# A few pre-pregnancy questions



## bigpurpleduck (Sep 2, 2010)

Hi all,

Pregnancy is a long way off for me at the moment, but we do plan to have children in the next few years. I have some questions about it, but don't really want to ask my doc or DSN because we won't be trying for a while - my DSN especially will get very overexcited!

What should pre-pregnancy and pregnancy A1c be?

What are my chances of miscarriage/birth defects?

Can I have a natural vaginal birth?

What should breastfeeding A1c be?

And for those of you who have had children:

How do you manage juggling diabetes and a newborn?

Thanks to all!


----------



## PhoebeC (Sep 2, 2010)

bigpurpleduck said:


> Hi all,
> 
> Pregnancy is a long way off for me at the moment, but we do plan to have children in the next few years. I have some questions about it, but don't really want to ask my doc or DSN because we won't be trying for a while - my DSN especially will get very overexcited!
> 
> ...



Our baby wasnt planned, i am now 15 weeks 3 days, had appointment yesterday and they are so pleased with how im doing.

They want you A1c to be as close to 6 as you can, if not before, then during. (And it is possible mine was 7 before and after 3 months its 6)

You would probley be induced at 38 weeks, or thats what they have told me and they want you to have a natural birth, they cant tell you this until your here.

I dont know the chances of things going wrong, i no there are more risks. Heart defects are more likely with a diabetic mum but they rreally do keep an eye on this all the way through.

Thats ll i can help with really  xx


----------



## beckyp (Sep 2, 2010)

bigpurpleduck said:


> Pregnancy is a long way off for me at the moment, but we do plan to have children in the next few years. I have some questions about it, but don't really want to ask my doc or DSN because we won't be trying for a while - my DSN especially will get very overexcited!
> 
> What should pre-pregnancy and pregnancy A1c be?
> 
> ...



This will be long...prepare yourself!!!

I'm sure you've noticed that at each routine appointment you have your doctor asks you if you have any plans for children yet (he/she has to for women at child-bearing age)...for years I had the standard 'no' answer and then completely surprised my doctor with a 'yes' last year!  He booked me in to the pre-conception clinic with my dsn who talked me through all the POSSIBLE problems (not definite problems) that could happen and how it's crucial to be well-controlled before trying.  

As far as I can tell from talks and literature is that the reason a lot of diabetics could maybe have problems throughout pregnancy (for example heart defects and malformation) is due to poor control prior to pregnancy.  The earlier you control your sugar levels (it takes time and patience!), the easier it is when you do fall pregnant.  The reason for it being that you (probably) won't know that you are pregnant until your missed period - by which time you will already be pregnant so the better the control, the better likelihood of a healthy outcome.  I say that, but my Mum's friend had 2 very (but large) babies 30odd years ago who were very healthy and they didn't control their sugars nearly as well then so a lot depends on you.

My doctor wouldn't give me the go-ahead to come off the pill until my HbA1c was below 7...I got it to 6.7 and he was really pleased (from 7.4).  From talking to my DSN it would seem that a lot depends on your circumstances, for example how long you've been diabetic as it's harder to control with time as your body changes so much.

I'm now 10 weeks pregnant and have been told that the majority of the diabetics at my hospital have healthy happy babies - although most mothers are induced early so a natural birth isn't off the cards, it's just 2 weeks early!  If you are carrying a large baby then a c-section would be likely.  

From the moment you tell them that you are pregnant they will monitor you closely.  You will be classed as 'high risk' so won't be allowed a home birth (unless you're really lucky in your area!) but the appointments at the hospital are generally every 2 weeks so they can monitor your sugar levels and give advice.  Your insulin requirements will increase throughout your pregnancy (possibly more than double the amount required at the end of pregnancy) but you will move back to the normal amount the moment the baby is born.  I think at 35 weeks (or less) you will then see them weekly as they will monitor the baby's size etc.

I was told 20 years ago that all diabetics have c-sections so was surprised when they told me differently in January but I don't mind either way, as long as the baby is healthy.

DUK Balance magazine had a really good month specifically for pregnancy a couple of months ago...did you get a copy or perhaps they would send you one?  There is also a publication from them (costs about ?4) which answers a lot of questions but I found that I got the best advice from this forum...there's nobody better to give advice than those who have gone through it!  

The one other thing I would say though is that DUK give guidelines for ideal readings 1 hour after meals.  On speaking to my DSN in a panic last week that sometimes I don't hit it and that I now have lots of hypos because I'm giving myself extra insulin to hit that amount which results in rebounds, it was made clear that they are GUIDELINES only.  Just a guide and not the law!  I have to set an alarm at 3am every night to give myself extra insulin as I go high in the night...the hospital have no idea why but because I acted on my own initiative they seem pleased that I'm well controlled throughout the rest of the day but only have the highs in the night - which I deal with.


