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Type 1 Diabetes and Pregnancy: One Mother’s Story
By Kim Barwise
I was 31 years old, happily married and had no health problems despite having had Type 1 diabetes for seven years. It seemed like the right time to have a baby. But on further thought, I worried whether the risks were too high. I was aware of some of the risks to a baby caused by high blood sugars. Would my baby be okay or would he or she develop diabetes? Some of these concerns are typical to anyone with diabetes, but the fear of being responsible for the health and development of another little being was somewhat overwhelming to me. I wanted to have some guarantee that everything would turn out well.
I spoke with my endocrinologist to determine which fears were real. Statistically, the level of risk for a woman with Type 1 or Type 2 diabetes and for the baby is largely determined by the health of the woman just before conception and within the first 11 weeks of pregnancy. Women with diabetes are typically not discouraged from having a baby unless they have experienced eye complications, damage to their kidneys or have heart disease. Good blood sugar control is crucial within the first five to 11 weeks as the baby’s organs are beginning to develop. If the mother’s blood sugar level is high during this time period, the baby’s spinal cord and heart could be affected. There are various tests offered to women at 16 weeks and at 20 weeks to determine the risk for spina bifida, Down’s syndrome and heart deformities.
Knowing that my blood sugar control was within a good range, and having the support of my endocrinologist and husband, I felt ready to get pregnant. It was a big disappointment. I had put a lot of effort into improving my blood sugar control, attempting to exercise, testing at least four times a day and trying to suppress my worries about my health and the baby’s. Was diabetes affecting my ability to become pregnant? According to my endocrinologist, diabetes does not affect fertility. Then, as soon as I stopped worrying, I became pregnant.
Once pregnant, my motivation to manage my diabetes significantly increased. I was conscious of the grams of carbohydrate I was eating, monitored my blood sugar levels seven times a day and adjusted my insulin regularly. The blood sugar goal set by my endocrinologist was 3.5 to seven mmol/L, but this goal can vary depending on the doctor and your ability to recognize and treat hypoglycaemia. While I was able to achieve a healthy blood sugar level throughout most of my pregnancy, I found blood sugar control difficult during the first trimester. This was probably related to the fluctuating levels of hormones that caused my blood sugar levels to become very high during my eighth week of pregnancy. Typically, women find blood sugar levels drop too low during the first trimester, but it is not uncommon for blood sugar levels to soar into the teens. The support of the endocrinologist and diabetes educators helped to calm my fears. They adjusted my insulin dose to compensate for the ‘highs.’
Although I am a diabetes educator, I found it difficult at times to be objective about my health and the baby’s. I had to recognize that I couldn’t treat my body like a machine and expect everything to be perfect all the time. Given the psychological impact of extra monitoring and the fear of complications, it was important to discuss my concerns with both my doctor and family in order to keep my perspective. Having the opportunity to vent during the first trimester allowed me to cope with the demands of the second and third trimester.
When the third trimester arrived, I found being pregnant and having diabetes became a full-time job. The frequency of ultrasounds and visits to the obstetrician and endocrinologist increased significantly. I was also very tired at that point in my pregnancy. Once, I was caught snoozing on the floor of my office (not recommended!). The frequency of hypoglycaemia increased because the blood sugar levels were so tightly controlled. Having a knowledgeable and supportive family and work environment was crucial to coping with the demands during this trimester.
In my view, one of the few benefits of having Type 1 diabetes was the opportunity to be induced at 38 weeks instead of 40 weeks. Early induction is often recommended because diabetes may cause the placenta to mature faster. When I was at 38 weeks, July was hot and humid, my sense of humour was waning and I felt I couldn’t possibly get any larger. I was ready to get this pregnancy over with and start being a mom.
The induction took much longer than I had expected. Yet 31 hours of labour were much more tolerable for me with an epidural. After a year and a half of planning and perseverance, the end result was a healthy, beautiful baby girl named Lindsay. All had turned out better than I had expected; it truly was a miracle!
If you are thinking about getting pregnant, my recommendation is not only ‘do it,’ but also ‘plan it!’ Talk to your endocrinologist or diabetes educator a few months in advance so that the birth of your child will be as wonderful as it should be.
Kim Barwise RN, BSCN, CDE is a diabetes nurse educator at Women’s College Hospital in Toronto. She believes the more you know, the more you can do.