Pregnancy and Type 1 Diabetes
Pregnancy and Type 1 Diabetes
| Author: Judy Kohn, RN, BSN, CDE |
| Last Updated: Monday, February 13, 2006 |
Q: "I have Type 1 diabetes and I use an insulin pump. I want to become pregnant—is that possible, and how will it affect my diabetes?"
A: You ask a very important question and one that needs to be discussed with your doctors, diabetes educator, and dietitian. Providing you are healthy and have no significant diabetes problems, and providing that your diabetes is in excellent control, then yes, it is possible to become pregnant and have a healthy baby.
Important points to consider:
- Increased risks: Although medicine has made significant progress, there are still increased risks to both you and your baby when you have diabetes. However, these risks-such as birth defects, having a large baby requiring a caesarean delivery, maternal toxemia (a disorder that results in hypertension, protein in the urine, edema, headache, and visual disturbances), or worsening of diabetes complications--can be greatly reduced with careful and meticulous diabetes care.
- Pregnancy must be planned: The first 8 weeks of pregnancy are the most critical because this is the time when the baby's organs are developing; poorly controlled diabetes during this period can lead to birth defects. As many as two thirds of all women with diabetes have unplanned pregnancies, and most women do not even realize they are pregnant until 6 or more weeks into the pregnancy.
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Physical assessment of your health before you conceive:
Pregnancy can worsen certain diabetes complications, and/or these complications
can affect the pregnancy outcome. Because of these risks, generally you would
be tested before you decide to become pregnant (i.e. before conception), as
well as periodically during your pregnancy. The complications that can be
affected include:
- Retinopathy (eye disease).
- Hypertension (high blood pressure); your doctor will determine what medications are safe to take during pregnancy.
- Nephropathy (kidney disease).
- Autonomic neuropathy (nerve damage to the internal organs) can interfere with the management of diabetes, if it involves gastroparesis, urinary retention, or blood pressure changes.
- Peripheral neuropathy (nerve damage of your legs, feet, or hands).
- Heart disease: your heart must be able to tolerate the increased demands of pregnancy.
- Varying insulin needs: While your insulin requirements might diminish slightly during the first trimester-- and in fact you may be prone to hypoglycemia-your insulin needs will eventually almost double during the 2nd and 3rd trimester. This means that you will need to test your blood glucose frequently as well as maintain frequent contact with your diabetes team.
- Genetic considerations: According to Medical Management of Pregnancy Complicated by Diabetes, by the American Diabetes Association, 3rd edition, it is rare for a newborn to develop diabetes. If you have type 1 diabetes and are 25 years or older, the chance of your child developing diabetes at some point is approximately 1%. If you are under 25 years old, this chance increases to approximately 4%. If both you and your husband have type 1 diabetes, the risk is not known but is expected to be somewhat higher. If you have type 2 diabetes, the risk of your child developing diabetes is about double the risk of the general population.
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Glucose goals are "tighter" during pregnancy: As
reported from Clinical Diabetes Journal vol. 23, #1, 2005.
- Goals recommended: Pre-meal: less than 95 mg/dl; 1-hour after meals: less than 140 mg/dl; 2 hours after meals: less than 120 mg/dl.
- Note however that some experts recommend stricter goals, with pre-meal readings under 90 mg/dl and 1-hour after meals under 120.
- Be sure to discuss treatment goals with your diabetes team.
Where do you start?
- First discuss this with your diabetes team-your diabetes doctor, obstetrician, diabetes educator, and dietitian. They will provide you with the necessary information to help you decide if you are ready for a pregnancy.
- The most important thing is to get your diabetes control as close to normal as possible, ideally for three months before you become pregnant.
- It goes without saying that achieving good control will require a diabetes team to help you with frequent glucose monitoring (often up to 8 times per day), following an appropriate meal plan, adjusting your insulin dosages throughout the pregnancy, and maintaining regular physical activity.
I know this can sound overwhelming, as you realize that undertaking a pregnancy requires a deep personal commitment to meet the many demands and responsibilities. So it is important to remember studies have shown that the risks to you and your baby are greatly minimized when you work closely with a diabetes team and maintain good diabetes control. Best wishes for a healthy and successful pregnancy.
Related Questions
Gastroparesis
Q:
"Can you explain diabetic gastroparesis?"
Related Links
American Diabetes Association (ADA)
http://www.diabetes.org
U.S. Food and Drug Administration's Office of Women's Health (OWH)
http://www.fda.gov/womens/
LifeClinic
http://www.lifeclinic.com
Juvenile Diabetes Research Foundation (JDRF)
http://www.jdrf.org
Important Notice: The responses provided by the team of Diabetes Educators are based on their personal experiences and expertise as practicing diabetes healthcare professionals, and are not to be considered diabetes management advice from Abbott Laboratories. Remember that information provided by the team of Diabetes Educators is for general background purposes and is not intended as a substitute for medical diagnosis or treatment by a trained professional. You should always consult your physician about any healthcare questions you may have, especially before trying a new medication, diet, fitness program, or approach to healthcare issues.
All tradenames and trademarks not owned by Abbott Laboratories are the property of their respective owners. For details on tradenames and trademarks and their respective owners, visit the non-Abbott trademarks listing.
