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Even with the development of increasingly “intelligent” tools to help manage type 1 diabetes mellitus, doing so is still difficult, and the risk of complications from having too high or too low blood sugar remains a constant threat to people with this disease. 

Diabetes is especially risky during pregnancy, which is why creating a diabetes support plan with a certified maternal fetal medicine specialist is essential for protecting both the health of the mother and the baby during pregnancy and childbirth. 

Type 1 Diabetes vs. Type 2 diabetes vs Gestational Diabetes 

Both Type 1 and Type 2 diabetes are diagnosed prior to pregnancy. It’s important to note the difference between mothers with gestational diabetes, type 2 diabetes, and those with type 1 diabetes (T1D), as the diseases are distinct and type 1 carries the most risks. Gestational diabetes is diagnosed during pregnancy, and is a risk factor for adult onset, or type 2, diabetes. Both Type 2 diabetes and gestational diabetes are conditions in which the body is resistant to insulin.   

In contrast, type 1 diabetes (in addition to latent autoimmune diabetes in adults, LADA) is a condition in which, rather than resisting insulin, the body does not make enough insulin.   Type 1 diabetics are diagnosed before becoming pregnant and pregnancy can make the tough job of managing their blood sugar even harder, which comes with risks to both the mother and fetus. 

The Risks of Type 1 Diabetes 

Not only does having diabetes (type 1, type 2, and gestational) increase the risk of other conditions such as high blood pressure, preeclampsia, and other adverse pregnancy outcomes. But Type 1 diabetes comes with serious risks such as the potential to develop diabetic ketoacidosis, a condition that can cause contractions, nausea, vomiting, and abnormal fetal heartbeat. 

If untreated, diabetic ketoacidosis can be life-threatening for the mother and the fetus. In diabetic ketoacidosis, the body’s environment can become acidic, which can also cause the fetus to become acidic.  

What Causes Diabetic Ketoacidosis? 

Diabetic ketoacidosis (DKA) can arise when the mother’s blood sugar rises to high levels, a condition called hyperglycemia. This can occur at lower glucose levels in pregnant women than non-pregnant women. Normal problems in pregnancy such as nausea and vomiting or urinary tract infections can be triggers for DKA.   

Diagnosing DKA involves testing the blood sugar (hyperglycemia can be considered anything over 200) and serum ketone assessment. Treatment involves careful monitoring, including hourly blood sugar tests and labs every 4 hours, and aggressive fluid intake. The key to treating DKA during pregnancy is to restore homeostasis slowly and consistently, which is why constant testing and a multi-disciplinary approach is the recommended course of action. 

Managing Diabetes During Pregnancy 

For type 1 diabetics, managing their blood sugar levels requires constant, consistent attention. This battle becomes even harder during pregnancy, as the body increases blood sugar levels in response to the developing baby’s needs for nutrients and energy. 

A pre-conception consultation with a maternal fetal medicine specialist is vital to helping type 1 diabetics manage their blood sugar levels effectively throughout gestation and decrease the risk of adverse pregnancy outcomes. Whether you take daily injections, or have a more high-tech approach with new continuous glucose management (CGM) devices, insulin pumps, or an “artificial pancreas”, knowing what to expect during pregnancy can help you manage your blood sugar effectively as your body undergoes a great change.  

Keeping your blood glucose levels normal lowers the risk of birth defects, preeclampsia, stillbirth, and other adverse pregnancy outcomes in general. By keeping regular appointments with a maternal fetal medicine physician, people with diabetes can ensure they have a safe, healthy baby delivered at the right time. 

Diabetic Care During Pregnancy 

At Maternal Fetal Medicine Associates, we are your partners in health and will help you every step of the way to ensure your pregnancy is safe and healthy no matter what health concern you have. Our experts in high-risk pregnancy have the expertise to educate, treat, and care for those planning on becoming pregnant who have type 1 diabetes. To learn more about how this disease may impact your pregnancy and childbirth, call us or contact us online to schedule your pre-conception appointment today. 

Maternal Fetal Medicine blogs are intended for educational purposes only and do not replace certified professional care. Medical conditions vary and change frequently. Please ask your doctor any questions you may have regarding your condition to receive a proper diagnosis or risk analysis. Thank you!