Women with type 1 diabetes can (and do!) get pregnant and have healthy babies. But you need to be extra vigilant about controlling your glucose levels and working closely with your doctor. Here's what to plan for when you have diabetes and are expecting, or hope to be.
Before you conceive, begin taking prenatal vitamins and book a pre-conception checkup with your endocrinologist. "Most birth defects occur within the first 4 weeks, before many women even know that they're pregnant," says Florence Brown, MD, an endocrinologist and co-director of the Joslin-Beth Israel Pregnancy Program in Boston. Checking your A1c level is essential. "When A1c is under 6.5%, your risk for birth defects is no different than the general population," Brown says.
But if it's too high, the risk of birth defects goes way up -- and so does the risk for preeclampsia (dangerously high blood pressure during pregnancy). Also, if you have complications like retinopathy or kidney disease, your doctor may want to get these issues in check before giving the green light for you to become pregnant.
Plan on Tighter Blood Sugar Control
When you're pregnant, you need to keep your blood sugar in a very tight range: 60 to 99 mg/dL fasting and 100 to 130 mg/dL an hour after meals. Eating high-fiber meals, keeping processed foods to a minimum, and preplanning three meals and three snacks a day should help.
Meanwhile, you'll have to take insulin 10 minutes before a meal rather than with your first bite, and you should expect your insulin needs to change drastically. Your doctor or diabetes educator can guide you on dosing.
Watch Out for Hypoglycemia
When your blood sugar starts to dip dangerously low, you probably get some warning signs, like dizziness or shakiness. But after you get used to keeping your levels in a very tight range, your body loses its normal response to fluctuations, which means you might not know, Brown says. The solution: More frequent blood sugar checks. If you still have trouble sensing that your sugar is dropping, you may need a continuous glucose monitor, which warns you with an alarm.
Get the Right Tests
Expect to get an ultrasound at your first prenatal visit as well as a level 2 (in-depth) ultrasound later in your pregnancy to check the baby's spinal cord, heart, and other organs. You will also receive ultrasounds in the third trimester to measure the baby's growth and well-being.
Ask Your Doctor
- Am I healthy enough to get pregnant right now? If not, what do I need to do to prepare my body for pregnancy?
- Who should provide my obstetrical care?
- How should I plan to adjust my insulin while I'm pregnant? And what should I do if I need extra help between checkups?
- Should I stop or change any medications I'm taking now?
- How should I monitor my blood sugar during pregnancy?