From Westerm Australia, Australia:
I have type 1 and am looking for advice on how to get pregnant. What do you suggest?
This is a very open ended question and either lends itself to some humor or a broad discussion on issues of conception in the context of diabetes. Generally speaking, women with diabetes and normal thyroid function should not have too much difficulty conceiving. There may be issues unrelated to diabetes that reduce fertility that I will not address. There are some important things to do before trying to get pregnant. First is to make sure that your glucose control is a close to normal as possible. In addition, you should be taking a folate supplement (5 mg daily). These measures will reduce your risk for fetal abnormalities related to diabetes. I would also recommend an eye and kidney evaluation for baseline status. Next, you need to find a boyfriend or husband, unless you have one. If you have regular menses, then you can improve your efficiency by having intercourse more frequently (every other day is optimal) around the time of ovulation which is roughly mid-cycle. The home ovulation kits work fairly well. However, if that is too compulsive for you, then just having intercourse every other day throughout the month is reasonable as well. If you fail to conceive after nine months to a year of intercourse, then you may consider consultation with an infertility specialist.
Additional comments from Dr. Jim Lane:If you have type 1 diabetes and you are wanting to become pregnant, I have listed a few suggestions that I think are good medical advice. They are not meant to substitute for having an obstetrician to manage your care.
- Pregnancy should be a planned event. The goal should be to have two consecutive A1c levels in the normal range to signify a durable level of tight control. Remember that good control at the time of conception is the best prevention for diabetes-related birth defects.
- Have a preconception visit with your obstetrician. Talk about issues such as whether it is recommended you be seen by a high-risk obstetrician, your general health, potential risks of the pregnancy to you and the baby.
- Start folic acid with your prenatal vitamins. The supplementation of folic acid is a recommendation for all women with diabetes prior to conception. It has been shown to decrease the risk of neural tube defects and may also help prevent diabetes-related defects.
- Talk about any other medications you are on and see if they can be safely continued during pregnancy or whether they need to be stopped or substituted with another drug.
- Talk about the schedule of follow-up for your care during pregnancy.
- The goals for glycemic control are different during pregnancy. They reflect a more aggressive level of control.
- Discuss who will be in charge of your blood sugar management. In some areas, the obstetrician maintains control. In other areas, your obstetrician will work with your diabetes doctor. Too many chefs in the kitchen is confusing.
Original posting 5 May 2006
Posted to Pregnancy
Last Updated: Tuesday April 06, 2010 15:10:06
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