CONTRIBUTING AUTHOR: Jessica Wong, MAN, RD
January 9, 2021 SOURCE
People with type 1 diabetes (T1D) are delivering healthy babies every day. With a little extra planning, care and effort, people with T1D who dream of becoming mothers can absolutely have normal, joyful pregnancies.
All women with pre-existing diabetes, including T1D, should seek out pre-conception support from their healthcare team to optimize their glycemic control, assess for any potential complications, review medications, begin prenatal supplementation and educate themselves about the importance of self-management of blood glucose (SMBG) both leading up to, and during pregnancy. It is important to prepare up to a year in advance of trying to conceive by letting your healthcare provider(s) know, so they can best help you keep blood sugars on track, reduce risk of complications, and make sure you and your baby stay healthy and happy.
Three common myths associated with T1D in pregnancy include:
1. It is harder for women with type 1 diabetes to conceive.
Whether they have diabetes or not, every woman will experience conception and pregnancy differently. Having diabetes does not mean you cannot conceive. Doing your best to ensure your blood glucose readings are within target leading up to conception - such as having an A1c (3-month average blood sugar) less than 7% - will improve your chances to conceive. It is true that women with T1D are at higher risk for complications during pregnancy, which is why it is necessary to work closely with your healthcare team. Pregnancy, in general, can present many challenges, whether you have a pre-existing condition or not. Planning well ahead of time will help you minimize risks and maximize positive outcomes.
2. There are more complications in pregnancy with T1D.
All pregnancies are at risk of complications and every pregnancy is unique. Having T1D may increase specific risks of developing high blood pressure (preeclampsia), having larger babies (macrosomia) or experiencing a difficult delivery. Having said that, taking the time to educate yourself about such risks allows you to be more informed and aware during pregnancy to support optimal health for both mom and baby, resulting in a smooth, enjoyable pregnancy.
3. If I have type 1 diabetes, I will pass it on to my baby?
It is natural for a parent to be concerned about the chances of passing on their own health challenges, like T1D, to their unborn child. The good news in the case of T1D is that research does not support a genetic connection to T1D, meaning there is limited evidence that T1D is passed down to children of parents with type 1 diabetes. However, children of a mom with T1D may be at a greater risk of developing type 1 diabetes than the general population. Specific to T1D, there are many potential contributing factors that influence a child’s risk of developing type 1 diabetes; such as gender, race/ethnicity, age of mom when diagnosed, whether one or both parents have type 1 diabetes, age of mom when baby is born, environmental factors, and family history of other auto-immune system disorders. Maintaining regular contact with your healthcare team will provide you the necessary support to help you do all you can to have a healthy pregnancy and baby.
So, how do you plan for a healthy pregnancy and baby with Type 1 Diabetes?
To assist in combating common myths and misconceptions about pregnancy and T1D, here are five strategies to help plan, prepare and support a healthy pregnancy with T1D.
1. Gather and inform your health-care support team.
Working with a healthcare team composed of professionals that are specialized in diabetes care; such as an endocrinologist, obstetrician, dietitian, and/or nurse educator prior to conception and throughout your pregnancy has demonstrated minimized risks for people with type 1 diabetes, for both mother and child.
2. Closely manage your blood sugars.
Keeping your blood sugar levels in target range will reduce the chances of complications for yourself and your baby. While it is important to closely manage your blood sugar levels at all times, it is especially important to do so for at least three months before conception. Set goals with your healthcare team, so that you know what range is appropriate for you and what strategies will help you achieve those goals. Aiming for an A1c of ≤6.5% is ideal.
Consider getting a continuous glucose monitor (CGM) that can help you track your blood sugars more frequently and consistently. Devices like these can make it easier to monitor and improve glycemic control, preventing damage to the heart, eyes (retinopathy), nerves (neuropathy) and kidneys (nephropathy). If poor control progresses, pregnancy induced preeclampsia (high blood pressure) may result. Uncontrolled blood sugars may also cause the baby to be born premature, or become “overfed” resulting in a large birth weight (macrosomia) that increases their chance of developing type 2 diabetes later in life. Other health concerns like seizures or stroke during pregnancy or labour are also of concern if blood sugars are not optimal.
