What I'd do differently if I were lucky enough to have another T1D pregnancy
What I’d do differently if I were lucky enough to have another t1d pregnancy
Hands down, one of the biggest concerns I've faced in my t1d tenure was how I'd be able to manage pregnancy. I was worried about:
Achieving much tighter control
'Morning' sickness and food aversion leading to hypos
Increasing insulin requirements
Health complications for my growing baby as a result of t1d
You guys probably share similar worries. I remember working with the Mum of a recently diagnosed t1d girl. Among other things, the Mum was concerned about whether her little daughter would ever be able to have her own family (the daughter could, btw, but her Mum was understandably preoccupied).
Any pregnancy will carry risks, even if it is deemed ‘low risk’, but throw t1d into the mix and it automatically becomes 'high risk' (still have issues with this terminology - see point 2 about a grass-roots language and pregnancy project you might want to get involved in!)
It's fair to say I found pregnancy with diabetes like unlocking another t1d level. Type 1 diabetes plus, if you will. It was completely manageable and I gave birth to a healthy little boy, but I won't sugar-coat it. It was damn hard work. I learned lots from the experience. And if I were lucky to do it again (hopefully one day!) there are some things I’d do differently.
Read on to find out 5 things I’d mix up for another t1d pregnancy.
1. I'd let go of the dream of a low intervention pregnancy
T1D pregnancies are classified as 'high risk' and require tighter control than usual t1d life. On safety grounds, the pregnancy becomes fairly medicalised, with frequent appointments, blood tests, and scans. This made me feel anxious. Coupled with the physical challenges of pregnancy, I struggled to enjoy this time (erm, where was my pregnancy glow?). If I experienced this again, I wouldn't beat myself up about it, or long for a less medically-intensive process.
2. I'd feel more able to challenge any unhelpful language
There's a lot of stigma and assumptions that fly around pregnancy with any type of diabetes. Due to the mechanics of t1d, there's potential for a foetus to grow bigger than average (a term called 'macrosomia'). During my last growth scan at 38 weeks, the sonographer repeatedly referred to my 'really big baby'. Super not what you want to hear when you're preparing for birth, and also ridiculous given my son weighed 8lbs. Not small, but not really big.
Psst, this is why I’m involved in a grass roots advocacy project about language and pregnancies in those with diabetes (any type!). If you’ve experienced a pregnancy with type 1, type 2, gestational, MODY, or LADA, and you’d like to share your experiences - good and bad - of language used, please find out more here.
3. I'd optimise specific nutrients in the pre-pregnancy, fertility window
These include vitamin D, iron, calcium, choline, omega 3s. I'd prioritise a food first approach where possible, and get in many different foods before any possible morning sickness or nausea kicked in. I'd consider: 2 portions of oily fish weekly and 2 handfuls of hemp seeds daily for omega 3, regular egg consumption for choline, a daily portion of dark green leafy veg and daily portion of Greek yogurt for calcium, 2 portions of grass fed red meat weekly for iron, and a vitamin D supplement.
4. I'd reach out to more families who were going through a t1d pregnancy at the same time
When I had Stanley, a family friend was also pregnant and t1d - hello Emily! - and it was beyond affirming and reassuring to have her to share things with, ramble on long blood glucose-lowering walks with, and vent with. For a possible next time, I dream of a community or group of us, navigating the trying times of a t1d pregnancy together.
5. I'd remind myself that, at certain points, blood glucose levels will go out of range
And I'd try to remember that I'm not robotic, and things will go skew-whiff. I wouldn't let the highs, or the lows for that matter, dictate my self worth or ability as a mother, pregnant woman, or person with t1d.