You asked… how does type 1 diabetes affect pregnancy?

By Alexander Williams
13th June 2019
In Depth, Opinion
 
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Our “You asked” feature returns again this Diabetes Week as we answer a question often asked in many forms among the diabetes community – “how does type 1 diabetes affect pregnancy?”

For everyone, pregnancy and child birth bring with them the opportunity for joy and, of course, many challenges. For mothers-to-be with type 1 diabetes there are additional demands including blood glucose testing and insulin dosing to think about.

However, with preparation and management, people with type 1 diabetes – both mothers and fathers – can  help to make a healthier pregnancy more likely.

Planning ahead

A healthy pregnancy starts before you actually become pregnant. If you can prepare yourself, and optimise your blood glucose control and health before you become pregnant, it could lower the risk of complications. Eating a healthy diet that is lower in sugar and ultraprocessed foods, and higher in ‘real’ unprocessed foods will typically help to maintain more stable blood glucose levels, and support a healthy body for mother and baby.

Additionally, being physically active, stopping smoking and excluding alcohol are recommended for everyone prior to and during pregnancy [1].  In addition, folic acid should be taken from before pregnancy and up until 12 weeks. For people with diabetes, a higher dose of 5 mg a day is recommended to prevent neural tube defects such as spina bifida. This should be started at least 3 months before becoming pregnant [2].

Managing blood glucose levels

There are many factors that play into the path a pregnancy might take. For many of these factors we have no control, as the human body is often complex and unpredictable. Also, any form of diabetes can increase the risk of complications in pregnancy [3].

Giving birth to a large baby is a possibility for mothers with type 1 diabetes, and this is linked to increased HbA1c and excessive weight gain during pregnancy [4] [5]. This may not sound like an obvious cause for concern, however, larger babies can complicate birth, often requiring a Cesarean or ‘C-section’. Large babies are also at an increased risk of metabolic issues in later life [5].

Aiming for good health and blood glucose control prior to and during pregnancy is something that we can have a degree of control over. Optimal management of type 1 diabetes can help to support a healthier pregnancy and baby [6].

Testing blood glucose regularly is fundamentally important in helping to manage type 1 diabetes for anyone. During pregnancy, with all the changes that are happening to the body, regular testing may need even more attention. Some people find a continuous glucose monitor (CGM) a useful addition. People may find keeping track of how blood glucose levels change throughout the day, and how various foods affect the blood glucose levels, can help inform dietary and lifestyle choices [7].

During your pregnancy, you will be in close contact with your healthcare team. If you are unsure about what your blood glucose targets are, or are struggling to meet them, exploring this with your healthcare team is very important.

What’s the take-home message?

Having type 1 diabetes brings with it some important additional considerations for pregnant women. As with many things in life, planning and preparation is important. Where possible, speak to your healthcare team if you are planning to become pregnant. Taking steps prior to becoming pregnant in order to optimise the management of your type 1 diabetes and health is important. Staying in touch with your healthcare team throughout your pregnancy will help you to ride the highs and lows of pregnancy, maintain optimal diabetes control, monitor your growing baby and prepare for birth… and beyond.

Hi, I've noticed there have been a few posts about healthy pregnancies with type 1 diabetic mums and I wanted to share…

Posted by Diabetes.co.uk on Tuesday, 28 May 2019

 

References

[1] NICE. (2010). Public health guideline [PH26]: Smoking: stopping in pregnancy and after childbirth. Available: https://www.nice.org.uk/guidance/ph26. Last accessed 12/06//2019.

[2] NICE. (2016). Quality standard [QS109]: Diabetes in pregnancy: Quality statement 1: High‑dose folic acid. Available: https://www.nice.org.uk/guidance/qs109/chapter/Quality-statement-1-Highdose-folic-acid. Last accessed 12/06/2019.

[3] NICE. (2015). NICE guideline [NG3]: Diabetes in pregnancy: management from preconception to the postnatal period. Available: https://www.nice.org.uk/guidance/ng3. Last accessed 12/06/2019.

[4] Ladfors, L., Shaat, N., Wiberg, N., Katasarou, A., Berntorp, K. and Kristensen, K., 2017. Fetal overgrowth in women with type 1 and type 2 diabetes mellitus. PloS one, 12(11), p.e0187917.

[5] Cyganek, K., Skupien, J., Katra, B., Hebda-Szydlo, A., Janas, I., Trznadel-Morawska, I., Witek, P., Kozek, E. and Malecki, M.T., 2017. Risk of macrosomia remains glucose-dependent in a cohort of women with pregestational type 1 diabetes and good glycemic control. Endocrine, 55(2), pp.447-455.

[6] Magon, N. and Chauhan, M., 2012. Pregnancy in type 1 diabetes mellitus: how special are special issues?. North American journal of medical sciences, 4(6), p.250.

[7] Feig, D.S., Donovan, L.E., Corcoy, R., Murphy, K.E., Amiel, S.A., Hunt, K.F., Asztalos, E., Barrett, J.F., Sanchez, J.J., de Leiva, A., Hod, M., Jovanovic L., Keely E., McManus R., Hutton E.K., Meek C.L., Stewart Z.A., Wysocki T., O’Brien R., Ruedy K., Kollman C., Tomlinson G. and Murphy H.R. on behalf of the CONCEPTT Collaborative Group., 2017. Continuous glucose monitoring in pregnant women with type 1 diabetes (CONCEPTT): a multicentre international randomised controlled trial. The Lancet, 390(10110), pp.2347-2359.

What do you think?