Pregnancy for women with type 1 diabetes

This review looked at pregnancy planning and care for women with type 1 diabetes (T1D). It found that preconception care and closely managing blood sugar during pregnancy can improve outcomes for both the mother and baby.

Pregnancy is always a time of bodily change. During pregnancy, blood glucose (sugar) and metabolism may be different from usual. Women with T1D, who use synthetic insulin to control their blood glucose, may need to adjust their diabetes management during pregnancy.

It is also especially important to control blood glucose during pregnancy. High blood glucose increases the risk of miscarriage and of birth defects of the heart and brain. Blood glucose levels are particularly important during the first trimester when the organs are forming.

Preconception and pregnancy care may improve pregnancy outcomes for women with T1D. It is important to review recommendations for women with T1D who are planning a pregnancy.

This review combined the results from 169 studies and professional guidelines on pregnancy in women with T1D.

It is recommended to have well-managed blood glucose before trying to conceive (TTC) and during pregnancy. This translates into an HbA1c (a measurement of blood glucose control over 2-3 months) level below 7%. Preconception care for T1D includes counseling on nutrition and diabetes management during pregnancy. Additionally, a prenatal with folic acid should be started before TTC. Folic acid can reduce the risk of brain and nervous system birth defects. DHA, a fatty acid related to brain health, is also recommended.

Patients should talk to their doctors about whether their medications are safe during pregnancy. Insulin is the only recommended diabetes medication during pregnancy. Continuous glucose monitoring (CGM) can help manage changes in sensitivity to insulin during pregnancy. Babies of patients consistently using CGM had better outcomes at birth. There were fewer babies with unusually high birth weights or low blood sugar at birth, or who required intensive care. However, using CGM only some of the time did not have a benefit compared to self-testing.

Women are recommended to be up to date on screening for diabetes complications before TTC. An eye exam is recommended in early pregnancy. This is because pregnancy can increase damage to the retinas of the eyes. 

Women with diabetes are nearly twice as likely to deliver via Caesarean section (C-section). A scheduled C-section is recommended if the baby has a large weight (estimated over 4.5 kg / 9.9 lbs). However, most women with T1D can safely have a natural birth. During labor, glucose should be checked frequently (every 1 – 4 hours).

Breastfeeding is recommended. However, the milk may come in more slowly for women with high blood sugar in late pregnancy, or for those who delivered via C-section. A study of mothers with T1D found that breastfeeding did not increase low blood sugar (hypoglycemia). 

This review found that women with T1D can have healthy pregnancies. Also, screening for diabetes complications and closely managing blood glucose can improve outcomes.

Talk to your doctor early when you begin planning a pregnancy.