Complications associated with Diabetic Pregnancy

[amydivin]

I just found out today that I am pregnant.  I also have type 1 diabetes and it has not been closely controlled during the past few months.  My last A1c was a 7.1, but it has gotten worse since then.  My Dr also has me on a ACE inhibitor, which needless to say I stopped taking today.  My question is, what kind of complications can I expect due to the poor control before pregnancy, and how can I prevent or help these problems with tight control during pregnancy?  My Dr was unable to answer some of my questions and wants me to see my OBGYN, but I am not able to see him for another week.  My Dr today asked me if I planned to "go through with it".  Of course I want to, but are my risks going to out-weigh the chances of a healthy child?

[biggpretty]

hello i am new to this i just had my 2nd mc on 4-18-06 i had my first one in july of 2005 i have diabetes 2 i am also over weight i was 6 wks just like the 1st pregnancy when i had my mc what should i do im 30 and have no kids i really want a child i am really getting discourged the first mc i had a d&c done but this one they wanted me to pass on my own it has really been hard when i went to the dr last week i was doing a little bleeding (the brownish kind) and the high risk ob told me that the cervix was closed so that i was ok and then a day before i go for a us i lost my baby does anyone have any advise to what might help me have a complete pregnancy is it healthy to be overweight and have diabetes 2  thanks again

[JDRF Team SGG]

All of what B_Johnson wrote is true, and he has given you some very helpful information. There is a second time during pregnancy when tight diabetic control is extremely important, too (in addition to those first few weeks when organs are forming). This is at the end of the pregnancy. High glucose levels at that time can damage the placenta, causing the patient to lose the baby. So please do keep the tight control you have now for the duration of your pregnancy. I believe that many doctors like to induce labor as soon as the baby's lungs are fully developed in order to protect the baby from this end-of-pregnancy danger. Both of my babies were induced early, and both pregnancies were uneventful. Both babies were healthy.

As you probably have figured out, I have been pregnant twice as a type 1 diabetic. During the second pregnancy, I was the patient of a team of doctors who specialized in type 1 diabetic patients. They used me as a guinea pig of sorts to prove that tight control not only promotes the development of a healthy baby, but also can make the difference between a large baby and a normal-sized one. My first baby was large, but the tight control helped me have a very normal-sized baby the second time.

Furthermore, the habits you develop now will help you as a mom. You want to be a healthy mother, full of energy so you can keep up with the small one. Pregnancy was a wake-up call for me, and my control has been excellent ever since. I am now a middle-aged grandma, and have benefitted by feeling great and having no complications at all even after 36 years on insulin. I wish you the same good health.

[amydivin]

Thanks for all your replies, to answer a couple of the questions I had, I am just now 1 month along.  I am 26 and have had diabetes for 11 years.  I dont know what my most recent HA1c will be, still waiting on the Dr. to call me back.  Since I found out a few days ago that I am pregnant, I have had no problems keeping tight control - I'm just worried about the month that has already passed without knowing and being on top of things.

[B_Johnson]

As you can see the chance of major complications is relatively low but still increased when compared to the general population.

The first 2 sort of go hand in hand.  The larger the baby, the more likely that vaginal delivery will not be possible. However a large baby also increases the risk of uteroplacental insufficiency which may lead to early fetal demise.  The risk of pre-term labor for this reason is also a concern.  This is in addition to the 4 to 5 times increased risk of UTI in diabetic gravidas that could lead to pre-term labor.

If you have not done so I would make an appointment with your OB and get the proper counciling.  In the end you risk is really dependent on how compliant you are with the prenatal visits and glycemic control.

[B_Johnson]

With tight glycemic control, your chances of having a normal pregnancy is comparable to that of the general population.

That being said, you will have to undergo quite a bit of prenatal testing.  This means seeing your OB as often as every 2 weeks or even every week especially in the 3rd tri.

The most important time for your glucose to be under tight control is during the first 8 weeks when the organs are forming.  That is why it is essential to plan a pregnancy if you have diabetes and concieve at a point when you have good glycemic control.

These are the common complications in diabetic mothers.  These numbers are based on a large study done in denmark during the 90s.

Macrosomia: 62.5 percent

   Cesarean delivery: 55.9 percent

   Preterm delivery: 41.7 percent

   Preeclampsia: 18.1 percent

   Neonatal jaundice: 18.1 percent

   Respiratory distress syndrome: 17.1 percent

   Congenital malformations: 5.0 percent

   Perinatal mortality: 3.1 percent

[JDRF-Team-ES]

I am not a doctor, so I can't answer any of the technical questions you have.  However, I am also a Type I diabetic who has gone through a pregnancy and came through it well.  I do not give any information about how old you are and how many years you have had diabetes or exactly what your A1C is right now.  All of these issues will impact your decision.  My strong recommnedation is that you find a high risk OB-GYN.  Even though most OB-GYNs do deal with pregnant women with diabetes, a high risk doctor is going to have a lot more experience and will be able to answer more of your questions with more acuracy.   A high risk doctor will also be able to help you manage your pregnancy better should you decide to continue it.  

My experience is that doctors who do not deal with diabetic mothers frequently only know what they read in the books or based on teh few patients they have dealt with or heard about and most of that is pretty bad news.  I was told by several doctors that I wouldn't be able to get pregnant, that they wouldn't let their wives get pregnant in my situation, etc.  I had a very easy pregnancy and had no problems getting pregnant.  There is never any guarantee, but I would really encourage you to talk to an expert before making any decisions.  I don't know how far along you are, but they may also be able to give you some information about the fetus' development that could be reassuring or help you make the decision otherwise.  Good luck to you.
ES