Planning for a Diabetic Pregnancy

Gina Capone Health Guide
  • Now that I am coming up on my first year wedding anniversary in April (April 18, in case you were wondering) baby fever has taken over my brain. My husband and I are not exactly ready for a baby quite yet but, starting a family is definitely on the horizon.


    Before we got married last year I prepped Mike that having children is going to be a huge challenge and he and I agreed that if it happens it does and if not that is ok too. There are so many concerns that I have because pregnancy in type 1 diabetes is considered risky and there is a higher risk for birth defects and miscarriages and very large babies. It concerns me so much that I will be one of the unlucky ones.

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    Last year on my personal diabetes chat website Diabetes Talkfest, I had a scheduled chat with Dr. Lois Jovanovic who is a diabetes and pregnancy expert out of the Sansum Diabetes Research Institute in Santa Barbara, California (click here for the chat transcript) who said that healthy pregnancies are possible in patients with type 1 diabetes with well controlled blood pre-conception blood sugars and an A1c of 6.5 or below.


    I have also heard first hand from a number of women with diabetes all whom have had healthy pregnancies that it is completely possible with a lot of hard work and determination.


    So with that knowledge, this past summer I really started watching everything I ate, exercised more, checked my blood sugars around 12-14 times a day (this was pre-CGM) and wrote everything down. I had gotten my A1c down from a 9.1 to 7.4. It was amazing! And I was very proud of what I had accomplished. I have not had an A1c below 8 in years. Go me!


    In September, I went to my endocrinologist appointment and we discussed pregnancy for real this time and what range was healthy to have a baby and he told me 6.5 just like Dr. Jovanovic had told me earlier in the year. I thought maybe he would have told me 7.0 and with a 7.4, I was almost there (good to dream I guess).


    He gave me a smile and said "Gina, you can do this you are almost there, I have faith in you." He is a very encouraging doctor. I did feel very frustrated because it took me a while to get down below an 8 and 6.5 to be honest seems impossible.


    "Ok doc, if you say so" I told him with a grin. He said as long as my numbers were in good range that I would be able to have a healthy baby and would be in the same health risk bracket as a woman without diabetes.


    That made me feel better. Now, If I can only get that blasted A1c down!


    That same day I met with my CDE/Nurse Practioner as well, I figured kill two birds with one stone. Frustrated that I have to really get down to an A1c of 6.5, I told her what the endo said and asked her "Ideally how long will it take to get an a1c of 6.5?" She responded, your next blood test.


    Really wow. That quick?


    Yes. You can do it Gina!


    That was two you can do its in one day! I started feeling like I could really do it.


    She said that my numbers just needed a bit of tweaking from the data she downloaded off of my pump, and I should be able to get it down by the next A1c. Are you ready to do this Gina?


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    Yes. I am ready. Scared but ready.


    I had some other questions while I was there.


    How long after you get your A1c down can you actually start trying?

    She said well right now you are not at a good range but, as soon as you get to 6.5, that I can start trying and it will have to stay around that number as long as it takes to get pregnant. That I should also go and see the gynecologist to make sure everything is ok on that end as well.


    What actually happens if your blood sugars are higher, if you do become pregnant without knowing lets say, hypothetically?

    She said, If you have an unplanned pregnancy your high blood glucose during early stages in pregnancy affect the baby's growing organs which is what can lead to birth defects. Which is why we wan't your A1c levels down 3 months or more before you actually start trying.


    Once I do get pregnant do I still have to keep an A1c of 6.5?

    She said, that I will have to try to stay as close to 6.5 as I can but, because of hormones and changes in my body that it will take a lot of work to stay there. She said excess sugar in the blood will also cause larger babies and it can be a harder delivery. That I will probably go through a lot of insulin changes throughout the entire term of pregnancy and will have to keep my numbers down as much as I can. And that I will have to stay on top of my diabetes care, and contact them weekly.


    My doctor and CDE both told me that I would have to see an obstetrician who handles high-risk pregnancies, and has cared for other pregnant women with diabetes, but, that they would handle my diabetes care throughout the whole time when it does happen. 


    My CDE said the best way for me to get my A1c down faster is to:

    • Check my blood sugar before meals, and two hours after meals.

    • Write down all of my blood sugar results during the day

    • Keeping a written log of meal plans and exercise.


    I know that trying to have a baby and having diabetes is going to be a hard challenge to face when it actually does happen. I am so scared of what can happen and that is why I would like to get my body as ready as I can before. So that I will be able to have the healthiest possible pregnancy without any risk of complications.


    Getting me healthy is the most important task right now.


    If you have type 1 diabetes and had a baby, I would like to hear from you about your pre-conception care. How long did it take for you to get a high A1c down if you were in my boat, and any other tips you feel you want to share with me as well would be greatly appreciated!



Published On: March 05, 2009