November is diabetes awareness month, and as a nurse health issues are close to my heart. Allison is an online friend of mine who has type 1 diabetes, and because of my own struggles with infertility I am also sensitive to any difficulty when it comes to conception and pregnancy. I encourage you to read her post today about how having diabetes affects everything related to pregnancy. It’s super interesting and I guarantee you’ll learn something!
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When Kathleen asked me to write about diabetes and pregnancy, because of Kathleen’s own troubles with pregnancy, I thought it was a brilliant idea! I’ve had type 1 diabetes for 19 years, so I know that often times people have flashbacks to the 1980s movie Steel Magnolias, with Julia Roberts and Sally Fields, in which the main character, a diabetic, dies. Not exactly what you want as a representation!
Here are the facts: women with type 1 and type 2 diabetes can have babies. What’s type 1 and type 2 diabetes? Essentially, type 1 diabetes is an autoimmune disease (like lupus or multiple sclerosis) where the immune system attacks your body and prevents you from making insulin, which is what allows your body to use food as energy. In type 2 diabetes, your body still makes insulin, but it doesn’t use it properly. This is why type 2 diabetics can take oral medications to help with insulin resistance, but type 1 diabetics always have to take insulin injections or wear a pump.
Now, I’ve never had a baby, so what I know about diabetes and pregnancy are from other women’s experiences. But I’m a newlywed, and so that means baby-making is top of mind for us.
For most women, pregnancy is complicated after you start trying to have a baby, whether from infertility, miscarriages, or health concerns for the baby. For women with diabetes, pregnancy is complicated before you start trying.
Deciding To Have Kids
Whenever you have a chronic disease, you have to make the intensely personal decision of whether or not to have children. Diabetes is partially genetic, so for many people, that’s a huge factor. A child with a mom with diabetes has a 4% chance of getting it, and it’s 7% if the father has diabetes. However, both of my parents don’t have diabetes, and neither does my brother, so I have a hard time using that as a reason not to have a child.
There really is no rhyme or reason for why someone gets diabetes, and I don’t want my life to be ruled by fear. Besides, I don’t consider diabetes to be devastating or debilitating like some diseases, and so my husband and I have decided that we will have kids. My life is pretty awesome, and if my kid ends up having diabetes (::knock on wood::), I’ll raise him or her to have an awesome life too!
Before Baby-Making
When you have diabetes, there isn’t much that you can’t do (except hold a commercial pilot’s license, join the Peace Corp and serve in the military). Pregnancy is definitely in the cards! But like most things that people with diabetes do, it takes a lot of preparation and planning. Pregnancy is no different.
I think the piece of advice that sums up diabetes and conception the best is this: “No accidental pregnancies!”
A woman with diabetes should not accidentally get pregnanct. In fact, if I’m concerned that I haven’t taken my birth control properly, I immediately tell my husband that it’s condoms or no sex! Of course, sometimes women do accidentally get pregnanct, and usually things turn out fine, but it’s a huge risk to the baby. Why?
Life with diabetes means my blood sugars are always fluctuating. Although modern medicine and technology allows me to live a fairly normal life, things aren’t perfect. Blood sugar meters aren’t 100% accurate, and the insulin works much slower than insulin made by the body. Not all carbohydrates are created equal, so some can raise my blood sugar faster than others. We also have to deal with constantly changing hormones and activity levels, which will affect our blood sugars. There are a lot of variables, and we only have “control” over a couple of them.
But a baby won’t care if I have diabetes. Embryos and fetuses are incredibly sensitive to blood sugar. Miscarriages and birth defects are hallmarks when a woman gets pregnant before her body is in “baby range.”
How do you get “baby range”? It usually means checking blood sugar levels twice as often, which can be up to 20 times a day! I’m not quite there yet — but I am so not looking forward to it! Luckily there is a device called a continuous glucose monitor that can help detect trends between tests, but it’s still a lot of monitoring and tracking. Eating small meals to prevent big blood sugar spikes is also important. Moms-to-be need to control their blood sugars so tightly that it can often take up to a year before she’s in “baby range.”
Sometimes this means a woman will start thinking about pregnancy before she has even found the guy!
During Pregnancy
Eventually I’ll be in “baby range,” but that doesn’t mean the work is over! A pregnant woman with diabetes needs to keep up the baby range throughout the entire pregnancy — and the growing baby does not make it easy! Each week, the baby puts more and more demands on the mom. The hormones involved in pregnancy cause insulin resistance. By the end of pregnancy a woman can be taking up to three times as much insulin per day!
Because of insulin resistance, blood sugars can be hard to manage. Remember “baby range”? Staying on top of all the changes causes a lot of stress and grief. How the mom manages her blood sugars affects the baby’s health and growth. Having some fluctuations in blood sugars shouldn’t freak a mom out, but when it’s your baby, concerns and worries just multiply! I’m not even pregnant and I’m already worried! In fact, managing diabetes while pregnant can be so emotionally draining that many women say the stress and grief is the worst part of pregnancy. Plus, medical professionals are not exactly sympathetic to the struggles of this disease, so there are lots of guilt-trips laid on by doctors. So not cool.
Gestational diabetes is familiar to many moms-to-be. Many of you moms probably did the glucose tolerance test to see if you had gestational diabetes. If you have gestational diabetes, you’re asked to modify your diet, monitor your blood sugar, and sometimes even taken medication. A pre-existing diabetes pregnancy is very similar to this. So imagine taking gestational diabetes and then multiplying the difficulty by ten! And obviously, gestational diabetes goes away when you have the baby, and pre-existing diabetes does not!
Birth
You may have heard that a baby of a diabetic woman will be born big. Many times, the size of the baby is a concern. Many diabetic moms have one of two options: scheduled C-section or scheduled induction (which also sometimes results in an emergency C-section). But not always! Some moms are also able to deliver naturally if the baby is not too big. Most doctors don’t like a diabetic mom to go past 39 weeks, and full term is 37 weeks. So it really depends on when the baby decides to show up!
I’ve always grown up to believe that as a diabetic mother, my birth plan will really be at the mercy of the baby. I can’t really plan anything. Depending on the size of the baby, we might have to induce as soon as the baby is full-term. But maybe not! It’s hard to predict, and many diabetic moms simply have to play it by ear. As a high-risk pregnancy, I don’t get the pleasure of designing a home birth or a birth at a birthing center with a midwife.
How You Can Help
Now that you know a little more about how a diabetic pregnancy works, you might be wondering how you can help. Here are a few suggestions:
>First of all, trust the mom-to-be! She’s the diabetic, so she knows what she needs to do. Instead of asking, “Can you eat that?” or “Should you do that?” just ask, “Is there anything you need?” Plain and simple.
>Keep in mind that she’s stressed out. If she vents about food or her blood sugars, now you know how hard it is. Be sympathetic and a good listener.
>Help out with doctor’s appointments. She probably has a lot going on! If you have a co-worker with diabetes or a friend with diabetes, offer to pick up some slack, especially toward the end of pregnancy. She’ll appreciate it!
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So what do you think? Even as a nurse I learned a lot from Allison’s personal knowledge – for example, I had no idea that diabetics had to work so hard for so long to prepare for pregnancy, and that if their blood sugars aren’t strictly controlled they could experience miscarriage and birth defects. Wow. I was also kind of floored by Allison’s guest post on Stephany’s blog chronicling a day in her life. What did you learn?
