Ten dietitian tips for pregnancy in type 1 diabetes

Guest Post, Sally Marchini, Dietitian

I’ve been asked to write this blog as a dietitian. It’s a little challenging mostly because each of us has different requirements and should set personalised targets, so these tips are for a general guide only.  I recommend that you should check with your own diabetes health professionals before changing any current plan. Hopefully what you learn in this blog will help you to be the leader of your d-team of health professionals. Keeping track of any questions you have to ask them will be a great advantage to you and your baby.

Having a baby as a person with type 1 diabetes can be a frustrating and scary experience, but it doesn’t need to be if we know how to help our healthcare team to provide us the best support along the way.

Planning

As with most aspects of diabetes, planning ahead is essential for best results.  It’s not always possible to plan a pregnancy, but if you have the opportunity to do so then your chances of birth anomalies will be greatly reduced.

Ideally planning will begin at least 6 -12 months in advance. During this time it’s important to ensure that you:

• are taking precautions to avoid pregnancy during this timeframe
• have started on a folic acid supplement  of 5mg/day
• have asked your doctor about the need for iodine supplementation
• talk to you doctor about stopping statins and all other diabetes meds except insulin
• stop smoking
• minimise alcoholic consumption
• improve your physical fitness

HbA1c target

Your main diabetes target will be to aim for an HbA1c of around 6% to minimise risk of anomalies in your pregnancy. But you don’t want to get there too quickly as it may affect your own eyesight (retinopathy). This is one area where medical guidance is particularly important.

Once you get there, it’s important to keep it there for at least 6 months to allow your body to stabilise before proceeding to pregnancy.

Diet

When planning the pregnancy, it’s important to get back to basics in many of the issues related to food. It’s worth having a reminder session on your carb counting and to understand more about the glycemic index of carbohydrates. Reviewing label reading is also an excellent idea.

Whereas people with type 1 are ordinarily encourage to eat carbohydrates freely, in this planning stage it’s encouraged that we get back into a strict routine with quite rigid diet patterns. The reason for this is partly to do with stabilisation of the HbA1c for 6 months prior to proceeding to pregnancy, but also to help make it easier for you while you are pregnant as it makes such a difference at that time.

That means we’re looking for regular meals and mid-meals with no more than 2.5-3 hours in between each one across the day.  And each meal should contain about 40-45g of nutritionally high low-GI carbohydrates, with snacks at 15-25g.

Another good habit to get into that will help your dietitian to help you better is keeping a food and BGL diary.  Although a pain in the butt to do, this can help not only to work out where you can make improvements but will help you to learn to recognise patterns based on your BGLs and the food you’re eating. And if this is your first pregnancy then such a record will be invaluable for future pregnancies too!

Eating for Wellbeing

Nutritional adequacy is very important to address for wellbeing in any pregnancy, and meeting the Australian Dietary Guidelines for women as outlined in this brochure for Healthy Eating During Your Pregnancy before and during the pregnancy should be a major focus, especially for those of us with type 1 diabetes. This brochure also outlines the foods that pregnant women should avoid for safety.

The helpful hints section at the back of the ‘Healthy Eating During Your Pregnancy’ brochure encourages:

“You can eat well by:

• enjoying a variety of fruits and vegetables of different types and colours
• increasing your grain consumption – mostly wholegrain (and low-GI) – in preference to discretionary choices
• choosing foods high in iron, such as lean red meat or tofu, which are important for pregnant women
• Making a habit of drinking milk, eating hard cheese and yogurt, or calcium enriched alternatives. Reduced fat varieties are best.
• Enjoying a wide variety of vegetables, legumes, fruit and wholegrains and drinking plenty of water every day can assist with constipation – a common occurrence during pregnancy.”

After all the excellent preparation and you fall pregnant, then what?

Firstly a huge congratulations is in order! Well done for doing all that you can to get yourself into shape to the best of your ability for the health of the precious baby growing inside you.

I hope at this point you’ll have developed a regular relationship with your doctors, dietitian and diabetes educator to help with the hormonal insulin requirement changes through the stages of the pregnancy.

Of immediate concern is learning to deal with your morning sickness. Planning for this is essential as you don’t want to take insulin and then not be able to keep your food down. Personalised advice is essential so I won’t make suggestions here other than to encourage you to ask your team about it.

Being prepared for extreme hypoglycaemic and hyperglycaemic (particularly ketones) is something else to look into. It may not happen to you, but you’re better to be prepared just in case. Also hypo warning signals often change during pregnancy, so being aware of this and testing your BGLs frequently can help you avoid extreme hypos, and to keep you and other safe in activities such as driving!

It’s important to know that your insulin doses will change throughout your pregnancy due to hormonal changes related to the pregnancy at different stages, so working closely with your diabetes team and keeping regular checks on your BGLs will help here.

A key nutritional focus aside from keep your BGLs in range is also managing your weight through the pregnancy. This is where your food and BGL diary will assist your dietitian to keep you on track.

This leaflet by Diabetes Australia, the NDSS and Diabetes Australia Vic called ‘Can I have a healthy baby? Diabetes and Pregnancy’ is a very helpful resource that I recommend familiarising yourself with.

In summary, my top ten tips to remember are:

1. Start your planning a year in advance
2. Learn to work closely with your diabetes healthcare team
3. Aim for an HbA1c of 6% stabilised for 6 months before conception
4. Come up to speed with carb counting and label reading
5. Aim for a strict routine with quite rigid diet patterns (set number of carb serves spread evenly across the day)
6. Keep a food and BGL diary
7. Follow the Australian Dietary Guidelines for Healthy Eating in Pregnancy to ensure nutritional adequacy and safety
8. Managing your weight through the pregnancy
9. Being prepared for extreme hypoglycaemic and hyperglycaemic (ketones) events
10. Enjoy the experience!!

Wishing you a smooth and healthy pregnancy that results in a happy, healthy baby and Mum.

Sally 🙂

Sally is owner of her private practice (Marchini Nutrition), and has had type 1 diabetes for close to 40 years and coeliac disease for many years too.