Pregnancy with T1D: Planning Ahead If You Can

Pursuing pregnancy as a person with type 1 diabetes can feel daunting and overwhelming. With a little extra planning, many people with T1D can successfully conceive and experience healthy pregnancies. This article will outline a few things to consider when planning for pregnancy with T1D.

First Things First: Talk to Your Doctor

If you’ve made the decision that you want to become pregnant, plan to have a frank conversation with your doctor ahead of time about what to expect with a T1D pregnancy, including potential risks and complications. Since T1D pregnancies are generally considered high-risk, you may want to assemble a healthcare team that specializes in T1D pregnancies, including:

  • OB-GYN
  • Endocrinologist
  • Registered Dietitian
  • Certified Diabetes Care and Education Specialist
  • Ophthalmologist

Additionally, you may want to explore options for birthing coaches, doulas, or lactation consultants ahead of time, disclosing that you have T1D.

Work with Your Team on Blood Glucose Goals

Your blood glucose levels matter before you’re pregnant. Blood glucose management is important for fertility and conception. Persistently high blood glucose can disrupt your ovulation cycle, making it more challenging to conceive. Aim for a hemoglobin A1c <7% and as close to 6% as possible (without frequent hypoglycemia) for at least 3-6 months prior to trying to conceive. This will help lower the risks of birth defects and pregnancy complications. If you’re not able to plan for your pregnancy, work with your healthcare team to reduce your A1c as quickly and safely as you can after learning that you are pregnant.

Consider Using a Continuous Glucose Monitor

Every person pursuing pregnancy with diabetes should consider using a continuous glucose monitor (CGM) before and during pregnancy. Blood glucose monitoring is important before conception and will remain important during pregnancy. While CGMs may be more expensive in up-front costs, they have been shown to improve pregnancy outcomes and reduce overall costs associated with a T1D pregnancy.

Consider Using an Automated Insulin Delivery System

Automated insulin delivery (AID) systems are insulin pumps that automatically adjust insulin doses based on glucose readings from a CGM. While research on AID use in pregnant women with T1D is limited, this technology has shown to improve blood glucose levels. With the tight management demands of pregnancy, an AID system could be hugely supportive.

Talk to your diabetes care team about your unique blood glucose goals prior to conception and diabetes technology that may help you reach your goals.

Take a Look at Your Diet & Nutrition Habits

A person’s diet and nutrition habits are closely linked to fertility and pregnancy outcomes. A diet rich in fruits, vegetables, lean meats or other protein sources, whole grains, omega-3 fatty acids, and dairy can help prepare your body for conception.

Even if you are able to meet all of your nutrient needs through foods, your healthcare team may still recommend taking a daily prenatal vitamin. Prenatal vitamins include many important micronutrients such as folic acid, zinc, calcium, iodine, and iron, which all contribute to a healthy conception and pregnancy.

  • Folate is a very important B vitamin in the early stages of pregnancy. Folate is found in dark leafy greens, citrus fruits, nuts, beans, and whole grains. The supplemental form of folate is called folic acid. People of child-bearing capability are encouraged to consume 400-800 micrograms of folate (through foods) or folic acid (through supplements) daily because deficiency of this vitamin in the early stages of pregnancy can cause birth defects.

It is also important to consume the right amount of calories for your body before conceiving, as being “underweight” or “overweight” can affect your fertility. Focus on making dietary improvements at least three months to a year before trying to conceive. If you need help with nutrition, talk to a registered dietitian who specializes in pregnancy and diabetes.

Consider Lifestyle Changes

Making positive lifestyle changes before trying to conceive can help improve fertility and pregnancy outcomes. Here are a few lifestyle changes to focus on:

  • Tobacco: Tobacco use is associated with decreased fertility; talk to your doctor if you need help quitting tobacco.
  • Alcohol: Excessive alcohol intake can increase the risk of ovulation disorders; limit or avoid alcohol if you are trying to conceive.
  • Sleep: Research shows that people who get less than 6 hours of sleep per night have poorer blood glucose management; aim to get at least 6 hours of sleep per night.
  • Physical Activity: Moderate physical activity can help improve blood glucose management, and may help you achieve or maintain your target weight.

Create a Support System

Whether this is your partner(s), family, friends, therapist, or T1D network, developing a strong support system is paramount. Diabetes is challenging enough, and you’ll want a strong support system every step of the way. Share your goals, successes, challenges and frustrations honestly with these people.

Diabetes support groups for T1D and pregnancy offered at your local clinic or through online groups can be a great way to connect with other people who are going through pre-conception, pregnancy, and post-partum with T1D. Check out Beyond Type 1 for inspirational stories of pregnancy with T1D as well as support group information.

You Can Do This

T1D pregnancies are generally considered high-risk, but thanks to advancements in diabetes technology and insulin, it’s very possible and feasible. No pregnancy comes without a few unexpected circumstances, whether T1D is part of the mix or not. As a person with T1D, the more you can plan and get the support you need, the safer your pregnancy experience will be.


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