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If you have experienced pregnancy with T1D, did you make a plan for managing T1D and pregnancy with your healthcare provider before getting pregnant?
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I gave birth to my son back in 1984 and I was in a high risk maternity unit for 6 months. I did not make any healthcare plans before the pregnancy.
In 1973 the pregnancy test came back negative —although later it was determined that I was three months along. So little was known where we lived about managing a diabetic pregnancy but our darling daughter is now 49! My pregnancy was induced because I had gained so much weight and the thought was that she would be premature but no, she was 9-1/2 lbs and full-term. Ignorance was bliss??
My Opthamologist told me I should never get pregnant because I had severe proliferative retinopathy. He was treating me with laser treatments in 1976.
I did go on and had my son in 1979 with no increased issues with my eyes.
I didn’t have an endocrinologist at the time. I was in the medical system with the Air Force
I lived in a rural area and checked with many doctors before I could find one who was willing to take me if I got pregnant. I finally found a GP who told me to get my insulin requirement down as low as I could before getting pregnant since I would need much more during the pregnancy. This was in 1970. I had a healthy, full term son in September 1971 weighing 8 lb. 2.5 oz. I was very careful about my weight then as well.
In 1968, after my husband and I agreed I would stop taking birth control pills, I told my endo, and we had a long discussion. The main tool I had, in those days, was a consistent diet, eaten to match when my 2 shots/day of Regular and NPH insulins tended to have their peaks (which, of course, was not all that consistent) and based on the definitions in the ADA exchange system, but adapted to what he and I considered, at that time, a somewhat healthier menu, and also somewhat adjusted to my preferences of ratios and timing of Carb/Protein/Fat. He and the OB he recommended all agreed the baby should be taken early, as did the new doctors I saw after I moved during the pregnancy.
During the last months of the pregnancy, when I wasn’t actually hospitalized, I would once a week go to a nearby hospital lab to get a fasting blood sugar test, which I would learn the results of when I next saw the doctor. So I couldn’t have been using that info very effectively. During my second pregnancy, my downstairs neighbor would come up and draw my blood occasionally and take it to his lab, test it and call me, a definite improvement but still far, far from what is available now.
When I asked about birth control, I had been told by several doctors that there was very little likelihood of my ever becoming pregnant. Nevertheless, I had been advised to get my tubes tied. That was not the solution I had been looking for.
When I did manage to become pregnant in 1987 (at the age of 35) it was a delightful surprise, and obviously no planning had been done for it. At least blood glucose monitors had become available by then. My son was perfect. Still is.
I am a diabetes specialist and could not personally get pregnant, but I try to discuss need for tight control and outline best practices before a T1d pregnancy with women I see w T1D where it is a possibility, if possible. I then offer to continue T1D treatment when they get pregnant w maternal fetal med (MFM) expert also following for OB side, or they follow w MFM for everything. Critical to stay well controlled for both mom and baby…:)
Key points for successful pregnancy w T1D IMHO:
1) CGM a must these days
2) limit but not eliminate carbs and avoid spike foods- breakfast cereal, fruit juice, white rice especially
3) multiple small meals w snacks- spread out eating
4) pre dose insulin by 2-30 minutes when possible to lower post meal BG
5) goals post meal < 140- hard to pull off unless doing the above, pre meal <100, mean BG on CGM < 125, best 115 if possible, rec A1c <6 if possible wo undue hypoglycemia – which is tough!
6) meet w nutritionist
7) dont over treat lows
8) Hybrid closed loop are not approved but the reality is that people do better with these than open loop pumps, even though they are not designed for pregnancy
9) understand what you are getting in to, and know you will be a moving target, especially in the second half when needs for insulin go up gradually
10) practice pre conception to try to get to these targets
11) close follow up w retinal specialist during pregnancy if any existing retinopathy, which can worsen during pregnancy
12) believe that all this greatly improves the chance for a healthy baby and mom at the end
Its work, but it works…:)
I mentioned that my husband and I were going to try soon beforehand, but my doctor basically just gave me the rundown of how many appointments I would have and the range my a1c would need to stay in. I wouldn’t necessarily call that a plan.
I was always under good control. My A1c was 6.0. So, I don’t think planning would have been necessary. Although at the time, I did not even think of it.
I did call my endo as soon as I knew I was pregnant. He told me that fetus’ like low blood sugar and so, the 60 mg/dl I was seeing in the morning was perfect! He advised I keep my BG between 60 – 80 mg/dl. I did and had a full term, normal weight baby girl – – 7lbs 3oz.