3. Review your medications and supplements list.
Arrange a detailed discussion with your doctor or pharmacist about your medications, supplements and the dosages you take. If you are on any medications related to your heart and cardiovascular health (e.g., blood pressure, cholesterol), it is important to highlight these to your healthcare team before altering your medication, supplementation and/or insulin therapy routine. Don’t forget to inquire about prenatal vitamins and mineral supplements like folic acid, zinc, and B6, as each are important to promote healthy growth and development, even before conception!
4. Eating a Healthy Diet.
Enjoying healthy, balanced meals is crucial to overall health and wellbeing. Working with a registered dietitian will help you learn how to balance meals and snacks, determine appropriate portion sizes and better understand the impact of meal frequency and timing. A dietitian can also offer support with carbohydrate counting and desired blood glucose response. A balanced diet includes lean meats and plant-based proteins, whole grains, fruits, vegetables, and low-fat dairy products that can help maintain a healthy weight and manage your blood sugars.
5. Exercise Regularly.
Exercising regularly keeps your body healthy and naturally reduces blood sugars. Regular physical activity also contributes to healthy weight and pregnancy. Recommendations include 150 minutes of physical activity per week for adults, with 2-3 days being dedicated to strength and resistance training. Be sure to connect with your physician before starting a new exercise routine or making changes to your lifestyle.
The 'Flip Side' of Babies and Blood Sugars
As Kim Vlasnik states in her Texting My Pancreas blog:
You're already a pro at packing and carrying all your diabetes supplies, so packing for baby will be a breeze!
You might think pregnancy is the elusive 'miracle cure' during your first trimester. Unfortunately, it's not. That honeymoon period of better blood sugars is fleeting, but enjoy it while it lasts.
You don't have to go through the Oral Glucose Tolerance Test (OGTT) during the second trimester because you already know your pancreas isn't pulling its weight.
There's a ton more real estate for sensors and sites on a pregnant belly, and they're not as noticeable while you're carrying extra baby weight.
The pesky "Can you eat that?" gets swapped for "Enjoy! You're eating for two!"
The health and welfare of both you and your growing baby is of utmost importance, so you'll be monitored more closely than most during your pregnancy, which means you get to see your baby (ultrasound) way more often than people who aren't managing diabetes while pregnant!! Enjoy the attention!
About the author:
Jessica Wong, MAN, RD is a Registered Dietitian with a Masters of Applied Nutrition from the University of Guelph in Ontario, Canada who has a passion to provide culturally appropriate nutrition care for families and individuals. Jessica believes that every individual is unique and deserving of individualized care plans based on their personal preferences, lifestyle and healthcare needs. Jessica’s interests in nutrition include research, including exploring various diabetes care-related topics that led her to publish a Practice-based Evidence in Nutrition (PEN) Pathway about the use and potential implications of ketogenic diets as an SMBG strategy for people with T1D. She also enjoys working with families in paediatrics.
REFERENCES:
BeyondType1. (N.D). Type 1 Pregnancy Risks and How to Minimize Them. Beyond Type 1. Retrieved from https://beyondtype1.org/type-1-pregnancy-risks-minimize/
CDC. (2020). Type 1 or Type 2 Diabetes and Pregnancy. Centers for Disease Control and Prevention. Retrieved from https://www.cdc.gov/pregnancy/diabetes-types.html
Diabetes Canada Clinical Practice Guidelines Expert Committee. (2018). Diabetes and Pregnancy- 2018 Clinical Practice Guidelines. Diabetes Canada. Retrieved from https://www.diabetes.ca/health-care-providers/clinical-practice-guidelines/chapter-36#panel-tab_FullText
JDRF. (N.D). The Complete Guide to Pregnancy Planning with Type 1 Diabetes. JDRF. Retrieved from https://www.jdrf.org/t1d-resources/living-with-t1d/pregnancy/pregnancy-planning/