Having Type 1 Diabetes doesn’t mean that you can’t or shouldn’t get pregnant. It does, however, mean that you need to have your blood sugars well-controlled before you get pregnant. If your pregnancy is unplanned, don’t stress, just start working with your endocrinologist to get your blood sugars under control. Since Type 1 Diabetes during pregnancy does categorize you as high-risk, you will need to have additional testing and procedures done to ensure the health of you and your baby.
Some women feel comfortable with handing their care over to their provider, but we encourage you to do your research and be a part of the decision-making process regarding your care. You should hire a provider you trust, can have honest discussion about your care, and be involved with the decisions about your care.
Some of the typical procedures you can expect to have done on top of your routine prenatal care:
Monthly Endocrinology Appointments
If your diabetes care is with an endocrinologist, you will meet with them once per month to check your A1c, adjust your carbohydrate ratios, adjust insulin needs, and adjust your corrections sensitivity for when you are over your target range. Your target range for pregnancy will typically be around 80-110 mg/dL fasting and a 1-hour post-meal target of 100-155 mg/dL. Although this is not always achievable (as is the nature of the beast), your endocrinologist will work with you to adjust things to make this more attainable.
Your blood sugars may drop at the beginning of pregnancy because of the hormones secreted by the placenta causing decreased glucose by the liver. Usually by the end of pregnancy your insulin needs increase by about three times, now because of different hormones secreted by the placenta causing insulin resistance. This is also why some women develop gestational diabetes.
OB or Midwife Appointments
You do not need to work with Maternal Fetal Medicine (MFM) for your routine care, or a Perinatologist, if you don’t want to. However, MFM will consult with your OB or midwife for your care due to your increased risk. You may be able to have a Certified Nurse Midwife (CNM) as long as they work in conjunction with MFM, as you typically risk out of CNM care. Some direct-entry midwives may be willing to take you as a patient if you have excellent care and prefer a home birth. Most direct-entry midwives will want you to keep up on your prenatal care with MFM in case any issues do arise.
Typically your care provider will want you to start having Non-Stress Tests (NST) around 32 weeks. If everything looks good with you and your baby, you can negotiate with your birth team about holding off until 34 weeks. Some women are leery of ultrasounds because scientists do not know the long-term effects of cavitation, heat, or acoustic streaming caused by ultrasound, so some women like to avoid any unnecessary ultrasounds.
Once you start your NSTs, your care provider may want you to have them twice per week. This can also be negotiated to weekly, if signs are showing that you and your baby are healthy. If your care provider is not willing to negotiate when you and baby are healthy, this may be a red flag and you should consider other providers.
During the NSTs they will also look at the Amniotic Fluid Index (AFI). The range for AFI is 8-18, but varies by gestational age. Closer to delivery amniotic fluid levels typically decrease. Diabetics tend to have higher amniotic fluid levels, especially if their blood sugars have run higher. Just like when your blood sugar runs high and you urinate more frequently, so does your baby which makes the amniotic fluid (baby’s urine) levels higher.
Your care provider may want you to have growth scans every few weeks as you get closer to delivery. Keep in mind that ultrasounds are not very accurate, but it is the best tool they have. Ultrasounds can be off by up to two pounds in either direction. If your care provider wants to induce or schedule a cesarean due to just the size of your baby, we suggest doing your research and even getting a second opinion. Just because your baby is measuring large does not mean that you cannot have a vaginal delivery.
Doctors like to induce diabetics for large babies because they are concerned about the increased risk of shoulder dystocia. There are signs to watch for with shoulder dystocia, like an abnormally long labor and/or pushing phase. There are also things that can be done if shoulder dystocia does occur. We encourage you to do your research on this subject and follow your motherly instincts. We encourage you to make your decisions based on asking your provider the B.R.A.I.N acronym (Benefits, Risks, Alternatives, Intuition, do Nothing) instead of fear. If your provider uses scare tactics like the “dead baby” card instead of backing up their opinions with facts that make sense to you, it might be best to look for a different provider that will take into account your goals for this birth.
Staying Healthy and Lowering Your Risk
It is important to eat well, exercise often, and keep your blood sugars as close to the target range as possible. Even with doing these things, you may still have a large baby, and that is okay. Some people just have big babies; be sure to take your and your partner’s genetics into consideration.
Stay tuned for our next blog post, “Diabetes: Reducing Risk of Complication During Pregnancy”.
Always consult your care provider. This general information is not intended to diagnose any medical condition or to replace your healthcare professional. Consult with your healthcare professional to design your appropriate care.
Karina was diagnosed with Type 1 Diabetes at the young age of 4. In spite of her diabetes, she has had three healthy children. It was after her first pregnancy and birth where she found her passion in helping other women to have empowering birth experiences. You can find out more about her and her birth experiences at our About Us page.