Ttc and pregnancy with Type 1 diabetes — The Bump
High-Risk Pregnancy

Ttc and pregnancy with Type 1 diabetes

I'm a type 1 diabetic and I'm ttc. I'm so ready to be a mom but I know I will be considered a high risk pregnancy due to having diabetes. If there are any other type 1's out there what should I be doing now and what should I expect when I do get pregnant and after pregnancy?

Re: Ttc and pregnancy with Type 1 diabetes

  • SLGILL1978SLGILL1978
    500 Comments Third Anniversary 100 Love Its First Answer
    member
    edited December 2015
    Have you been to the doctor? When we were ready to TTC, I met with my primary care doctor and OB first. As far as when you get pregnant it all depends on how you take care of yourself. Different practices, OBs and/or hospitals follow different "plans/practices" for lack of a better word. For example, my OB was lenient on my fasting sugars in the morning. As long as they were below 120, I was good. I know some doctors are adamant that while pregnant, fasting sugars are to be between 65-95. My OB told me if I follow all his instructions/directions, then I will have a healthy baby (which I did). I didn't have to see a specialist at all during my pregnancy. I went to the OB once a month until my 34-35 week, then I went weekly, which is about a week early than normal pregnancies. I saw my primary care doctor every three months as usual. 
    *Best advice? Schedule an appointment or speak with both your primary care physican and OB. 
  • Your doctors (Endo and OB) are going to be the best people to ask. I say that because they will let you know specifically how things will go in your area and what your options are. I'm a type 1 and I'm also a nurse, so this is from my experience (I'm pregnant with baby number 2).
    For TTCing, I know a big thing for diabetics is folic acid because we actually need to take more than other pregnant ladies. Our babies are at higher risk for birth defects in general.
    Also, it's common in diabetics to have miscarriages. I have had miscarriages. There's not anything to definitively say why unless your diabetes is poorly controlled, but we are just at higher risk. I also have PCOS and I was told I would never have kiddos. So lots of variables there.
    Getting your A1c within range for pregnancy is a big deal, but not something that will totally ruin things if you don't have it in range when you become pregnant. Mine was 7.7, granted I had other endocrine issues going on before I became pregnant and my pregnancy was unplanned. I shouldn't have been able to get pregnant honestly. Anyways, I was able to get my A1c down to 4.9 and granted mines 5.6 right now.
    Tight control helps to ensure your baby won't be big and won't have an uneven fat distribution which can cause complications when having a vaginal delivery. Shoulder dystocia is something people can sue for malpractice and it scares doctors so many prefer to do C-sections to avoid it. But with a C-section comes major abdominal surgery and healing risks because of diabetes.
    Where I live there are 2 hospitals to choose from for delivering, but I'm only allowed to deliver at one because they have more resources. The hospital I'm delivering at has a 9lbs cut off for babies, so if they are 9lbs or bigger they are an automatic C-section. I don't get to deliver in the birth care center because if I need to go to the OR they want everything available to me.
    Also my OB did extra testing via ultrasound (fetal echocardiogram and I had to have an echocardiogram) and blood work to ensure things are how they need to be. My team consists of my Endo (who is also my PCP), my OB and my MFM. I usually just see my Endo and OB because my MFM watches all of my ultrasounds.
    Babies born to diabetics tend to have their lungs to mature 2 weeks slower than those born to non-diabetic moms, so 39 weeks is full term for babies born to diabetics.
    If your placenta is failing, that is cause for you to deliver your baby earlier because it means your baby isn't getting what it needs. Another sign is less insulin needed because the placenta causes insulin resistance to just increase and at the end of pregnancy it's obscene really. I'm taking massive amounts of insulin.
    I had low amniotic fluid with my previous pregnancy which is a sign of placenta failure, but they didn't find it until 38 weeks and the OB delivering babies at the hospital refused to deliver me that day. She was a firm believer that drinking tons of water helps increase amniotic fluids. It doesn't. Studies have disproven that idea. So I was induced at 39 weeks and my daughter was the first baby born to a diabetic that didn't have to go to the NICU for monitoring and to actually be stable.
    With this pregnancy, I have too much amniotic fluid and horrible insulin resistance. So we know my placenta is working well.
    Hope that gives you some insight, but do lots of research and talk to your doctors. They make they calls and they decide at the end of the day.

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  • Hi OP - I'm a type I diabetic and recently found out I was pregnant - currently at 5 weeks. I saw a maternal fetal medicine specialist before I started trying to get pregnant, which was very helpful. I highly recommend seeing one now, before you get pregnant. They hooked me in with their NP who specializes in diabetes management, and who I can e-mail or call anytime I have a question. She is the one who insisted I get started on continuous glucose monitoring before I started trying to get pregnant. There are very strict guidelines for blood sugar control while pregnant (much stricter than usual!), and monitoring requirements are different than non-diabetics who are pregnant (my MFM wants twice monthly appointments until 3rd trimester, at which point they want monthly). And definitely get ready for the increased insulin requirement. My mind is blown already by how much more insulin I am using, just in the 5th week. That is an interesting point about the folic acid - I didn't realize diabetics need more, but am taking relatively high doses, thankfully.


