Preconception Planning
Target A1C Before Pregnancy
Aim for an A1C below 6.5% (ideally) or as close to normal as safely possible before conceiving. This reduces the risk of birth defects and complications.
Pre-pregnancy Health Checkups
- Comprehensive eye exam to check for retinopathy
- Kidney function tests (urine albumin and creatinine)
- Thyroid function tests
- Blood pressure evaluation
- Cardiac assessment if indicated
Medication Review
Some diabetes and blood pressure medications need to be changed before pregnancy. Work with your doctor to switch to pregnancy-safe alternatives.
Folic Acid Supplementation
Take 400-800 mcg of folic acid daily starting at least 1-3 months before conception to reduce the risk of neural tube defects.
Diabetes Management During Pregnancy
Target Blood Sugar Ranges
- Fasting: 60-95 mg/dL (3.3-5.3 mmol/L)
- 1 hour after meals: 100-129 mg/dL (5.5-7.2 mmol/L)
- 2 hours after meals: 100-119 mg/dL (5.5-6.6 mmol/L)
- A1C goal: Less than 6% if achievable without significant hypoglycemia
Increased Monitoring
Test blood glucose 6-10 times daily, or use continuous glucose monitoring (CGM) with frequent checks. Monitor for ketones when blood sugar is elevated.
Insulin Needs Change
Expect insulin requirements to increase throughout pregnancy, especially in the second and third trimesters. Work closely with your diabetes team to adjust doses frequently.
Hypoglycemia Awareness
Be extra vigilant about low blood sugar. Always carry fast-acting glucose and let your support person know how to use glucagon.
Your Healthcare Team
Key Team Members
- Maternal-fetal medicine specialist (high-risk OB)
- Endocrinologist with pregnancy experience
- Certified diabetes educator
- Registered dietitian specialized in diabetes and pregnancy
- Ophthalmologist for regular eye exams
Frequent Appointments
Expect weekly or bi-weekly appointments with your diabetes team, and monthly or more frequent visits with your OB. More monitoring means better outcomes.
Fetal Monitoring
Your baby will be monitored closely with regular ultrasounds to check growth and development, and non-stress tests in the third trimester.
Birth Planning & Postpartum
Delivery Timing
Most women with well-controlled T1D can deliver at 39-40 weeks. Your team will discuss the best timing and method of delivery based on your health and your baby's health.
During Labor
Your blood sugar will be closely monitored and managed with IV insulin if needed. The goal is to keep levels in a tight range (70-110 mg/dL) during labor.
After Delivery
Insulin needs typically drop dramatically immediately after delivery. Your doses may temporarily be 30-50% of your third trimester needs. Work with your team to adjust.
Breastfeeding with T1D
Breastfeeding is encouraged and safe with T1D. Have snacks available during feeding sessions as breastfeeding can lower blood sugar. Stay hydrated and monitor glucose levels.
Postpartum Support
Continue working with your diabetes team postpartum. Adjust to new sleep schedules, eating patterns, and the demands of a newborn while managing diabetes.
Remember: Thousands of people with T1D have successful pregnancies every year. With planning, excellent diabetes management, and the right healthcare team, you can have a healthy pregnancy and a healthy baby.