speak-up, advocate for yourself and be firm.

Women with type 1 are generally induced or scheduled for a c-section around 38 weeks, why is this? Did this happen to you?

The statistics show that diabetic women (type 1 and type 2) who go past the 38-week mark have an increased risk of experiencing a stillbirth and other complications. So this was one area I wasn’t gonna fight anybody on.

At the end of the day I can tell you that Lucy’s birth was just as amazing and mind-blowing even though I had a c-section. It felt incredibly special and my recovery was actually pretty easy. I expect to have another c-section with Violet unless I go into labor naturally on my own prior to 38 weeks and the doctors think a VBAC (vaginal birth after cesarean) is safe to pursue. All I want is a healthy baby and for me to be healthy too.

This time, carrying your second child, what’s different?

In a nutshell, I worry less. When you start simply thinking about pregnancy as a woman with type 1 diabetes you constantly come across warnings and lectures, “This could happen!” and “That could happen!” and “You have to be the perfect diabetic or else!” It’s incredibly overwhelming. Plus you want to be perfect because you feel like the odds are stacked against you.

The reality is that women with type 1 diabetes can absolutely have successful, healthy pregnancies and create healthy, beautiful babies. This time I knew that I was going to have days where my blood sugars would run higher because of a sudden increase in pregnancy hormones. So now I see those higher, stubborn blood sugars as just my signal that it’s time to increase my insulin doses.

This time I’m also not trying to achieve an A1C lower than 5.7 percent. I know my capacity to stress about my blood sugars and I need a standard I can maintain without bursting into tears from stress, right?

Unlike you I was lucky enough to be starting my family at a time when we know women with type 1 diabetes can safely have healthy children. My advice is simply work with your health provider because it’s important to be in good health before you get pregnant and fortify yourself with knowledge so when the bumps come you know how to ride them.

Ginger Vieira is the author of three books, a health coach and mother of one daughter with Violet due next month. She has lived with type 1 diabetes and celiac disease since 1999, and fibromyalgia since 2014.

Jennifer Smith is a Certified Diabetes Educator and Registered Dietician who has lived with type 1 diabetes since 1990. Jenny and her husband have two boys.