Family Planning with Type 1 Diabetes

Family Planning with Type 1 Diabetes

Currently, good blood glucose control during pregnancy is still a big challenge for women with type 1 diabetes (T1D). Twenty-five years ago, doctors warned women of child bearing age with T1D, becoming pregnant was too dangerous for a mother and her child. Now, women with T1D can successfully deliver babies because of advances in health care, research and insulin. Pregnant women with T1D are at higher risk of serious complications of diabetes, such as retinopathy (eye problems), worsened kidney function, high blood pressure and low blood sugar. About two-thirds of pregnancies in women with diabetes are unplanned, which increases the likelihood of having problems during delivery and birth defects in the baby. Women with T1Dneed careful family planning at least one year before becoming pregnant to decrease the risk of complications.

Before considering pregnancy,patients will need to know the possible complications of pregnancy and diabetes that will affect the mother and her baby. Talk with your doctors about these risks. This may be scary, but you will be better prepared for pregnancy and decrease the likelihood of having complications. You will be asked to check your A1C (a blood test that tells you how well controlled your blood sugar has been in the past three months), check blood sugar more often (up to 10 times a day), and have tight control of your blood sugar.2, 3Women with T1D who become pregnant are recommended to achieve a  fasting blood glucose level of ≤ 90mg/dL, one-hour post meal level of ≤ 130-140 mg/dL and two-hour post meal level of ≤ 120 mg/dL.8 While A1C may be useful, it should be used as a secondary measure, after self-monitoring of blood glucose. Usually 6-6.5% is preferred but < 6% once the pregnancy progresses may be optimal; as long as this can be obtained without low blood sugar reactions. You will have regular appointments with your doctor, a Certified Diabetic Educator (CDE), a dietician and other members of your healthcare team. You have to be fully committed and agree to the pregnancy plan that you and your healthcare team develop to have the best chance for a healthy pregnancy and delivery.

Your diet is very important. An appointment with a nutritionist is recommended to make sure you eat the right types and amounts of food based on your pregnancy status and diabetes control. The nutritionist will teach you how to count carbohydrates (sugar in food) and calculate carbohydrate-to-insulin ratios (how much insulin to use with certain meals).8Women taking insulin for diabetes will have changes in their insulin needs due to changes in their body during pregnancy.3, 4They may need less insulin during the second half of the first trimester compared to the amount of insulin they were taking before becoming pregnant. As the baby grows, the baby will take more carbohydrates from the mother and some women may be eating less due to morning sickness. In the second half of the second trimester, women may need more insulin due to weight gain and an increase in growth hormone levels in the baby.

With T1D diabetes, your body is unable to take in and use glucose like it normally would, because of a lack of insulin.  This leads your body to use fat for energy. When your body breaks down fat for energy, you produce ketones. The accumulation of ketones in your blood may lead to a condition known as ketoacidosis (DKA), which is a medical emergency. In pregnant women with diabetes, DKA can develop rapidly at lower blood glucose levels compared to a non-pregnant women, which delays proper diagnosis. Early DKA symptom recognition will minimize the adverse outcomes of this complication. Hence, regular monitoring of ketone levels is recommended.2, 3

Regular exercise and moving your body is as important as taking your medication and having a good diet during pregnancy. Regular exercise and movement will help women achieve tighter blood sugar control, and will reduce stress as well. Women who follow a good diabetes treatment plan during pregnancy will decrease the chance of pregnancy complications.

This Article is Brought to you By Our Guest Staff Writers:
Jigarkumar Patel, PharmD Candidate of 2017, MCPHS University
David Sze, PharmD, Medical Affairs Fellow, MCPHS University
Jennifer Goldman, RPh, PharmD, CDE, BC-ADM Professor of Pharmacy Practice, MCPHS University, Boston MA
Clinical Pharmacist, Well Life, Peabody, MA

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