I am 36 years old with type 1 diabetes, mild nephropathy (creatinine 2.5), and poor control (A1c 9.3). I had a miscarriage in February at 12 weeks and I would like to try getting pregnant again. Since the miscarriage, I’ve been working closely with a perinatologist and my blood sugars are really good. My fasting is now 90 to 120 mg/dl [5.0 to 6.7 mmol/L] and two hour postprandial blood sugars range from 100 to 150 mg/dl [5.6 to 83 mmol/L. At bedtime, I am low, around 90 mg/dl [5.0 mmol/L]. My last creatinine was better at 2.3.

I am wondering if, with these numbers, it is safe for me to try to get pregnant again. I am willing to wait a little longer and maybe get on a pump if that is what I need to do, but I just need some affirmation that my efforts are not in vain.

Your blood sugar is under better control. However, I am concerned about your kidney function. You have moderate renal impairment. This places you at risk for poor fetal growth, pre-term delivery (50%) and early onset of preeclampsia (40%). If you develop severe enough preeclampsia, it may damage your kidneys even further. Having said that, there is still a 75 to 90% chance of a successful outcome (meaning a baby that ultimately does well and you yourself not suffering any additional long term complications). Nevertheless, you are taking some risk to your own health with a pregnancy.

OWJ
Additional comments from Dr. Jim Lane:

The biggest issue of all is the fact that you have a significant amount of renal disease already. The fear is that the renal disease will worsen during the pregnancy and the fall in function may permanently damage your kidneys and put you on the road to dialysis or transplant sooner. No matter how good your pre-pregnancy blood sugars, the effect of the pregnancy on your kidneys is a very serious issue. The same can be said for any retinopathy you may have.

JTL