Type 1 Diabetes and Pregnancy: Episode 2 – Pre Pregnancy



you pre pregnancy and pregnancy though very exciting times can also be very stressful for most women if you have type 1 diabetes it can be downright overwhelming it can drum up questions and concerns and quite frankly misinformation about what to expect and how to manage your pregnancy and diabetes for me as a type 1 I found it very difficult to lock down that perfect a1c to conceive safely go for it green light red light weight so in this kickoff episode armed with my trusty notebook I speak with endocrinologist dr. Julia Lowe and nurse and diabetes educator Fiona Thompson Hutchison and we discussed some of the common questions and concerns associated with this first important part of pregnancy specifically for those of us with type 1 diabetes common questions such as is it common for women with type 1 to have babies can we have safe and healthy pregnancies and of course what is the deal behind getting that a1c under 7 take a look how common are type 1 pregnancies in general so that's an interesting question when I was a resident they were extraordinarily uncommon because people were kept in hospital or full-time now there is common as women with type 1 diabetes are so it's a actually about point 5 percent of pregnancies are affected by type 1 diabetes and it's 12th for Sunnybrook it's 12 to 15 people a year and can a type 1 mom have a safe and have no absolutely we have a we have a brochure we give to people to help them plan their pregnancies that we've designed but yes they can indeed it just takes a bit more planning and unfortunately as we know it should be a planned pregnancy but about 50% of pregnancies are not planned what would you recommend for someone with type 1 diabetes to do to do to have a safe pregnancy experience well the first thing is to talk to your healthcare professional your endocrinologist soon as possible your diabetes education team because we want every pregnancy to be a planned pregnancy there are some things for example there are some drugs that you shouldn't take and there are some drugs that you should take so if for example you're on an ACE inhibitor or to protect your kidneys then you shouldn't be taking that when you're planning pregnancy some women will be on a cholesterol-lowering agent and it shouldn't take that when the planning pregnancy but you should take folic acid about five milligrams to prevent or to reduce the risk of having neural tube problems in the baby and you need go to control you need as good control as possible ideally an hba1c under seven percent that many physicians would argue it should be lower than that and what is the chance that my baby will have type 1 is it different if the mom has it so this is one of the really fun questions because actually that the chance is higher if dad has it so the odds are about 3% of mom has it about 5% of dad has it and if you already have a child with type 1 diabetes unfortunately it's about 8% for subsequent siblings and if both parents have it I don't really know the answer to that you would think logically it would be higher but it's not just a genetic effect type 1 diabetes there's this big environmental component that we don't really understand yet and it's something that obviously children brought up in the same environment so there may be and you know that there may be something in the family environment that protects against diabetes or there may be something in the family environment that is more likely to induce diabetes and we just don't know what it is you mentioned that it was important for my a1c to be below 7 when I get when I want to get pregnant yes why is that because it reduces the risk of congenital abnormalities in babies so below 7 percent is it's a bit of a balance ideally we'd like the a1c to be normal but if your a1c is normal then you're carrying a high risk of having hypos and hypose are dangerous for you and for your baby in the early stages of pregnancy so because you might have an accident so you might fall over you might pass out it's so it's dangerous to have high pose you're also more at risk of hypose early in pregnancy so we want to reduce that risk because it's a risk to your you to your health so it's a bit of a compromise under 7 percent gives us a slight increase in the risk of congenital abnormalities but most of these are going to be minor ones so we don't worry about that as much as we worry about you hurting yourself in due to hypoglycemia so it's a balance but even if you have a higher a1c you can still have the chart the odds are still that you're going to have a healthy baby we just have to be a bit more careful about things get controllers early as we can in pregnancy so I always tell my patients with type 1 diabetes every pregnancy should be a planned pregnancy but if by chance something goes wrong please let me know as soon as possible because we will do everything we can to make sure that things go as well as possible for you so in that same breath obviously because you're seeing pre-planned birth control is obviously something yes very encouraged yes very much encouraged and I mean there there are things like you know the oral contraceptive may interfere with your blood sugar but we can handle that it's better to avoid a pregnancy until you're really ready to have one so I get the news I'm pregnant who is the first person that you think I should contact so ideally contact your endocrinologist as soon as possible we endeavor to respond to everyone who said lets us know they're pregnant within 24 hours it may be a call from the nurse educator maybe a call from your endocrinologist but but you should get a response pretty quickly and can I expect that I'll be having the same team or it would be a different team so it may be a different team because in some places there is a specialist diabetes in pregnancy team and not every endocrinologist who looks after type 1 diabetes has expertise in pregnancy so it may or may not be your same endocrinologist however once you're connected with the diabetes in pregnancy team should be the same team maybe it's slightly changing faces it might be you know the doctors rotate a bit but but basically it should be the same team all the way through so what helps in achieving a hemoglobin a1c below 7 we spoke with Fiona Thompson Hutchison to hear what advice she gives have some patience it does take time not everything is achievable very at the very beginning and an a1c under 7 is sometimes difficult for some women especially if you're starting much higher we recommend that you stay really close together with a health care team and have some some patience and and realize that achieving that goal does take some time thank you so much for watching make sure to comment and share this video with your family friends and health care team in the next episode we'll be talking about the first trimester be sure to subscribe to our YouTube channel to get updates on our latest videos

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