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December 27, 2001

Family Planning

Question from Delhi, India:

I am 31 years old, I have hypothyroidism (controlled), mild hypertension (130/90), Polycystic Ovary Syndrome, and I have had type 1 diabetes for six years which is poorly controlled. My hemoglobin A1cs have been over 11% for the last year. I just found out I am seven weeks pregnant (unplanned), and although I am taking 130 units of Actrapid and 30 units of Monotard at bedtime, my blood sugars are averaging 200 mg/dl [11.1 mmol/L] and 250 mg/dl [13.9 mmol/L] after meals. My obstetrician is advising that I terminate the pregnancy because she fears the risks are too high. It is my first conception, and my the ultrasound showed normal growth of the foetus. Please advise as I need to make a decision on my pregnancy urgently.

Answer:

Your hemoglobin A1c is very high which does place the fetus at risk for structural abnormalities (heart and spine defects primarily), but there is about a 75% chance that the fetus is normal. At this time, it is too early to detect these abnormalities by ultrasound. It might be possible to obtain good views of the spine with a vaginal ultrasound at 11-12 weeks at the earliest. Otherwise, an adequate examination is usually done at 16-18 weeks gestation.

If your blood sugars are still as high as you report, then this needs to be addressed. You need to be on more insulin and possibly a different mix. I use Regular and NPH or Humalog and Ultralente. Another point of management is to review your diet with a dietitian, if possible. Proper control of calories and balance of carbohydrate, protein and fat intake may help to improve your glucose control.

OWJ
Additional comments from Dr. Phillip S Ledereich:
Consider going to a high risk OBGYN [perhaps at a nearby medical school], preferably who is knowledgeable about diabetes and pregnancy, rather than your average, “run of the mill” OBGYN, who would recommend you abort your child. You may need to be hospitalized for intensive glucose monitoring, with insulin. Consider even starting the insulin pump at this time, to help minimize risks to the baby.

PSL