Diabetes and Pregnancy: Patient and Doctor Tips

Concerned about starting a family? Diabetes and pregnancy can be a tough pairing — although contrary to old school thinking, it’s more than possible to have a healthy pregnancy and healthy baby if you are living with type 1 or type 2 diabetes.

To Find a few of the best and many down-to-earth advice possible, we talked recently with two wonderful pros, one from the doctor side and one by the patient POV:

Dr. Kristin Castorino of the William Sansum Diabetes Center at Santa Barbara, who among other things follows in the footsteps of renowned D-pregnancy expert Dr. Lois Jovanovič, serving as the attending doctor in the Santa Barbara County Public Health department instructing medical residents how to care for women with diabetes and pregnancy.

Brooke Gibson, a form 1 for 32 years who has had four healthy pregnancies (!) And is founder of T1D Sugar Mommas, a San Francisco Bay Area support group for expectant and new moms with type 1 diabetes.

Both were kind enough to share their best gems of insight with our community at the following double-interview.

As always, we invite anyone with first-hand knowledge of these subjects to delve in, in the comments section below.

(Also, stay tuned for an summary of Gestational Diabetes, that we’ll publish soon with some great suggestions on dealing with this condition specifically.)

DM) Ladies, on your opinion, what are the largest overall misconceptions about diabetes and pregnancy?

Dr. Castorino) I think the greatest misconception about diabetes and pregnancy is there are only two countries — pregnant and pregnant.     In Fact, pregnancy is much more complex.     A female’s body structure is changing rapidly — and may necessitate almost weekly alterations to her diabetes regimen, such as changes in insulin condition or changes in the way your body responds to carbohydrates. The first trimester is a period where women are most sensitive to insulin and may also be fighting morning sickness and the two of them May Lead to more frequent hypos.     On the opposite end — the next trimester is well known for significant insulin resistance. Many women’s insulin demands double their pre-pregnant level from the final months of pregnancy. Not to be forgotten is the postpartum period.     Soon after ingestion, many T1 women’s insulin demands drop by 70-80 percent particularly if they are breastfeeding.

Brooke Gibson) By an overall overall perspective, the largest misconception seems to be that diabetic women can’t have healthy babies, and this is the furthest thing from the truth.

What do women have a tendency to worry about most that is unfounded?

Dr. Castorino) It’s true that many women with pre-existing diabetes stress that they cannot have a healthy baby.     Their Web searches, and maybe old medical remarks have skewed the latest data which shows that women with T1 that is well-controlled have healthy infants ordinarily. I expect all    women with T1D (particularly young ones) understand that T1 should not impede programs for pregnancy.     Additionally, many women with T1 are very concerned they will pass T1 on to their child.     Though there is a risk —    see ADA truth — in most cases the danger isn’t significant (1 in 100). But for guys with T1 the danger is greater (1 in 17).     With all the improvements in diabetes technologies, many diabetes experts concur this should not be a deterrent to people with T1 who are considering starting a family.

Brooke Gibson) I think one of the biggest things… is that if they have a single high blood glucose, they are doing a lot of damage to their baby. While long-term high blood sugars can have a developmental impact, an individual single blood glucose that is corrected quickly should not inflict any issues. This was something that I was always informed by my perinatologist. Particularly in my first pregnancy when I’d freak out about having a high blood glucose, she would remind me I was not keeping it there for an elongated period of time and I was doing the best I could do to correct it immediately.

What SHOULD women with diabetes be most concerned about during pregnancy?

Dr. Castorino) During pregnancy, your goal should be to be in the best hands of T1 or T2 of your life.     During pregnancy, the Aim is near normal blood glucose most of the time.     Scientists at the University of Colorado (Teri Hernandez & Lynn Barbor) showed that women without diabetes have blood glucose Assortment of 60 — 110mg/dL during pregnancy.     From all of the research that has been done for women with diabetes while pregnant, the best way to create the usual glucose environment for infants is to avoid things that cause large glucose changes. By far, the No. 1 cause of unpredictable blood sugars is food — especially food that you know makes your blood glucose high. One trick would be to be “dull” by often eating foods that are reproducible and easy to accurately bolus for. For variety, try vegetables that are fresh.

Risk of Passing Type 1 Diabetes to Your Baby

From the American Diabetes Association:

  • Generally speaking if you’re a man with T1D, the probability of your child developing diabetes are 1 in 17.
  • If you’re a woman with T1D and your child was born before you were 25, your child’s risk is 1 in 25.
  • If your child was born once you turned 25, your child’s risk is 1 in 100.
  • Your child’s risk is doubled if you developed diabetes before age 11.
  • If you and your spouse have T1D, the risk is between 1 in 10, and 1 in 4.

Brooke Gibson) as stated, higher blood sugars are something that you want to attempt to avoid as much as you can, and… the further you progress into the pregnancy the more insulin resistance you will most likely experience. From the time you’re on your third trimester, your basal rates can be changing every 1 to 2 days. This isn’t true for everybody, but for many T1D women. And it’s important to keep in mind that every pregnancy differs. My insulin demands were different in each one of my four pregnancies.      

What is your top tip for women with T1D who are already or trying to get pregnant?

Dr. Castorino) My top tip is that becoming pregnant is a marathon, not a sprint.     Women spend many years trying to avoid pregnancy, then all of a sudden, the stars align and They’re ready to Begin a family.     It’s normal to require a year or two to become pregnant. This Is a Great time to make sure you have all the resources you need for the Ideal T1D management of your life.     If You’re considering obtaining a new CGM or pump, get it.     If you’ve been wanting to change your exercise routine — make those adjustments and find out how they influence your glucose control.

