From Indiana, USA:
We lost our child several months ago; our doctor didn't put my wife on insulin during her pregnancy. Her blood sugar levels were over 180 most of the time and as high as 230+. We are looking into having another child and are interested in get any and all the information on this subject. Thank you.
I am very sorry about your loss and I hope that you and your wife do not have that experience again. It is not clear from your letter whether your wife has preexisting diabetes or only develops diabetes during pregnancy (called gestational diabetes).
If your wife is diabetic when she is not pregnant, then probably one of the most significant factors contributing to successful pregnancy outcome is preconceptual glucose control. Here's some advice I give my patients:
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. Similarly, your hemoglobin A1c should also be in the normal range. Check with your doctor's office to find out what the normal values are (usually less than 6 to 7% depending on the assay).
The more times you check your blood sugar the more information can be gained about your glucose control. However, you have to be practical. At a minimum I would recommend checking a fasting, before lunch, before dinner and bedtime blood sugar. If you want to check at one hour after meals this would also be useful but not necessary after each meal.
Depending on your blood sugar control and any other problems, you will be seeing your obstetrician once a week to maybe once every two weeks.
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. It is important that you work with a diabetes team (an obstetrician, an internist or endocrinologist with expertise in diabetes during pregnancy, and a dietitian). This group usually will have established contacts with other useful specialists such as an ophthalmologist.
If your wife is only diabetic during pregnancy, then it will be important during the next pregnancy to screen for diabetes earlier than usual given your history of high blood sugars and fetal loss. Pregnant women are typically tested for diabetes between 24 and 28 weeks gestation. However, in her case I would recommend testing at 10 to 14 weeks. If these results are normal, then she will still need to be tested at the usual time of 24-28 weeks. Depending on the results diet and/or insulin may be required.
One other thought occurred to me. If your wife has never been tested for diabetes in the non-pregnant state, it might be worthwhile doing so. Her blood sugars were high during her pregnancy, and I am suspicious that she may have diabetes that is present when not pregnant.
Original posting 17 Aug 97
Last Updated: Tuesday April 06, 2010 15:08:53
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