Ep. 23 - Essentials for Pregnancy Planning - Type 1 & 2 Diabetes (Pt. 1)

There are some key considerations for pregnancy when you have Type 1 or 2 Diabetes. In Episode 23, Jaimee talks about the importance of aiming to achieve recommendations for glucose management to reduce some possible very serious complications to Mum &/or Bub during pregnancy. As someone living with Type 1 Diabetes, Jaimee understands how it feels to be told you should not fall pregnant until you get your HbA1c down to 6.5% or less! It can feel like an unachievable and unfair target. Listen in to hear why pregnancy planning is SO important for women with T1D & T2D. Jaimee also covers other considerations around medications, supplements and screenings which should be discussed with your diabetes team. 

Warning ‼️ some content may be triggering and confronting in this episode.

The essentials are covered in this podcast as Part 1, with more to come in the future.

This is not individualised advice and you should always work with your diabetes team when making adjustments to your diabetes management.

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Transcript

Jaimee 0:10

Hi everyone. Welcome back to another episode of Diabetes in the Raw. This is Jamie Solo today, and it is a very short episode, probably a part one really just to get the topic out there. So today I'm going to talk about preconception care, which is basically care in the lead up to pregnancy. So it might be called preconception or pre Pregnancy care. And really, I'm just going to put the real basics out there. And when I say basics, it's just a very important essential information that women would need to know about prior to pregnancy. If you have type one or type two diabetes. The reason for this is I am studying my master's of nurse practitioner, specializing in diabetes, and I've been doing a huge assignment on preconception care. And it's just very scary how many women aren't given the opportunity to really know what they need to do prior to pregnancy. And I know not everyone out there plans pregnancy, but it is essential for women with diabetes to know. to do so if at all possible. And even part of the guidelines are actually to make sure you're on contraception so that you don't fall pregnant. If you're not, you know, if you're not set up to do so with diabetes. And I do know how that sounds. And as someone who does live with type one diabetes and has been through two pregnancies, I understand how that sounds. You know, you can't fall pregnant until you get your diabetes under control. But the more I read into it. The more important it is, and it is for the health of you and your baby. The, the risks to us with diabetes in pregnancy are really huge for both mum and baby, and most of them can be prevented if you do plan your pregnancy and get your glucose levels up. To the target ranges, which brings me to the guidelines. So I'm sort of going to read a bit of a list out at the moment, but really we want to try and get our HbA1c's down to less than 6. 5 percent or 6. 5 percent or less. And that's the guidelines because It reduces the risks of all sorts of nasty things, and I'm, I'm in two minds about whether to read some of those out or not, but I guess women only know how important it is if they're aware of what can happen. So, to, to start bluntly you can lose your baby if your glucose levels aren't, you know, in the desired range. And obviously, if you're sitting just above target, the risk isn't as high as though it would be if you were sitting much, much higher. And I have had women, when I've been working in this space professionally, who have come into pregnancies with quite high HbA1c's. And you may know of people who have, and have had Babies that appear to be healthy, and I say appear because sometimes we won't know the full effect on baby until they are older. And, and that could be anything from you know, abnormalities with organs through to things like learning difficulties and things like that. And I'm not going to dig into the research around that, but I guess it's just something to be aware of. And maybe I can cover it with someone else that specializes in pregnancy in a later podcast. Other things a baby going low with their glucose levels after delivery. So that is something that can happen for women with any type of diabetes during pregnancy, if the glucose levels haven't been well managed throughout. Babies can have breathing difficulties, they can be larger, you might hear the word large for gestational age, or you might hear macrosomia. That's all to do with glucose levels being elevated throughout pregnancy for mum, because then baby does produce extra insulin, which can cause them to grow ahead of time, and obviously their organs aren't developing any quicker. Other things that we might see is preterm delivery, so being delivered earlier than ideal. We might see birth weight extremes, as mentioned. Sometimes that's actually small for gestational age as well. So it's not always bigger babies and that can come with its own challenges. We've got increased rates of congenital anomaly. That's basically anything from issues with the heart being formed in, you know, the first trimester. And often women don't know they're pregnant until later on in the first trimester. So it is extremely important that we try and get glucose levels. To target range before conception. Yes, and neonatal death, I've already mentioned, and I know it sounds extremely harsh, but it is reality. I read a study and it was terrifying to read about stillbirth and neonatal death, which is one of the reasons why I just wanted to get this podcast out there. So what can you do? The advice on the Australasian Diabetes in Pregnancy Society website goes through a whole lot of things. And this isn't for you to go and look up. It's more to be aware of so that you can engage with your endocrinologist and or diabetes educator, dietician, you know, your team to help you with all of these things. So it's healthy eating and that's referring to carbohydrate content, the glycemic index, everything that a dietician could help with. Individualized weight management is a big thing. Women who come into pregnancy with an elevated BMI or above a healthy weight do have increased risks. during pregnancy, and that's with and without diabetes, but especially important for women with diabetes. There's actually a guideline for women with type 1 and 2 diabetes to take some folic acid in the lead up to falling pregnant and in the first trimester. And that's to do with helping reduce risks to the brain and spine in babies during development in that first trimester. We've also got physical activity, self monitoring of blood glucose levels, or continuous glucose monitoring, with CGM, or Continuous Glucose Monitoring, being free to women who are planning pregnancy in Australia, I would highly recommend that if you haven't already used a CGM, you definitely get onto that. So your diabetes educator, or endocrinologist, or diabetes team can definitely help with that. It's all through the National Diabetes Services Scheme. Yep, so HbA1c less than or equal to 6. 