Women With Type 1 Diabetes Need Individualized Guidance During Pregnancy

For women living with type 1 diabetes (T1D), the journey toward motherhood can come with a lot of clinical hurdles. A recent qualitative study published in Women’s Health (London) highlights that women with T1D frequently navigate a landscape of ambiguous information, feeling a desperate need for individualized guidance that acknowledges the psychological and physiological weight of their condition.¹

“Women with T1D who attend preconception care have reported experiencing anxiety and/or worries about pregnancy,” the study authors said. “Information about the need for pregnancy planning in addition to stricter glucose control, even before pregnancy, could create fear of hypoglycemia as well as fear of pregnancy complications and emotional strain associated with balancing self-management and daily life in women with T1D.”

For pharmacists, who often serve as the most accessible point of contact for medication management, understanding this delicate balance is critical to supporting patients through the complexities of preconception, gestation, and the postpartum transition.

The investigators of the survey found that many women feel overwhelmed by general information found online or through frightening birth stories from acquaintances, and they may lack a clear understanding of the specific reasons why strict glycemic control is required prior to conception.

“All women reported that they were dependent on support and guidance from HCPs [health care providers], but what they considered to be the optimal timing and amount of information from HCPs varied. Many women had sought information from other sources, such as the internet and acquaintances, with mixed experiences regarding its usefulness,” the study authors said.

Pharmacists play a vital role in clinical medication reviews, identifying and recommending the discontinuation of potentially teratogenic or harmful medications such as angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), and statins, which should be replaced with safer alternatives before pregnancy is attempted. Furthermore, the rise of glucagon-like peptide 1 (GLP-1) receptor agonists necessitates careful planning, as manufacturers recommend discontinuing agents such as semaglutide (Ozempic, Wegovy) at least 2 months before a planned pregnancy due to their long half-life.²

During the gestational period, the physiological demands on insulin management are dynamic and often exhausting for the patient. Although early pregnancy may see a period of enhanced insulin sensitivity, the second and third trimesters are characterized by progressive insulin resistance driven by placental factors. By the 36th week, total daily insulin requirements may double compared with pre-pregnancy doses.^1,2

Pharmacists can assist patients in understanding the history of resistance and the necessity of aiming for a hemoglobin A_1c goal of less than 6.0% during pregnancy, provided it can be achieved without significant hypoglycemia. The American Diabetes Association (ADA) 2026 Standards emphasize that insulin remains the first-line pharmacologic treatment, as oral agents like metformin and glyburide cross the placenta and lack sufficient long-term safety data.²

The integration of advanced diabetes technology has revolutionized maternal care, yet it requires expert oversight. The ADA now recommends automated insulin delivery (AID) systems with pregnancy-specific glucose targets for individuals with T1D to improve time in range and reduce neonatal complications. However, pharmacists should be aware that most currently available AID algorithms are not yet optimized for the lower fasting glucose targets required in pregnancy, sometimes necessitating the use of assistive techniques like manual mode or fake carbohydrate boluses to reach optimal levels. Patients in the current study expressed that although they are committed to this rigorous self-management, they are highly dependent on the support and guidance of their health care team to balance these uncertainties.^1-3

The transition to motherhood introduces a new set of risks that pharmacists must help mitigate. Immediately following the delivery of the placenta, insulin resistance drops dramatically, and requirements may fall to roughly 34% lower than pre-pregnancy levels. This period is particularly dangerous for severe hypoglycemia, especially when compounded by the caloric demands of breastfeeding and the erratic sleep schedules inherent to caring for a newborn.²

Women in the qualitative study reported a deep-seated fear of experiencing an insulin shock while alone with their children, highlighting a need for ongoing psychosocial support and medication titration well into the postpartum year. By providing sensitive, evidence-based consultations, pharmacists can help ensure a safe and healthy pregnancy for patients with T1D.¹

“We suggest that preconception care should include specific information on family planning and pregnancy to help women prepare for pregnancy and motherhood,” the study authors concluded. “In addition, postpartum follow-up should also continue with assessment of mothers’ mental well-being and diabetes management. Our results emphasize that HCPs should have a sensitive approach when addressing these topics to women with T1D.”

READ MORE: Insulin Management Resource Center

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REFERENCES

1. Anurathan JS, Varsi C, Stalheim AM, et al. Expectations and experiences regarding family planning, pregnancy, and motherhood in women with type 1 diabetes - A qualitative study. Womens Health (Lond). 2026;22:17455057261425791. doi:10.1177/17455057261425791

2. American Diabetes Association Professional Practice Committee for Diabetes* . 15. Management of Diabetes in Pregnancy: Standards of Care in Diabetes-2026. Diabetes Care. 2026;49(Supplement_1):S321-S338. doi:10.2337/dc26-S015

3. ACOG. Pregnancy With Type 1 or Type 2 Diabetes. October 2025. Accessed March 16, 2026. https://www.acog.org/womens-health/faqs/pregnancy-with-type-1-or-type-2-diabetes