The Critical Role of T1D Management in Pregnancy
by IDS Director of Lifestyle and Nutrition, Jenny Smith
Management of type 1 diabetes takes a day-to-day strategy. The initial stages of education are the pivotal point for directing someone down the road to understanding their role in healthy, long-term management.
As a person with T1D for 37 years, as well as a certified diabetes care and education specialist, I am amazed at the number of times I’ve worked with someone who has not had good direction in their life with diabetes. Whether newly diagnosed or with many years of T1D, information will change, and having the right information early on can go a long way in long-term health outcomes.
One of the times in life where a lot will change is in pregnancy with diabetes.
Early education on what to expect is not often discussed, leaving women floundering in the early weeks of pregnancy. I have the privilege of working with T1D women during pregnancy and have tracked the difference between preparation in preconception compared to education once pregnant. Women who prepare for tight pregnancy management in the 3-6 months prior to conceiving tend to have an easier time with the early transition into pregnancy, as well as for what they expect to come as pregnancy progresses. The changes that happen in the body during pregnancy are amazing and with T1D can have a major impact on overall control and the health of mother and baby. Preparation ahead of time can help the mother get ready for the mental challenge of navigating things that change repeatedly in a short period of time.
One of the risks that I discuss with women during preconception visits, as well as during pregnancy, is preeclampsia.
A pregnancy complication that is characterized by high blood pressure as well as high levels of protein in the urine and can have a profound impact on the mother and infant. This condition typically shows up after 20 weeks of pregnancy and impacts about 5-10% of all women during pregnancy, but for women with T1D, it happens more frequently – about 17% of the time.
A nationwide cohort study done in Sweden compared data from women without diabetes (1 million +) to women with T1D (4400) and the differences in HbA1C and associated risk/presentation of preeclampsia in pregnancy at >20 weeks.
In a nutshell, (the full article is quite interesting) the risk and presentation in those with known T1D was 16.8% (744 women in a small group) vs only 2.9% of women without T1D (48,861 women in a much larger pool). The risk increased in those who had increasing HbA1C values. This fact ties the relationship together in the case for education and prevention of risk – both prior to conception as well as ongoing, in-depth education for healthy management during pregnancy. Risk factors can be mitigated with the right information. While the cohort study focused on looking at HbA1C, which represents an average of glucose in the past 2-3 months, today we have technology that can give real-time information about the fluctuation in glucose levels all day long. Use of CGM and following time in range (63-140 for pregnancy with T1D) as well as standard deviation, goes in depth in targeting day-to-day adjustments where the HbA1C can’t. This takes knowledgeable clinicians to help a woman make the right adjustments and understand why it is important.
Supporting women through pregnancy is something I know well. I have been helping women navigate through pregnancy for many years. I had great clinical support through my 2 pregnancies, but still lacked the personalized diabetes education that is necessary to keep up with the ever-changing insulin needs, adjustments to lifestyle and nutrition needs.
I personally looked up a lot of information that was not put together in one easy-to-read book (so, I wrote one with a colleague!) called Pregnancy with Type 1 Diabetes: Your Month-to-Month Guide to Blood Sugar Management. Thus, my interest in helping women navigate this beautiful transition to motherhood with the goal of getting them there in a healthy way. This involves starting with education and adjustments to life even prior to conception and it also means addressing some of the scary things that could happen if adjustments are not made during pregnancy to meet the tight BG targets.
Preeclampsia and many other risks in pregnancy can mostly be prevented with quality care and the education to support a woman with diabetes so she knows what to do and what is at stake. Thankfully, Integrated Diabetes Services is a great place to get that additional handholding and support. If you are planning a pregnancy or are pregnant and feel you need some individualized help, please reach out!
