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Question:

From Blacksburg, Virginia, USA:

I am a type one diabetic who is in the process of trying to conceive. In the area where I live, the nearest endocrinologist and the high risk obstetrician/gynecologists (OB-GYN) he recommends are located over an hour away. I have an A1c of 6.0 and have no diabetes related complications. I was wondering is it necessary to see a high risk OB-GYN or could I go with someone more local?

What are good questions to ask, to evaluate whether a particular OB-GYN would be a good match for treating a pregnant type one diabetic? My endocrinologist prefers that type 1s work only with high risk OB-GYNs while my current gynecologist disagrees and recommends a doctor in her practice who is not a high risk OB-GYN. She said while he has experienced treating type 2s and people with gestational diabetes, he has only treated a couple of type 1s over his years in practice. Should I try to find a doctor with more experience with type 1s? One woman told me she wouldn't go to an OB-GYN who treated less than five type ones a year. My gynecologist said that is asking too much of an OB-GYN as type 1s make up only a small amount of the population. She says any OB-GYN should be able to handle a type one pregnancy. Is that accurate? Are there any special considerations I should make when choosing an OB-GYN to treat a diabetic pregnancy.

Answer:

There is not a straightforward answer to your question. Managing a pregnant patient with type 1 diabetes can be challenging. However, I do not feel that it needs to be done exclusively by a high risk specialist. Your endocrinologist can continue to help you manage your blood glucose. Much of this can be done by weekly review of your glucose log by telephone. Your obstetrician can manage the scheduled prenatal visits and the delivery. The high risk specialist can be consulted for ultrasound evaluation to rule out fetal abnormalities and to follow fetal growth. Between the high risk specialist and your own obstetrician, a delivery plan can be developed for appropriate timing and glucose management during labor and lactation. The only question would be if you had to be admitted to the hospital for some complication of either diabetes or pregnancy, who would be managing you? Once again, this could be done in consultation with the high risk specialist. With a hemoglobin A1c of 6.0 and no other complications, you are heading into a pregnancy in good shape. You risk of complications is low.

OWJ

DTQ-20060720095545
Original posting 31 Jul 2006
Posted to Pregnancy

  
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Last Updated: Tuesday April 06, 2010 15:10:08
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