Both pregnancies were unexpected. I had great specialist doctors and they were wonderful. Both girls born beautiful.
Didn’t intend to get pregnant, but oops! 1976. Had great son, spent a few days in hospital twice for doctors to check on progress, then had induced labor (didn’t work- did c section) three weeks before due date. No perfect baby. Three grandkids. Happiness.
Yes perfect baby.
No real planning. Was told by my OBGYN that I might have trouble getting pregnant. My husband and I decided to not use birth control anticipating it would take a while. The only precautionary step I took was to discontinue my ARB that I was taking for kidney protection as it’s not safe during pregnancy. I became pregnant 3 weeks later. Then had baby #2 16 mo later. Then my husband got a vasectomy because clearly we couldn’t be trusted. Haha Saw my endo and OGYN frequently during both pregnancies. What’s on a pump, and used a CGM intermittently, as the tech wasn’t great at that point Thankfully, both boys born full term and healthy, but BIG (10lbs). They’re now teens. Crazy how time flies.
I got diagnosed with Gestational Diabetes at 30 weeks and had to take insulin the rest of my pregnancy. I’m not sure we had a great plan other than the doctor telling me everything that went into my mouth would affect my blood sugar and health of the baby. I got pregnant again when Baby 1 was 11 months old and got diagnosed with gestational again at 9 weeks of pregnancy. Dr had me diet and exercise until month 7 when we moved cross country and I was put on insulin again. Supposedly T1 D went away when baby 2 was delivered. I got diagnosed for good when Baby 2 was 9 months old and both kids and I got a cold. So I don’t think I had all of the correct resources that I could have had. Thank God we are all healthy.
It was not a planned pregnancy. Didn’t even have an endocrinologist at the time (back in 1979).
I was diagnosed with diabetes at 6 months pregnant. So no plan was in place.
By the time I was ready to have a child I was advised against it, on bp meds and in early 30’s.
My girlfriend, a T1D, was pregnant with her 3 child and also the previous 2 children. She had a great gyn and they both handled the result well. We have been married since 1987 and shared our T1D well and supportive.
Back in the 60’s I was just under the care of my regular doctor and the GYN team
Yes, 3 children. No 1, no plans with doctors, but read everything I could find at the university library regarding diabetes & pregnancy (No internet back then). The clinic lended me my first glucometer, that was the size of an old casette player! Spent entire winter cross country skiing, then biking up to date of delivery. Healthy baby girl (1979) 7 lb. No 2. Got a pump but CGMs did not exist, took the bike into hospital in time for the delivery this time! Healthy boy (1982) 7.4 lb. No 3, I ended up in hospital due to a placenta previa, catastrophy C-section at week 28, but healthy baby boy (1987 on St. Valentine Day!) 2.4 lb.
Best “pregnancy” no 4, since he was adopted. 🙂
Oh Yes, we did! I planned to get pregnant at 28 years of age or older since the risk of having a child with type 1 diabetes declines significantly. And, my A1C was 5.8% at least six-months before getting pregnant.
Once I met those criteria, I got pregnant right away. I took the job of controlling my diet, exercise, and blood sugar very, very seriously for nine months. My blood sugar was 120 1-1/2 hours after meals. And, it was not greater than 200 ever. My A1C didn’t get above 5.9%.
Delivered a healthy boy weighing 6 lbs. 11oz. Who is not type 1.
Both before our marriage in 1969 and six months later before stopping my birth control medication, my spouse and I had appointments with my physician, an internist, to discuss first the possibility of a successful pregnancy and methods of glucose management. There really wasn’t much available. I was still on MDI using U 80 Regular (beef/pork) and NPH insulin with test tape urine testing. My physician told us that as a 21 year old, after 13 years with T1, I was as healthy as I was ever going to be and that we shouldn’t delay if we wanted children. Since we were both still going to school that wasn’t exactly our plan. Six months later we changed our plans and had a second appointment. I was told that with pregnancy I would be referred to the care of a high-risk OB-GYN physician and to apply for medical financial assistance thru the State (California). That was the total before pregnancy plan. We graduated that June 20th and exactly one month later, 6 weeks early, on July 20th, 1970 our 7 lb. 15.5 oz. healthy “premie” daughter arrived.
This question does not apply to real men!
No pregnancy.
I do not do ANYTHING that would greatly impact my T1D without discussing it with my endo and having a plan in place.