My next tip is that miscarriage is common for ALL WOMEN (10-17 percent of pregnancies end in miscarriage), although maybe not all women prepare for maternity and are watching for the earliest signs of pregnancy.     In fact, about half of all pregnancies in the USA are proposed, and the remainder are a surprise. Many women miscarry and don’t even realize it.     So once you’re working hard at getting ready for pregnancy, in addition, it is important to discover a balance and revel in life “BC” — until kids.

Brooke Gibson) Among the most important steps besides getting good blood glucose control is to be certain that you’ve got a fantastic supportive health care team. You need an endocrinologist and OB/GYN who aren’t likely to make you feel awful for any reason and who will help and encourage you. They need to be knowledgeable and ready to guide you and not make you feel like you’re just screwing this up across the way. It’s extremely important to be open to changes and suggestions as you monitor your blood sugars and food intake. Furthermore, locating a local group like our T1D Sugar Mommas is a great support system! It’s wonderful to be able to talk to women who are in family planning phases, pregnant or have had kids.

Likewise, what’s your top pregnancy tip for women with T2 diabetes?

Dr. Castorino) Women with T2 can find out in their T1 sisters, since much of “what works” for T1 May Be Used for T2.     For example, consider using a continuous glucose monitor to help better manage glucose values, particularly associated with foods.     The same as T1, women with T2 should strive for near-normal blood sugars while avoiding low blood sugars.

Tests & Targets Throughout Diabetic Pregnancy

Instead of the typical A1C test every 3 months, during pregnancy you’ll probably get the test every couple weeks.

Tight glucose control during pregnancy generally aims for 60-105 mg/dL before meals, and less than 140 mg/dL after eating.

Target A1C when pregnant is less than 6 percent.

All pregnant women get an ultrasound about week 18 to monitor the baby’s development; with diabetes, expect to find ultrasound scans considerably more frequently.

Brooke Gibson) I’m not an expert in this area, but I think that it would need to be the same information for a T1: Make certain that you’ve got a fantastic supportive medical staff and any other additional support that you can. It will be very important to see your diet closely as an unlike with T1 you can’t give insulin to control your blood sugars to cover whatever you eat.

What if these women be searching for in a health care professional who can guide them through a healthy pregnancy?

Dr. Castorino) Most women with T1 or T2 in maternity need more than 1 individual on their healthcare team:

  • Obstetrician (OB/GYN) — This is the individual who will deliver your baby. It is nice when they are comfortable with diabetes but it’s frequently not the case. Consult your OB how she or he manages women with diabetes.     This can allow you to build your team.
  • Diabetes and Pregnancy Expert — Look for another healthcare professional who understands this field well, such as a dietitian, diabetes educator, perinatologist, or endocrinologist — the title is less important than the experience.
  • ____________ (fill in the blank) Everybody else who is instrumental in supporting a Wholesome pregnancy, like a counselor or psychologist, or dietitian.    

Build your dream team so you have the help that you need.

Brooke Gibson) It’s definitely a bonus when your doctor has expertise with T1D and pregnancy. But sometimes your health care professionals will only prefer to concentrate within their particular expertise. Making sure you’re in good communication with all your physicians is what’s most important. You can receive your own endocrinologist give you the ability to control your blood sugars and your OB who can guide you during your pregnancy. Ensure that your endocrinologist or OB professional knows to request the additional tests a T1D might want or need, such as an echocardiogram for a fetus at about 18 to 20 weeks and also the strain testing near the end of pregnancy.

Bonus query for T1D Momma Brooke: ​As someone who went through multiple parasitic pregnancies yourself, what would you most like to share on the subject?​​

Brooke Gibson) Being a pregnant T1D is absolutely an additional full-time job along with everything else happening in your life. It’s important to remain on top of your blood sugars and be in good contact with your medical team.

Among the biggest things I’ve learned is to not be too hard on your own. Find a support system that helps you during this experience. A good deal of the fears you may have may be exactly the same as someone who doesn’t have diabetes. Every woman expects to have a healthy, happy baby.

Know that it’s possible to have healthy babies. And also look at it as an edge to take a few extra peaks in the developing baby inside your belly. I certainly enjoyed every one of my additional ultrasounds!

Image Attribution

Image Attribution

URL: https://www.youtube.com/watch?v=zR7CcrijJmw

Thanks to our resident doctor and patient specialists!

**NOTE ALSO**: T1D ExChange is presently running a survey of women with pre-existing T1D who have given birth in the last ten decades, to enhance medical knowledge on diabetic pregnancies. Should you qualify, please take the survey here.  

Some Resources on Diabetes and Pregnancy

JDRF Toolkit for Pregnancy and Type 1 Diabetes — a thorough guide for prospective and present expectant parents with type 1 diabetes accessible electronically and in print. T1D Sugar Mommas logo

T1D Sugar Mommas — Brooke’s San Francisco-based support group for type 1 PWD mothers, also present on Instagram.

Diabetic Mommy — an online blog and community site run by a mom with type 2 diabetes.

“Balancing Pregnancy with Pre-existing Diabetes” — guidebook by urge and T1D mom Cheryl Alkon.

“Diabetes and Pregnancy: A Guide to a Healthy Pregnancy” — comprehensive manual for women with T1, T2, or gestational diabetes by David A. Sacks.

Seven Things That Are Wonderful About Becoming Pregnant with Type 1 Diabetes — a fun take on the condition by famous writer and urge Kim Vlasnik on her site Texting My Pancreas.

Disclaimer: Content created by the Diabetes Mine team. For more details click here.

Disclaimer

This content is made for Diabetes Mine, a customer health blog concentrated on the diabetes community. The content isn’t medically reviewed and doesn’t adhere to Healthline’s editorial instructions. For more information regarding Healthline’s partnership with Diabetes Mine, please click here.

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