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July 26, 2000

Gestational Diabetes

Question from Alabama, USA:

I am 28 years old. My A1c level came back 7.1. I have never had problems that I was aware of with diabetes, although it does run in my family. I was diagnosed yesterday with diabetes. Also I am 10 weeks pregnant. They want to start me on insulin immediately. My blood sugars have been 80-197 mg/dl (4.4-10.9 mmol/dl). Do I need to begin on insulin? Should I get a second opinion? Is this the only way to control my blood sugar? Would I benefit from a diet change first? Thank you if you answer -- this is scary for me because I am pregnant. The doctor has already told me that I might have a baby with defects. How severe could these be with readings like the ones I have?

Answer:

Since your blood glucose is elevated this early in pregnancy along with the elevated hemoglobin A1c, I would suspect that you have preexisting diabetes. Insulin is the only option for treatment during pregnancy. Diet will help but probably would not be enough. Your baby is at some risk of congenital abnormalities due to hyperglycemia during early pregnancy, but this is not 100%. It will be important that you have some testing done during the course of the pregnancy: blood tests for alpha fetoprotein (this screens for spina bifida) and ultrasound of the fetus at about 16-18 weeks for an overall review of anatomy followed by another at about 20-22 weeks to examine the fetal heart.

After the pregnancy is over you might do well on oral hypoglycemic medication along with diet and weight loss. However, additional testing may be necessary to determine what will be the best management plan.

OWJ