----------



## getcarter76 (Sep 3, 2010)

bigpurpleduck said:


> Hi all,
> 
> Pregnancy is a long way off for me at the moment, but we do plan to have children in the next few years. I have some questions about it, but don't really want to ask my doc or DSN because we won't be trying for a while - my DSN especially will get very overexcited!
> 
> ...



Hi Em....

I notice you have been T1 for a long time. Just so you know i have got a young daughter (nearly 5) even though i have had this m/c and one other before her birth. I have been diabetic for about 27 years now and when i had my daughter had been pregnant for 23 years at this time and am on MDI regime. 

In answer to your questions...

- HBAIC - I was told it should be less than 6.5 before pregnancy. During pregnancy it should remain no higher than this but women will find that their HBA1c drastically improves..probably because of the overwhelming feeling of putting the baby first.

- Chances of m/c/defects - If you are well controlled then technically speaking your chances should be no higher than any other woman. The chance is still though 1 in 4 end this way (which i was told just the other day and surprised me as quite high). After my first m/c, I fell pregnant with my daughter 4 months later and born perfect in every way and had a straight forward pregnancy which is why I believe my m/c this time has to be something to do with my thyroid/something not quite ticking correctly. If you look after yourself and all is in order there shouldn't be any problems and DON'T read the internet - its just scarey - my mistake!!!!

- Natural birth - Chances are lower as a diabetic but its not ruled out. Until you are pregnant and monitoring you throughout this is something you would know at this time. I ended up with a C section like most but an emergency one as my daughter was distressed whilst they tried to induce me. This is something i would NEVER go through again and opt for an elected C section should i ever carry to term again - but thats just my experience. Hindsight makes things easier. 

- Breastfeeding HBA1C - Again, your HBA1C should all be within the 'good range' but breastfeeding isn't easy or as natural as you would hope. I did breastfeed my daughter for the first 6 months but was surprised at how difficult it is to pick up the 'nack'. If your levels are well controlled throughout though then this wouldn't be a problem.

- Juggling diabetes and a newborn - Hard hard hard....but its all well worth it 

Hope this helps

Bernie xx


----------



## bigpurpleduck (Sep 3, 2010)

Thanks so much to all of you! For some time my doc was very concerned about me not being on the Pill because my A1c wasn't great, and I did feel for a while that it wouldn't be a good idea to have children. However, now my A1c is getting there and it's a possibility. It's nice to hear that healthy pregnancies happen, with hard work.

Thanks again, you've put my mind at ease!


----------



## Lizzzie (Sep 3, 2010)

Hi Em   I heard that 15% end in early miscarriage. A lot of the miscarraiges happen before the point when, a few years ago, most women would have realised they were pregnant. But pregnancy tests are so much more sensitive now and picking them up so early, that we're becomming increasingly aware of them instead of just putting it down to a slightly late period.


----------



## hawalkden (Sep 7, 2010)

Hi guys
I was just about to put something like this onto a new thread. Me and Jason my fianc? are thing well hoping to try before Christmas. Was thinking a soon as next Friday after we?d been to my next Diabetic Consultant appointment. 
I?m just waiting for them to be so negative and be saying about my HBA1C and my past year of being in hospital. 
(I was in a diabetic coma in February for a week, ventilated and then got a blood clot so had a tough year which I want something positive out of this year and fall pregnant) 
I?m feeling nervous about going to see my Consultant and being pushed away till I ?control? my bloods. 
Wish me luck! 
Happy bumpo soon =) x


----------



## bigpurpleduck (Sep 7, 2010)

Good luck! Let us know how you get on. I'll be interested to hear, as I'm currently undecided as to whether to discuss pregnancy with my DSN or not, since it will be a good couple of years before we start trying at the very least.


----------



## Twitchy (Sep 9, 2010)

Hiya...

I think the other ladies have covered all your questions already, but I just wanted to add this... I did nct antenatal lessons first time round & really, really wish I hadn't!  I ended up feeling really bad that I hadn't had a 'natural' birth experience & had struggled with breastfeeding etc - in my experience (which to be fair is all I can comment on) the other 'nct' mums were horribly competitive, weren't very nice about my being diabetic (like it's a choice?!), having a c section or (coincidence or effect?!) having pnd afterwards.  I'd really recommend trying to talk to other mums at your diabetic antenatal clinics - I've made some lovely, genuine friends that way!   At least you've got something in common... 

When I first was pregnant I was told I had a 70% chance of a C section and the pregnancy would not exceed 38wks.  The reasons given were for a 'controlled' safe delivery (one less variable I guess; duration!), and for some unknown reason, diabetic's placentas just don't seem to last as long as 'normal' mothers, so after 38 wks the risk of still birth rockets.  I know a lot of women feel under pressure to try & make the docs let things go beyond 38 wks in case labour might start naturally, to get that 'holy grail' of a natural birth, but personally I decided to go with the (extremely!) experienced consultants views - not that I had a choice in either case as it turned out!  I just felt it wasn't worth risking baby's life for what was essentially at that point a lifestyle choice...

Just my thoughts! 

Best of luck...


----------

