Pregnancy and Diabetes ~ One woman’s story
Deciding to get pregnant was something I started discussing with my endocrinologist about a year before I married my husband. He informed me that the closer my A1C was to 6% prior to pregnancy, the less risk there would be of birth defects and complications.
I have never had that hard of a time keeping my diabetes under control. I generally check my sugars 2-3 times a day and wear an insulin pump and have been able to keep my A1C between 6.5% – 7% for years–that was always good enough for me. But it definitely wasn’t going to be enough for my unborn child. So, I started to test 3-4 times a day and was more careful with my carb counting. I had also occasionally taken pump breaks and used needles for a few days at a time. I stopped that completely and made sure that my pump was in at all times. So for the two years prior to conceiving, I kept my A1C under 6.5%.
A few months before we started trying, I met with a diabetic nutritionist, a maternal fetal medicine doctor, my OB and of course my endocrinologist. The endocrinologist was satisfied with my A1C of 6.3%, but my OB wanted it under 5.5%! I have never had an A1C under 6% and for me, I wasn’t sure I could achieve that without a lot of hypos. So I stuck with the endocrinologist’s recommendations.
It took about 4 months to conceive and during that time we moved from South Jersey to North Jersey. I met with my new endocrinologist less than a month before getting pregnant. Thankfully my OB was already in North Jersey, so I didn’t have to establish a new relationship with the doctor who would deliver my baby. At the endo’s appointment in July, my A1C was 6.0%, which was the lowest it had been in a long time, so I was thrilled about that. We discussed putting a plan in place for me to start sending my blood sugars to them twice a week once I became pregnant so that adjustments could be made as needed.
About mid-August my husband and I found out I was pregnant. I was immediately sent to the MFM for an ultrasound to check on the baby. It was so early there wasn’t even a baby yet. There was a gestational sac and a yolk sac, which indicated I was about 5 weeks pregnant. At the OB’s office the next week, the ultrasound showed a fetal pole and a heartbeat, but it most certainly didn’t look like a baby yet. Even at my next ultrasound, which was at 8 or 9 weeks, it was more blob than baby. But it was still amazing, that this tiny blob had a heartbeat that we could not only hear but also see. One advantage to having diabetes and being pregnant has been being able to see my baby’s progression on a regular basis.
My blood sugars immediately started to drop once I was pregnant. My basal rates had to be lowered and I had to start snacking between meals to try to keep my sugars up. For weeks it was like this. I also had nausea from about 6 weeks to 14 weeks. Snacking helped control that too. At 12 weeks, I had the standard blood work and ultrasound to check for any genetic problems like down’s syndrome. The results came back normal, but a hormone produced by the placenta called PAPP-A came back very low. This put me at risk for a baby with intrauterine growth restriction, pre-eclampsia, and other placenta problems. As a type 1 diabetic for almost 20 years, I was already at risk for these problems so this made me especially nervous.
I tried to get information from all my different doctors to see if the PAPP-A was low because of my diabetes or if this was an unrelated problem. Unfortunately, no one was able to give me an answer. All it meant was that I would get extra testing towards the end of the pregnancy, which I was going to get anyway because of diabetes.
I tried not to worry too much about it and progressed through my pregnancy into the 2nd trimester without any complaints or problems. I was still dealing with some low sugars between meals and my A1C had dropped to 5.9%, which made me feel like I was creating a healthy environment for my baby. The next ultrasound was at 20 weeks, where we found out we were expecting a boy! We also found out that he was growing right on schedule. More blood work to test for genetic disorders all came back normal. Around this time, insulin resistance started and my bolus rates had to be adjusted, just a bit. I also had a fetal echocardiogram, which was basically an extended ultrasound on his heart because diabetics have a higher risk of having a baby with heart problems. That came back fine as well. Every test we got through made me feel a little more relieved and I got to enjoy being pregnant.
After the New Year, my insulin resistance really started to kick in. I was seeing sugars well over 200 after meals. My fasting sugars were still in range, but I just couldn’t seem to keep my post prandials in check. So we started to increase my bolus rate. I had started my pregnancy with a rate of 1 to 15 at every meal. It seemed like every week they had be adjusted down. I am currently 35 weeks pregnant and now take 1 unit for every 5 carbs I eat. I have almost tripled my daily insulin rates! But they say that this happens to all women. Most women’s pancreases do all the work for them!
For the past few months I feel like it is a constant game of trying to catch up to the high post prandials. I will have a couple of days or a week where everything is staying within range and then bam, random highs. I have also found that it takes much more insulin to get my sugars back into range once they are high. There have even been a couple of instances where my sites went bad, which was something I had never experienced before. My A1C is surprisingly still 6.0%. Having days where I spent hours in the 200s made me very nervous for the baby. My 28 week ultrasound looked great. My son weighed in at 3 pounds, 1 ounce, which put him in the 70% percentile but still in normal range. I was thrilled to hear that all was going well.
But then the high post prandials started to catch up with us. At my 32 week ultrasound his weight had jumped to 5 pounds, 10 ounces, the 85% percentile! His femur bone was on track at 50%, but his head and belly were in the 95% percentile. I feel like I have started to fail him. I’m no longer providing him with that healthy place to grow. My doctor is now talking C section. I really want to have a natural, medicine free birth.
I don’t know how the rest of this pregnancy will progress. He moves a ton, so I know he is doing okay in there. I have NSTs every week now which he is passing with no problems. But he is getting bigger. I find out this week, at 35 weeks, how big he has grown over the past 3 weeks. I hope that it has leveled off. I know that my insulin resistance has lessened. I still have high post prandials about once a day but it is much better than it was. I hope that that will make a difference and his weight didn’t explode once again. His weight will determine when I am induced and if I get to try for a natural delivery or not. My OB’s initial thought on inducing was 39-40 weeks to prevent the risk of stillbirth because of placenta decay. But I wonder if he will want the induction to be sooner if the baby is too big. Part of me wonders if he would be better off out of me, even though it would be too early and he would probably have to spend time in the NICU. At least my diabetes wouldn’t be potentially harming him anymore.
I now go to the MFM every week, to the OB every two weeks, to the endocrinologist once a month. Throw in the dentist and the eye doctor and I have probably been to more doctors this year than in my whole life combined. But it is all worth it for that little guy. I want him to be healthy and happy and I would go to the doctor everyday if that meant he could have the same start as the baby of a non-diabetic woman.
Overall, my diabetic pregnancy has been a smooth one. I feel like I gave myself a really good start and that helped a lot. As I near the end, I wish things were going as smoothly as the beginning, but I know that I am getting the best care and the doctors will be able to help me make the right decisions for my health and my baby’s health.
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