5.3.0.0 Type 1 Di­a­betes

Women with type 1 di­a­betes have an in­creased risk of hy­po­glycemia in the first trimester and, like all women, have al­tered coun­ter­reg­u­la­to­ry re­sponse in preg­nan­cy that may de­crease hy­po­glycemia aware­ness. Ed­u­ca­tion for pa­tients and fam­i­ly mem­bers about the pre­vention, recog­ni­tion, and treat­ment of hy­po­glycemia is im­por­tant be­fore, dur­ing, and after preg­nan­cy to help to pre­vent and man­age the risks of hy­po­glycemia. In­sulin re­sis­tance drops rapid­ly with de­liv­ery of the pla­cen­ta. Women be­come very in­sulin sen­si­tive im­me­di­ate­ly fol­lowing de­liv­ery and may ini­tial­ly re­quire much less in­sulin than in the prepar­tum pe­ri­od.

Preg­nan­cy is a ke­to­genic state, and women with type 1 di­a­betes, and to a less­er ex­tent those with type 2 di­a­betes, are at risk for di­a­bet­ic ke­toaci­do­sis at lower blood glu­cose lev­els than in the nonpreg­nant state. Women with pre­ex­ist­ing di­a­betes, es­pe­cial­ly type 1 di­a­betes, need ke­tone strips at home and ed­u­ca­tion on di­a­bet­ic ke­toaci­do­sis pre­vention and detec­tion. In ad­di­tion, rapid im­ple­men­ta­tion of tight glycemic con­trol in the set­ting of retinopa­thy is as­so­ci­at­ed with wors­en­ing of retinopa­thy (13).

The role of con­tin­u­ous glu­cose mon­i­tor­ing in preg­nan­cies im­pacted by di­a­betes is still being stud­ied. In one RCT, con­tin­u­ous glu­cose mon­i­tor­ing use in preg­nan­cies com­pli­cat­ed by type 1 di­a­betes showed im­proved neona­tal out­comes and a slight re­duc­tion in A1C, but in­ter­est­ing­ly no dif­fer­ence in se­vere hy­po­glycemic events com­pared with con­trol sub­jects (71).