5 percent and that's without having lots of hypos. So there are some specific ranges we aim for during the preconception stage, and that is a glucose level between 3. 7. 8 more than 70 percent of the time, so that might seem quite tight to a lot of people or I'd probably be saying most people with diabetes would find that pretty difficult but it is possible and you just need to work very closely with your team and if you're sitting a fair way above that, At the moment it might take a little bit longer, and you definitely need to work with your team in terms of safety to achieve that. You might even want to talk about insulin pumps before falling pregnant, because that can be something that's challenging to do once you are pregnant. So if you've been thinking about it, and you want to talk to your team, that could be a really good idea. We want to minimize the time below 3. 5, and so the CGM will be really useful for helping to identify that as well. We want to reduce glycemic variability, which is basically how much we're going up and down, and the CGM is a great way to measure that as well. We want to make sure we're familiar with sick day management, ketone testing. If you haven't tested your ketones in years, it's a good time to make sure you've got all the equipment and strips in date that you need and maybe do a review of when you should be checking for those and how and when to give more insulin if you are sick and have ketones. Hypo management, so just a revision, making sure you've got your hypo treatment with you when you are trying to reach quite tight ketones. glucose levels. Driving, obviously very important if we're also sitting a bit lower. We still need to be ideally around five to drive. That guideline is still recommended in Australia, but with CGM I guess it might be a bit safer to sit closer to five given that we've got our trend arrows. But just keep, just keep it in mind that you do want to be safe when driving. Contraception until you're Glucose levels are optimized, as I said at the start, that is for safety for you and baby in pregnancy. And at one point in my life, I did think that was, you know, pretty harsh to tell women they shouldn't be falling pregnant. And now that I understand the risks compared to women without diabetes My passion is now to get it out there, why it's so important, and not just tell you, you can't fall pregnant until you get your glucose levels down. You, the guilt that comes with, you know, elevated glucose levels when pregnant, I can really, really relate to firsthand. So I can only imagine what it must feel like for women who, do have babies who have been affected because diabetes management wasn't ideal during pregnancy or prior to pregnancy. So yes, it's definitely you know, it's definitely to help you on your pregnancy journey. Your health care team should talk to you about why it is important to have tighter glucose control during pregnancy and, you know, even with gestational diabetes, the targets are tighter when women are growing a baby compared to when we're not, whether that's type 1 or 2 diabetes, and that is for very good reason, and there is a evidence around it. It's not just something someone's made up for no good reason to make our life more difficult with diabetes. And then there's things to consider around vaccinations and possibly other supplements as well. So just make sure you check in with a specialized diabetes team. There's also not always health care professionals who specialize in this area that understand the importance I can personally speak from experience when just having gone through my GP at the start of a pregnancy and not even being asked if I am on folic acid before, you know, I actually meet up with my diabetes team and that's just something that a GP could easily check on, but they're just not all aware of it. So. it really is up to you as a woman with diabetes to chase things up with your diabetes team and not expect your GP to know everything. It is a specialized area. With probably more for women with type 2 diabetes, some of the medications you may be on for Glucose control and type 2 diabetes could actually be harmful to a growing baby. So you do want to check on all of that before you fall pregnant as well. And you might need to be switched onto some different medications. And then finally, we basically need to make sure we've got all our complications screenings up to date. So blood pressure, eyes, feet, kidneys thyroid, celiac, and mental health. is a huge thing. And as I mentioned, I completely understand the burden and how hard this can be. But I do worry about the mental health of women who haven't been advised on the importance of glucose management prior to pregnancy and especially in the early stages of pregnancy, because the mental health side of things that could come if we don't get desired outcomes could be even worse. Even dental. Dental check ups can be important before you fall pregnant as well. And other blood tests, so as I mentioned, the doctors might want to check thyroid, celiac, B12. If you've got any other medical conditions, bariatric surgery, anything like that, there will be extra considerations. So I hope that's helpful. As I said, I will be on my way. Possibly with a guest to talk more about diabetes and pregnancy, but this was just a kickoff to get us started. And please do reach out if I can support you on your pregnancy journey. My contact details will be in the show notes. Thank you. Bye.