Women with type 1 diabetes can have a healthy pregnancy if blood glucose levels are controlled. It is important to get good control of your blood glucose levels prior to pregnancy. If hyperglycemia (high blood glucose) is present in the first 8 weeks of pregnancy, there is a risk for congenital malformations. Later in pregnancy, hyperglycemia may result in a large baby, making delivery more difficult and increasing the risk for a caesarian section.
Care during pregnancy
Women with type 1 diabetes are also at risk for retinopathy (damage to vessels of the eye), so your eyes should be checked by a specialist during pregnancy. Changes to the kidneys may also occur in a small percentage of women if damage was already present prior to pregnancy. Blood work may be done to monitor your kidney function. Certain blood pressure medications (ARB’s and ACE’s) and cholesterol lowering statins are not recommended during pregnancy. Speak to your doctor about alternatives to these medications when pregnant. The recommendation for folic acid is 5mg 3 months prior to conception until 3 months post conception.
Determining insulin needs
Insulin needs change throughout pregnancy and may increase to 1 ½ -2 times the pre-pregnancy dose. Blood glucose levels may be variable in the first trimester due to insulin sensitivity, nausea and vomiting. It is recommended to eat 3 meals and snacks as needed (at least 1 at bedtime), which can help with managing your blood glucose levels and determining your insulin needs.
Blood glucose targets
Targets for blood glucose levels are: less than 5.3mmol/L before meals, less than 7.8mmol/L 1hr after meals and less than 6.7mmol/L 2hrs after meals. Since glucose levels are lower, the goal for your HbA1c is less than 6%.
Regular activity is beneficial to keep good control of blood glucose levels, manage weight gain and increase energy levels. Speak with your doctor if there may be activity limitations.