From Watertown, New York, USA:
I am a 37 year old woman with IDDM; I was diagnosed at age 11. I started on an insulin pump six months ago and love it. My A1c's are good. My question is about pregnancy. I have only been able to get pregnant once and miscarried at 3 months. My doctor had never dealt with a pregnant diabetes patient before.
My blood pressure is good, my triglycerides are good, my creatinine is good, my HDL's and LDL's are wonderful. My only complication was retinopathy in one eye for which I had laser treatment 5 years ago. There has been no new growth since then.
I would like to try again and have heard there is a risk inventory one can take to assess how well one might do in a pregnancy. Where might I get a copy of the test to see how I would do?
There is not a formal risk scoring system for pregnancy and diabetes; however there are several factors that will affect pregnancy outcome which you have touched on in your question.
Probably one of the most significant factors contributing to successful pregnancy outcome is preconceptual glucose control. Basically the closer that fasting and postprandial blood sugar values are to normal (I use <105 mg/dl fasting, and <130 mg/dl at 1 hour postprandial as guidelines) the greater the likelihood that the risk of congenital abnormalities will be minimized. However, do not drive yourself crazy over an occasional elevated blood glucose value. As a global view of your glucose control, it will be worthwhile measuring a hemoglobin A1C value. If this is in the normal range during the preconceptual period, there is also a reduced risk of effects on the fetus.
Your overall medical condition is important. As long as your blood pressure is normal and you have no evidence of kidney disease then the risk to a pregnancy is minimized. Therefore, it is important to assess these factors prior to conception as you have done. It is good that you are working with a diabetes team and you should seek out an obstetrician who is skilled at managing diabetes.
Your age is of significance in terms of your risk for chromosomal abnormalities in the fetus. Babies of diabetic mothers are also at increased risk of some specific defects such as spina bifida and heart abnormalities. Therefore, I would urge that you obtain genetic counseling and have appropriate screening during the pregnancy. Incidentally, this does not imply that you have to have an amniocentesis. There are several noninvasive tests that can be done that are less risky, although they are not as definitive as the results of an amniocentesis.
[Editor's comment: Dr. Jones mentions having an obstetrician who's familiar with managing diabetes. An alternative would be to have an obstetrician who is willing to work closely with an established Diabetes Team that is skilled in managing diabetes pregnancies. WWQ]
Original posting 28 Apr 97
Last Updated: Tuesday April 06, 2010 15:08:52
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