The overturning of Roe v. Wade has been characterized as both an attack on women’s reproductive rights and access to a procedure that, in some cases, can be a life-saving medical option. The unintended consequences of such bans and restrictions have also begun emerging in unexpected places, such as in vitro fertilization.

But another group of people who may have to be extra cautious with their health in the current climate are diabetes patients.

According to a 2017 study published in Diabetologia, people with type 1 diabetes have a higher rate of abortions than people without diabetes. “The frequency of termination is higher in women with type 1 diabetes” compared to the general population, the authors wrote, noting that the proportion of abortions for medical reasons – either maternal or fetal – is similarly higher among people with type 1 diabetes. 

Among all the type 1 diabetes abortions examined in the study, nearly 24% were completed for medical reasons.

Abortion has historically been seen as an option for people with diabetes, as they face a more complex pregnancy journey than someone without the disease. In an article published by Jezebel, writer Zoe Witt – who has diabetes – argued that “pregnancy is particularly dangerous for diabetic people.”

“Staying pregnant when faced with these complications can jeopardize our lives. Abortions can save our lives, she wrote.

Being pregnant with diabetes can be a tricky path if not well-managed. First, a pregnant person would need to make sure their A1C — or blood sugar levels — are low enough.

The American Diabetes Association recommends having an A1C of 6.5% or lower if pregnant. If the A1C is 10% or higher, the risks of having a baby with a heart, kidney, brain or spinal cord defect are much higher.

But the journey leading to birth requires other check-ins. Individuals with diabetes need to monitor the baby’s size (people with diabetes have a higher chance of having a baby with fetal macrosomia, which can make delivery difficult) as well as the level of amniotic fluid (which can rise when the mother’s glucose isn’t well-maintained). According to the Centers for Disease Control and Prevention, a patient with diabetes who doesn’t control blood sugar levels has a higher risk of miscarriage or stillbirth.

On a Facebook post by Type 1 Diabetes Support and Information, people with diabetes described their experiences with pregnancy and abortion.

“Everybody’s situation is different,” one user wrote. “My baby had development complications due to my diabetes and I chose to have a termination at 26 weeks. I could have continued with the pregnancy for the same outcome – once the baby left me it wouldn’t have survived.”

The CDC recommends that pregnant people with diabetes stick to a health plan to minimize the risk of complications. To that end, diabetic patients are encouraged to check in with a doctor frequently during pregnancy, eat healthy foods to control blood sugar, exercise regularly, take diabetes medication and insulin, and monitor their blood sugar. Still, having safe, accessible abortion as an option in the event of unexpected complications would likely give patients some peace of mind.

As of last week, 12 states had mostly banned abortion in the wake of the Supreme Court’s decision in Dobbs v. Jackson Women’s Health Organization. An additional two states, Ohio and Georgia, have banned abortions at six weeks. Utah, North Carolina and Florida have banned abortions at up to 20 weeks.