August 5, 2003
Question from Chicago, Illinois, USA:
I am 23 years old, I have had type�1 diabetes for 10 years, and I recently found out I’m five weeks into an unplanned pregnancy. Although I’ve been taking very good care of myself since I began suspecting that I was pregnant (about two weeks ago), I hadn’t been taking very good care of myself prior to that. It’s only recently that I have been taking my shots regularly, and in the months preceding the pregnancy, days would go by when I did not take them at all.
Last week, my A1c was 10.2%. Although I feel this is more reflective of my self-care two months ago than now, I’m really, really worried about birth defects and the health of the baby. Is it possible that I began taking good care of myself early enough in the pregnancy to avoid defects? What are my chances of having a healthy baby?
The critical time of fetal development is during the first eight weeks of pregnancy., and the effects of uncontrolled diabetes are greatest during this period. A hemoglobin A1c of 10.2% places you at high risk for fetal abnormalities, but it does not mean absolutely that the baby will have problems.
At five weeks of gestation, it is too early to look for abnormalities, but at 10-12 weeks ultrasound may be able to pick up some clues about development. Later in the pregnancy (16-20 weeks) a more thorough examination can be done. It is important that you get your blood sugar under control now, because the benefits of more normal glucose levels are still there for this pregnancy. I would strongly recommend that you consult with a high-risk pregnancy specialist. There are lots of good ones in your locale, and your obstetrician/gynecologist probably refers to one on a regular basis.