Type 1 Pregnancy Risks and How to Minimize Them

Editor’s Note: This page is part of a series on diabetes and pregnancy. CLICK HERE for more great resources and personal stories.

There’s a lot to consider when trying to get pregnant or being pregnant as a type 1 woman. There’s of course, the maternal desire to do everything you can for your unborn child so that he or she may have the best life possible. An ideal pregnancy is a full-term and uneventful one, the outcome a healthy, happy baby.

Having type 1 diabetes doesn’t mean you can’t have that; it just means that you have to be more vigilant, more prepared because of the heightened risks involved. But you’re a type 1, so you already know how to do that. In fact, you’ve been doing it ever since “D-day,” so take a deep breath and trust yourself.

All pregnancies have the chance for complications, but having type 1 makes you more susceptible to specific ones. Here are the most important things to do in order to lower those risks:

Pregnancy Advice for lowering risks for complications

1. Keep your blood glucose levels in range

The most important thing you can do as a type 1 mother-to-be is to try and get your blood glucose levels in a healthy range. Check your number and check often. This will decrease the chance of excessive sugars being given to your baby. Excessive sugars for your baby may cause them to grow quickly as if being “over fed” (Macrosomia) or can do harm to the early development of organs (fully developed by week seven).

This is not just vital for your baby’s health during pregnancy but also before conception. Doctors recommend having your blood glucose levels in range three to six months before you become pregnant.

Target blood glucose range pre-pregnancy (NIH)—

• 4.4-6.1 mmol/L80-110 mg/dl before eating
• 5.5-8.6 mmol/L100-155 mg/dl one to two hours after eating

Target blood glucose range during pregnancy (NIH)—

• 3.3-5.5 mmol/L60-99 mg/dl before eating
• 5.5-7.2 mmol/L100-129 mg/dl one to two hours after eating

Be sure to set goals with your doctor ahead of time so you know what an appropriate range is for you. Also, if you aren’t on a continuous glucose monitor (CGM) and pump already, talk to your doctor about the possibility of using these devices as they can be helpful in monitoring and controlling your blood glucose levels (BGLs). Remember that a healthy, pre-planned diet can also help you mange BGLs as you can anticipate how you will respond to the food you’re consuming. Exercise can also reduce the need for insulin, helping you to stay healthy for your baby while naturally lowering your blood sugar. (Be sure to always consult a doctor before making changes to your lifestyle).

2. Find a doctor and see her/him often

You’ll need to monitor your health and your baby’s health more often, so align yourself with doctors you trust and who ideally have experience with mothers who have type 1. If you are planning a pregnancy, you should have a pre-pregnancy exam that includes the following:

• An A1C test (your target score should be less than 7%)
• Blood pressure check (women with type 1 tend to have higher blood pressure; higher blood pressure can lead to preclampsia)
• Health evaluation for heart, kidney, nervous system, thyroid and eye (if you have an organ, gland or system of fibers that are unhealthy, you run the risk of further damaging these specific areas, so may be recommended to improve health before coming pregnant)
• Take prenatal vitamins that include folic acid—if you can, take them one month before conception. This can help prevent birth defects in the brain and spinal cord.

Risks to be aware of …

• Preeclampsia (gestational hypertension or high blood pressure with protein sometimes in the urine)—women with type 1 are predisposed to this as they often have higher blood pressure to begin with.
• Developing insulin resistance – During pregnancy, the placenta supplies a growing fetus with nutrients and water. The placenta also makes a variety of hormones to maintain the pregnancy. In early pregnancy, hormones can cause increased insulin secretion and decreased glucose produced by the liver, which can lead to hypoglycemia (low blood glucose levels). In later pregnancy, some of these hormones (estrogen, cortisol and human placental lactogen) can have a blocking effect on insulin, a condition called insulin resistance. As the placenta grows, more of these hormones are produced, and insulin resistance becomes greater.
• Worsening of diabetes complications – if you become pregnant while specific organs, glands or the nervous system is not healthy, this may worsen under the increased difficulty of diabetes management and keeping your blood glucose in range.
• Difficulty delivering – this is often because of the larger size of the baby, sometimes necessitating a cesarean or early inducement of delivery. A larger baby may also run the risk of shoulder dystocia where the anterior shoulders of the baby fail to pass the pubic symphysis or fail to pass without manipulation.
• Premature delivery – due to the larger size of the baby.
• Miscarriage (the loss of the baby before 20 weeks, or stillbirth, which means the baby dies in the womb after 20 weeks) – this may be due to possible birth defects caused by excessive sugar in the blood.
• Macrosomia (a larger than normal baby)
• Birth defects (problems that arise during gestational development of baby)  – largely caused by blood sugar levels that aren’t in healthy “safe” ranges and may include: respiratory distress syndrome [RDS], cardiovascular issues of the heart and other problems of the brain, spine, kidneys, gastrointestinal tract, limbs and mouth.
• Hypoglycemia (low blood sugar at birth, though this shouldn’t last but a few days after birth)

Remember that you aren’t alone and others have gone before you. Knowing the risks and having a plan in advance to combat those risks is smart and … maternal. And know that every pregnancy is unique, so your experience may vary from someone else. Even your sequential pregnancies may vary (and quite often do) from your first. Consult professionals, find friends to talk to who are also type 1 mothers and continue to monitor your BGLs. And remember, try to remember, to breathe too.

Verified by Natalie H. Strand, MD— 

Dr. Nat was diagnosed with type 1 diabetes at the age of 12. A Mayo Clinic trained chronic pain specialist, she is the director of integrative medicine at Freedom Pain Hospital. After her post-graduate fellowship, Dr. Nat competed in and won The Amazing Race on CBS. She has also worked closely with leading diabetes organizations to promote exercise and healthy living among people living with diabetes. She is also a mother.

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Stories from Type 1 mothers—

• Pregnancy, Twins + Type 1 by Noor Al Ramahi
• Pregnancy and Repeat Diagnosis by Megan Hanson
• A (Gestational Diabetes) Wake Up Call by Casey Tunguz

Additional resources—

• Balancing Pregnancy with Pre-existing Diabetes: Healthy Mom, Healthy Baby by Cheryl Alkin
• CDC – Pregnancy and Diabetes
• NIH – Diabetes and Preparing for Pregnancy