    Good luck, and feel free to message me anytime. This is an interesting adventure for sure, and it is great we live in a time when Type I diabetics can safely navigate a pregnancy (with lots of help!).
  • I have been reading all about this lady's pregnancy journey at sixuntilme.com. She shares her journey and what it was like checking her blood sugars, and what it's like breastfeeding. I found it to be very helpful! Also check the JDRF type 1 diabetes and pregnancy article. Google that and it should come up!

    Me: 27 years old            DH: 27 years old
    Type 1 Diabetes since 2001, MTHFR hetero A1298T
    Dogs: Raider 4 yrs, Dex 4 yrs
    Married in July 2014
    TTC #1 since late Feb 2016
    BFP #1 3/29/16     MMC: 5/5/16
    BFP #2 7/6/16    SCH, D&C 8/4/16
    BFP #3 12/26/16     EDD: 9/6/17
    My Chart / My Diabetes/Pregnancy Blog
    My Type 1/TTC/Pregnancy Podcast: 
    Juicebox Podcast Episode 118
    A1Cs:
    1/12/16 6.7%
    5/25/16 6.0%
    11/2/16 6.1%
    3/22/16 5.8%
    4/27/17 5.4%
    6/13/17 5.3%
               
    "Sugar Fancy Tutu"
  • Hi. Based on how much I learned in my first appointments, I would recommend asking your endocrinologist and Maternal Fetal Medicine doctor(s) about things including...off-limits and suggested diet/exercise/medication, frequency of appointments with each specialist who will be involved in your pregnancy plan, timeline/types of testing and labwork, blood sugar goals, ketone testing, expected healthy weight gain, who will primarily manage the adjustment of your insulin levels, likelihood of certain risks/complications (to self and baby) and how they can be prevented/managed/treated, if sex/travel/etc is safe, delivery options, etc. Honestly, some of the additional concerns that go along with diabetes in pregnancy are flat out grim and overwhelming to hear, but personally I think it is better to be informed so we can make the best health choices possible and not be completely shocked if things don't go as we hoped. If there is a silver lining, at least many of the risks are known and therefore have a protocol, and being high risk = more frequent and detailed sonograms?
  • The most important thing for us TD1 moms is to have a good team and to take care of and be kind to ourselves.  I just had a beautiful, healthy baby girl but it was a lot of work.  I had a team following me, an endo, my OB, and Maternal Fetal Medicine.  I thought my endo and OB were the most helpful because I had long term relationships with me and knew my specific circumstances.  There will be many appointments, especially at the end, so be prepared.  I was going to the OB every Tues. and the hospital every Thurs. for several weeks at the end. I think the most important thing is to realize that it won't be perfect all the time and all you can do is the best that you can do.  I had to learn to not beat myself up over every imperfect blood sugar level because those hormones are CRAZY.  I have a pump and a CGM, both of which helped me SO much to effectively manage because by the end I was taking about triple the amount of insulin that I did before pregnancy.  It was quite a journey but my little girl is worth every minute.  Best of luck to you!!  If you think I can help with any specific questions, feel free to message me :)
  • I was diagnosed with Type 1 diabetes at age 2.  I had my 1st child at age 28 and am now 31.  I knew Type 1 meant high risk.  My husband and I's main goal was healthy baby.  I was in very close contact with my obgyn and endocrinologist.  I alerted my endocrinologist that we were thinking of conceiving.  It was suggested that I get my diabetes in as tight control as possible 6 months before trying to get pregnant.  I'm a planner and can be a worrier,  Great combo for a diabetic, right?  :)  You have more tests while your pregnant, more appointments.  You have a higher chance of birth defects, heart problems, etc.  So, it is a little nerve racking because you have the normal uncertainty of being pregnant and then your diabetes adds on to that.  I was in very close contact with my endocrinologist especially.  If my blood sugars were off for a few days, then I would email him.  We would come up with an adjustment and take it from there.  Your insulin requirements will change tremendously throughout the pregnancy.  At least all the hospitals around me, will induce you at 39 weeks no matter what.  They will not let you go to week 40.  They said research suggests a higher still birth rate in diabetic moms if they let them go to week 40.  My induction didn't quite go as planned.  My son had the umbilical cord wrapped around his neck, so came down to a C-section.  Even if your blood sugars are in great control, the baby tends to be on the larger size.  At 39 weeks, I delivered a 8 pound, 6 ounce baby.  I had my a1c in the 5's, which I have never ever been able to do.  I worked really hard to take care of myself and honestly don't work as hard without a life growing inside of me.  I'm more typically in the 6's to 7's. Pretty soon after delivery, your insulin requirements go back down.  Your obviously new mom tired and taking care of this beautiful baby, so it has been a struggle for me to take care of my diabetes as well as I should have.  My energy went more into my child, then my own health after he was born.  He is absolutely the best thing in my life.  For non-diabetes related issues though, I had massive complications after my C-section and made the tough decision to not have anymore.  My baby was healthy though, no issues.  That's what we hoped for more than anything and he was healthy.  The joke is we should have wished I was healthy after delivery too.  But I'm fine now.  I would say take the best care of yourself as you can, do not beat yourself up over your blood sugars, have a good rapport with your doctors, and just have support from family and friends.  I had a pump, no cgm at the time.  Pump was a life saver and just made it easier to change things and see trends. 
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