I have had diabetes since the age of 14. I am 25 now and take two daily injections. I would like to start conceiving. What are the chances that my children will be born with diabetes or develop it in the future? What are the chances of them developing any health risks/abnormalities if my blood sugar levels are kept between 4 mmol/L [72 mg/dl] and 7 mmol/L [126 mg/dl] or between 4 mmol/L [72 mg/dl] and 10 mmol/L [180 mg/dl]? I am very concerned and upset as I a nurse/midwife I know is advising me not to try and conceive at all because of all the health risks I may be putting on that child, how I’d feel if the child were born with diabetes and if I had to give the baby injections from birth.

If you peruse previous questions on this web site, specifically those about pregnancy, the risks of pregnancy and diabetes have been discussed in some detail. Briefly, the key to minimizing your risk is to have well controlled blood sugar prior to conception and maintaining that throughout the pregnancy. The first trimester is the time the embryo is most sensitive to hyperglycemia that can cause structural defects, heart and spine in particular. After the first trimester, the effects of hyperglycemia are evident in excess fetal growth. The glucose parameters that I recommend are: fasting–70 mg/dl [3.9 mmol/L] to 90 mg/dl (5.0 mmol/l) and one hour after a meal–less than 120 mg/dl (6.7 mmol/dl). These are ideal and no one achieves this on each testing, but, the closer, the better. I would also encourage you to have your pregnancy managed by an obstetrician with an interest in diabetes along with consultation with your endocrinologist. I would highly recommend an eye and kidney evaluation prior to conception as well, to establish some baseline measurements. Finally, you should add folic acid to your diet (5 mg/day). This is a prescription dose that you will have to receive from your physician and should be started before you try and conceive. This will help reduce the risk to the baby for spina bifida.

OWJ

[Editor’s comment: You should also read our previous questions about Genetics and Heredity.

BH]