Thinking Ahead

Hello ladies! This is my first post in this forum, but I've been reading posts and responses on and off for a while. I've had T1 for almost 5 years, on a pump and CGM, and my A1C has been under 7% for about a year and a half. I've been married for 2 years and we are kind of, sort of, just starting to think about having a baby.

I'm honestly not too worried about diabetes and pregnancy. I've read a lot on here, I know that Cheryl Akon's book is very informational (although I haven't read it yet), and I have a good endocrinologist. He wants my A1C to be 6% or lower before starting to try. My lowest was 6%, and at that time I was having an scary amount of lows, so I'm more comfortable in the 6.5% range.

I'm wondering about what else needs to be done before starting to try. I go to the eye doctor once a year (I was just there in September) and have no signs of retinopathy or other diabetes-related problems. I know I will have to see a high-risk doctor, but do you see that doctor before you get pregnant, or is that usually afterward? I take an ACE-inhibitor for a slight kidney issue (hyperproteinuria diagnosed around 3 years ago), so will I have to see another doctor just for that issue?

Also, unrelated to diabetes, how far in advance before starting to try do you start taking prenatal vitamins?

This is a whole new (slightly scary) world for me, and I just want to be super extra prepared when the time comes! Thank you for your help!


You are in great shape and sound ready for a healthy pregnancy now.  Managing pregnancy with type 1 is completely do-able.  After I went through it I wondered why I had waited so long.  

Tell your doctor when you're ready to try so he/she can prescribe a baby friendly ACE inhibitor.  The most common ones, like Lisinopril, can cause birth defects.  I'd started taking ACE drugs for high protein about 5 years before getting pregnant.  Once I was expecting my doctor switched me to a different drug for the pregnancy and I didn't have to see any type of specialist.  My kidneys continue to be 100% healthy thanks to ACE inhibitors.  

I had a 7 A1c when I conceived. Having a baby on board gives instant incentive to have tight blood sugars.  During the pregnancy it didn't feel like a burden to test often and carb count and without doing anything crazy I had a 5.1 A1c for the duration of my pregnancy.  In the years since I've gone back to my normal 6.5 A1c and that works for me.  

Some women start the prenatal vitamins when they start trying to conceive.  My pregnancy was unplanned, but when I conceived I was in a super happy and healthy place in my life and my marriage.  I think that's just as important in starting a baby off right as taking prenatals.  

Take care and I wish you the best.  Being a mom is such a wonderful blessing.  

Thanks for your reply!

Hi Erica,

Your situation sounds VERY much like mine! I just got married myself - back in August of this year. While I'm not actively trying with my husband at this time since we're newlyweds still, I joined this forum to learn more about being a type 1 and pregnant. Like you, I have pretty good H1Ac's - however they are a little higher than yours - my last one was 6.2 and my endo also told me I need to get below 6% before even thinking of trying.

I have also seen a Type 1 diabetic specialist related to pregnancy - as recommended by my OB-GYN. The reality is, no matter what, i will be high risk in pregnancy as you will, as well. So I'm told I will be monitored very closely - this means weekly trips to the Dr's office, etc and probably early bed rest - not sure how that fits in with your job/lifestyle but just something to anticipate. I started prenatal vitamins already. Even though we're not actively 'trying', i'm in my 30's and I'm told prenatal vitamins can't harm you ony help - they're just an extra dose of iron to really help boost your body. So my advice would be to start the pre-natal vitamins now wouldn't hurt at all - i know a lot of women who take them more than 1 year in advance of conceiving just to be prepared :)

On another note: i want to address your ACE inhibitor questions. I used to take an ACE inihibitor for a short amount of time (a few months) and stopped because of the horrible, terrible side effects that it gave to me - dizziness where I almost passed out. The ACE inihibitor was also meant to treat microalbuminuria that was found in traces in my urine and elevated levels. I DO know for a fact (and please check with your endo to corroborate) - but if you are planning to conceive or become pregnant, you can't take an ACE inhibitor at the same time - it's contraindicated and can really mess you up. So please, please be careful if you want to start trying while on the ACE inhibitor. My Dr. told me that I would have to go off of the ACE inihibitor while trying to become pregnant or while pregnant; the reality is, since it gave me such bad side effects, I stopped taking it. I almost fainted in a restaurant bc it dropped my blood pressure so low! Your endo would be able to advise you of this - a cardiologist usually prescribes this type of medication but it doesn't sound like you have heart problems so I would check with your endo first.

hope this has helped and good luck!


You're right that any type 1 pregnancy is going to be high risk and you'll see the doctor more often than non-diabetics.  But it doesn't have to be as much as you've been told.

I saw the OBGYN once a month for the first couple months and sent my blood sugars to him for the first few weeks.  But my doctor agreed I knew what I was doing and I went back to having appointments on the same schedule as a non-high risk pregnancy.  I had a couple more ultrasounds in the last month, but otherwise wasn't at the doctor more than any other mom.  

There's no diabetes related reason that would require you to have bed rest for your pregnancy.  It may be required for preeclympsia (high blood pressure) or other reasons, but not diabetes.  I worked full-time and attended exercise classes right up until I went into the hospital to be induced at 39 weeks.

Re: ACE inhibitors.  They're pretty standard for people with diabetes, both to prevent and reverse kidney damage.  I also had the side effects you experienced but switched to taking the drug right before I went to bed and it mitigated the dizziness and light headedness.   While pregnant I took a different, baby friendly ACE inhibitor and it didn't have the strong side effects like Lisinopril (guessing it's also not as effective as Lisinopril).  I've now had diabetes 35 years and have healthy kidneys. Drugs like Lisinopril is the reason why the rates of kidney disease have been dropping for people with diabetes in the last decade.

Sounds like you're about ready to me! I'm currently 25 weeks with my first and so far so good! My A1c was 6.4 at conception and my last one was 5.6. My endo does not do them any mroe often now that I'm pregnant because we are in constant contact about my everyday numbers. I see a regular OB/GYN for my prenatal care, and saw her in advance as well to discuss my concerns. She's great! As for the high risk portion, I see my Maternal- Fetal Medicine at my hopsital once a month for and ultrasound and check up, That'll be changed to every 2 weeks with non-stress tests starting next month, and then weekly starting at I think week 33 or so. My endo is very adamant that an A1c of 6-6.5 is perfect, and jokingly tells me to hand over my pump to the maternal-fetal folks and tell them to ' see if they can do better' when they lecture me that it should be in the 5's. I still got there though! With a lot of monitoring and hardly any significant lows! :-)

As for the ACE inhibitor, I was on one for several years but stopped taking it with the approval of my endo and primary care doc when I got married. For me the benefit of taking it wasn't worth the risk of what might happen if I got pregnant. Plus I'm extremely bull-headed and wasn't willing to let medical professionals dictate my personal life decisions... so they agreed that it'd be better for me to go off it.

As far as all the high risk stuff, with good numbers and being msart ingeneral you should not have to do anything a non-high risk person doesn't do. I have zero restrictions and my doctors do not expect me to require any bedrest. I will be indused if I don't go into labor on my own by 39 weeks though, but that's something I have learned to accept. It's just a label really, but hasn't impacted me at all. I just enjoy that fact that we get to peek at our son once a month and watch him grow in ways most 'normal' people don't get to see :-)

Last note: My mom is also type 1 diabetic and her A1c's were in the 7's the entire time she was pregnant with both me and my two brothers. We were all born healthy via c-section without any complications. Lightining just struck twice when i was diagnosed with Type 1 at 16 years old...weird!