Type 1 Pregnancy Risks and How to Minimize Them

People living with type 1 diabetes can absolutely have healthy pregnancies and healthy babies. With diligent monitoring of your blood glucose levels, exercise and support from an aligned health care team, a healthy pregnancy is completely possible.

How can I have a healthy pregnancy with type 1 diabetes?

1. Keep your blood glucose levels in range.

The most important thing you can do throughout your pregnancy is to keep your blood glucose levels in the pregnancy target range. This decreases the chance of excessive sugars going to your baby, which may mimic overfeeding and can lead to accelerated growth (macrosomia), or may disrupt the early development of organs in the first trimester.

Doctors also recommend having your blood glucose levels in range three to six months before you become pregnant.

Target blood glucose range pre-pregnancy:

• >70% time in range (meaning, 70% of the time or more, your blood glucose is between 70-180 mg/dL or 3.8-9.9 mmol/L)
• <7.0% A1C, or <6.5% A1C if possible

Target blood glucose range during pregnancy:

• >70% tight time in range (meaning, 70% of the time or more, your blood glucose is 63-140 mg/dL or 3.4-7.7 mmol/L)
• 70-95 mg/dL or 3.8-5.2 mmol/L fasting blood glucose — your blood glucose before eating
• 110-140 mg/dL or 6.1-7.7 mmol/L one hour post-prandial glucose — your blood glucose one hour after eating
• 100-120 mg/dL or 5.5-6.6 mmol/L two hour post-prandial glucose — your blood glucose two hours after eating

Be sure to talk to your doctor about the appropriate range unique to your pregnancy and circumstances. 

2. Ask your doctor about a continuous glucose monitor (CGM). 

If you aren’t on a CGM already, now is a good time to consider it. CGMs can help you keep blood glucose levels in target pregnancy range.

3. Find your health care support team and communicate with them 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 pregnancy with type 1 diabetes. If you are planning a pregnancy, you should have a pre-pregnancy exam that includes the following:

• An A1C of less than 6.5% if possible
• Blood pressure check. Hypertension that shows up in your 20s and 30s can be related to or independent of diabetes. It’s important to know your baseline blood pressures and manage hypertension prior to conception.
• Health evaluation for heart, kidney, nervous system, thyroid and a retina exam. If you have an organ, gland or system of fibers that are unhealthy, you run the risk of further damaging these specific areas, so your doctor may recommend certain health improvements before coming pregnant.
• Discuss current medications, especially if you are on any non-insulin diabetes medications, blood pressure or cholesterol medications, and come up with a plan for conception. 
• Take prenatal vitamins that include folic acid. If you can, take them starting one month before conception. This can help prevent birth defects in the brain and spinal cord.

What does prenatal care look like for pregnancy with type 1 diabetes?

• If available, a CGM is recommended for all pregnant individuals with diabetes. 
• From 12 weeks onward, the standard of care is to take aspirin to reduce risk of hypertensive disorders of pregnancy. 
• A first trimester ultrasound is done to monitor for birth defects and miscarriage. Higher glucose can increase risk for early pregnancy complications and loss. 
• In second and third trimesters, the goal A1c is < 6% if possible. 
• A targeted ultrasound second trimester ultrasound may be done to check for visible birth defects.
• It’s important to use diabetes technology and work with your healthcare team to adjust your insulin to tackle pregnancy-related insulin resistance and meet glycemic targets. 
• Tests done starting at 32–34 weeks: 
  • Nonstress test to monitor baby’s heart rate 
  • Biophysical profile to check baby’s breathing, movement and amniotic fluid levels
  • Stress test to measure baby’s heart rate in response to contractions 

Other health factors to watch for during a pregnancy with type 1 diabetes

• Preeclampsia, which is gestational hypertension or high blood pressure that occurs after 20 weeks. Type 1 diabetes is a known risk factor for preeclampsia. 
• If you have known conditions related to diabetes like kidney disease or retinopathy, it is important to work with your health care team to monitor those conditions during pregnancy. 
• Fetal growth will be monitored later in pregnancy to determine if your baby will be larger.
• Difficulty delivering–this is often because of the larger size of the baby (macrosomia), 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 or gestational hypertensive disorders
• Neonatal hypoglycemia, which is low blood sugar in your newborn at birth. This shouldn’t last but a few days.

Remember: every pregnancy is different

Be open to having your own experience. By caring for yourself, you’re already taking steps toward a healthy pregnancy. Consult health care professionals that support you, find friends to talk to who are also T1D parents and continue to monitor your blood glucose levels. You’ve got this!