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Type 1 diabetes and pregnancy
Can you give birth if you have type 1 diabetes?
Women with type 1 diabetes can have a safe pregnancy and give birth to a healthy baby but won’t always be able to have a vaginal delivery.
If you have type 1 diabetes, your baby can be larger. And because there are risks with having a larger baby you might need to have your baby early and be induced at week 37 or 38 or you might need to have a Caesarean section (an incision in your womb) rather than a vaginal delivery. Your maternity team will chat to you about what’s best for you and the baby.
Women are advised to plan for pregnancy with their healthcare team before coming off contraception to reduce the risks to their health and their baby’s.
If you have an unplanned pregnancy, don’t be hard on yourself and don’t panic. As soon as you find out you’re pregnant, get in touch with your diabetes healthcare team. They should get back to you with advice and appointments for health checks for you both.
Will having type 1 diabetes during pregnancy affect the baby?
Most women with type 1 diabetes have healthy babies. But pregnancy hormones can make it harder to keep your blood sugar levels within target range. And if you have high blood sugar levels, this can affect your baby’s development. It can cause birth defects, make babies larger and increase the risk of a difficult birth, and the risk of miscarriage and stillbirth. Shortly after birth, some babies might need admission to the neonatal care unit for problems such as low blood sugar levels and jaundice and may need support with heart and breathing problems.
To reduce the risks to your baby’s health, it’s important to tell your diabetes healthcare team you want to try for a baby so they can help you plan.
To help monitor your baby’s health and your health, you’ll get extra appointments, checks and scans from your maternity diabetes teams throughout the pregnancy. You should be seen by your healthcare team every two weeks. And you’ll usually give birth in hospital.
Can type 1 diabetes be passed from mother to baby?
Babies aren’t born with type 1 diabetes. And there’s only a slightly higher risk of your child developing the condition later on. For more information, see our page on Causes of type 1 diabetes. Many people with type 1 diabetes have no family history.
Planning for a pregnancy if you have type 1 diabetes
Planning your pregnancy can help you reduce the risk of serious health complications for you and your baby. Ideally, you’ll start seeing your healthcare team at least 6-12 months before stopping contraception, so they can help you prepare for a healthy pregnancy.
Your healthcare team can support you to reach a HbA1c of 48mmol/mol or lower. Any reduction towards the target will help protect your baby. The first 6-8 weeks is when the baby’s organs develop which is why it’s important to get support with blood glucose management before you get pregnant.
If your HbA1c is above 86mmols/mol it is strongly recommended that you do not try for a baby until your HbA1c is lower, because of the associated risks to the health of mum and baby.
Your healthcare team should also:
Carry out kidney and eye checks
Prescribe high dose folic acid every day (5mg)
Review your medication as some medicines may need to be swapped for safer options during pregnancy.
Discuss with you whether you’d like to try a Continuous glucose monitor (CGM) which alerts you when your glucose levels are going too high or too low.
Discuss how insulin pumps and hybrid closed loop systems work and whether you might be eligible.
Support you to make changes to your diet, give advice on physical activity and if needed help to stop smoking or drinking.
If you're pregnant and have type 1 diabetes, if you're in England, Wales and Scotland, you should qualify for a CGM on the NHS during pregnancy. If you're in Northern Ireland, check with your healthcare team.
If you are unable to use a CGM or would prefer to use a flash glucose monitor (Freestyle Libre) then you should be offered this.
Type 1 diabetes and pregnancy diet
If you have type 1 diabetes and are pregnant, there isn’t a set diet. But it’s important to eat healthily and keep active for the health of both you and the baby. The types and amount of carbohydrates you eat and drink make the biggest difference to your blood sugar levels. Get support from your dietitian and ask them for advice on portion sizes and how to choose healthier carbs.
Type 1 diabetes and managing blood sugar levels during pregnancy
Managing your blood sugar levels as well as you can to help reduce the risk of health complications to you and your baby is really important. A combination of reviewing your insulin requirements with your healthcare team, eating healthily and keeping active.
We know pregnancy hormones can make managing blood sugar levels especially difficult, despite your best efforts. And that can be due to insulin resistance – the insulin you take for your type 1 diabetes may not work as well. This is quite common in the second and third trimester (from week’s 16-20 onwards) and most pregnant women find they need to take more insulin especially before meals.
You should get lots of extra support from your healthcare team to manage your blood sugar levels. They’ll talk to you about how to manage your blood sugar levels during pregnancy and your target blood sugar levels. And should discuss using a Continuous Glucose Monitor.
If you’re interested in using an insulin pump or a hybrid closed loop system, it’s worth having a conversation with your healthcare team to see if you may qualify.
Pregnancy and type 1 diabetes complications
If you have type 1 diabetes, pregnancy can put you at greater risk of more hypos, which may be more severe and you may experience hypo unawareness which is when you are unable to notice that you have low blood sugar levels.
Diabetic Ketoacidosis (DKA)
Hypers (high blood glucose levels), are also a risk and can lead to DKA (diabetic ketoacidosis) and DKA is more common in pregnancy.
DKA happens when there is a severe lack of insulin which means the body can’t use glucose for energy and starts to break down fat instead. When this process happens chemicals called ketones are released. If left un-checked the ketones can cause the blood to become acidic. Ketones can cause serious problems during pregnancy.
Although DKA usually happens when blood sugar levels are high, during pregnancy DKA can happen even when blood sugar levels are within normal range. Make sure you have a blood ketone meter and test strips and seek immediate help if your ketone levels are raised or you are experiencing symptoms of DKA or feeling unwell.
You should also be offered a CGM during pregnancy, CGM has alarms which can help to alert you when your glucose levels are going too high or too low. A CGM can also help keep your glucose levels within target range.
Other complications
You may develop high blood pressure, or be at risk of kidney or eye problems as pregnancy can make existing complications worsen. You’ll have eye checks and kidney checks before and during pregnancy.
Pre-eclampsia
If you have type 1 diabetes, you have a higher risk of pre-eclampsia. This is high blood pressure and protein in the urine that should be picked up during your routine antenatal appointments. This pregnancy complication can be a serious condition and dangerous for mum and baby in the second half of a pregnancy (20 weeks). But you’ll be closely monitored and offered medication if needed. For more information, go to the NHS’s Pre-eclampsia treatment page.
If you notice during pregnancy that your baby’s movements have slowed, stopped or are different to normal, you should contact your midwife or maternity unit immediately. There are staff on the hospital maternity unit 24 hours a day, seven days a week who can check your baby is OK.
Getting emotional support
There’s lots to look forward to if you’re pregnant. But having the burden of diabetes to manage on top of pregnancy is a lot to think about. Ask for help if you need it. Speak to your midwife and tell them how you feel. If you aren’t comfortable discussing things with your healthcare professionals, you can also contact our helpline on 0345 123 2399 if you want to chat through any worries or ask any questions. You can also reach out on our forum. It can be helpful if you have someone you can take with you to appointments to support you.
"With my first pregnancy, I came off contraception thinking it would take a while to get pregnant and I had time to plan. But I fell pregnant straight away. And the enormity of the situation hit home and what it all meant."
