Pregnancy and type 1 diabetes (T1D) can go together, but it might just take some extra planning and care. Kristi, mum to beautiful six-year-old Harry, tells her story of becoming a mother at 37, despite a complex journey with T1D since she was diagnosed at 11.
“When I got to 30, I thought I’d left it too late to have a baby. Especially as I’ve had a history of T1D complications and have two other autoimmune diseases – Coeliac and an underactive thyroid. My endocrinologists had always told me I’d need to try and get pregnant as young as possible to increase my chances. I fell pregnant at 37 years old, shortly after my wedding − the timing meant that for me I was the most fit and healthy I’ve ever been. We actually conceived naturally and very quickly.
I had the full support of my healthcare team, and I had to attend so many more medical appointments than a mum-to-be without T1D. I even had a specialist pregnancy endo, a fetal heart specialist, and lots of extra scans.
I’m not stressed or anxious at all normally, but being T1D and pregnant really brought out full-blown anxiety in me. The responsibility of growing a human was huge! I wanted to try and make my body the best possible place for him. Aside from all the extra appointments there were almost daily insulin adjustments, and a food and insulin diary. Not to mention, fighting the carb cravings! I wish CGM was available back then! The only way I coped was by setting small goals and milestones, then adjusting these as I reached them. 20 weeks… 24 weeks… 30 weeks…
I actually had a reasonably smooth pregnancy until I hit 30 weeks and was hospitalised. I was shocked, but my healthcare team were worried about my kidneys. I’ve have impaired renal function as a result of my T1D. Harry was born by C-section at 32 weeks, and to us he was perfect. He was admitted to the NICU as he was very small. Our next goal was getting Harry home.
After 60 days in the NICU, we finally got to go home as a family of three.
It wasn’t until we got home that I realised the enormity of what I’d achieved, in spite of having a chronic illness. The next challenge was managing T1D plus a newborn! A new baby is hard for any mum. Don’t be afraid to ask for help or support – I did. At the time Harry was born, there wasn’t the support groups and networks like there is now.
Today, Harry is amazing. He’s happy, healthy and excelling at school. Me having T1D didn’t affect him at all. For anyone with T1D considering being a mum I would say, have open and frank discussions with your healthcare team about your expectations and theirs. It helped me a lot to know that I wouldn’t be carrying my baby to full-term. This meant it wasn’t as traumatic when I eventually did have to give birth at just 32 weeks. This isn’t the case for everyone though and many mums with T1D can go to full-term. Even for mums without T1D, a lot of the time their births don’t go to plan anyway!”
Tips for mums-to-be with T1D
In the past, women with T1D were discouraged from becoming pregnant, because they faced increased risk of complications. Thankfully, this is no longer the case and women with T1D can expect to have a healthy baby. The key, as with all aspects of T1D management, is planning.
Women with T1D must be prepared to put in a little extra work during pregnancy to ensure a healthy mother and baby. The below tips come from our book, Straight to the Point: A Guide for Adults with Type 1 Diabetes. Download your free e-book here to read the full chapter on T1D and pregnancy.
- Speak to your healthcare team about your plans at least three months before trying to conceive.
- If like many women you fall pregnant without planning, don’t panic! Make an urgent appointment with your doctor to review your T1D and general health and put a plan in place from there.
- Start taking a folic acid supplement and daily multivitamin. Discuss an appropriate dose with your doctor.
- Work with your doctor and educator to achieve the best blood glucose level you can. This means an HbA1C below 7.0 and if possible, below 6.5 if this can be achieved without increased episodes of hypoglycaemia. The first eight to 12 weeks are when a baby’s major organs develop, so it is important to gain tight blood glucose control before you fall pregnant.
- Engage the support of a healthcare professional team, which might include an endo, specialist obstetrician, midwife, diabetes educator and dietician.
- You will need to visit your endocrinologist and obstetrician more regularly than women without T1D. Your doctor will provide you with a schedule of check-ups and tests. Certain complications are aggravated by pregnancy so your doctor will closely monitor this.
- Achieving very tight blood glucose control throughout your pregnancy can be stressful and demanding. Your insulin requirements will change as you battle morning sickness and your pregnancy progresses. You might find your usual early warning signs for hypos change or disappear completely.
- The growth of your baby also needs to be closely monitored by your healthcare team.
- There is no reason for you not to expect a normal birth. Many women with T1D carry their baby to full-term and go into labour on their own.
- Discuss delivery options with your obstetrician and make a plan for your baby’s birth towards the end of your pregnancy.
- If you wish to breastfeed, there is no reason why you will not be able to. You will just have to watch for fluctuations in your blood glucose levels and plan ahead as you will need additional carbohydrates when feeding, especially in the early months.
Will my baby be born with T1D?
It is natural for people with T1D to worry about passing the disease on to their children. It is important to remember that 80% of people with T1D have no family history of the disease.
Your baby will not be born with T1D and the chance of your baby developing it in their lifetime is only five percent (or seven percent if the father has T1D).
Could your baby help solve the mysteries of T1D?
The ENDIA (Environmental Determinants of Islet Autoimmunity) study is underway in Australia with the aim to find ways to prevent T1D in future generations. If your baby will have a first-degree relative with T1D (mum, dad or sibling), you could be eligible to take part in this nationwide study. If you’d like to find out more about ENDIA, head to their website or call: (08) 8161 8747
The NDSS booklet on type 1 diabetes and pregnancy is also a very good resource for women planning and preparing for pregnancy.