I am 21 years old, have had type�1 diabetes since my 16th birthday, and started on a pump about a year ago. I have always had good control, with my highest hemoglobin A1c being around 7.5% (6.8% average for six months), I have recently got married, and I have been thinking about starting a family.

What are general safety precautions people with diabetes must take to bear healthy children? How can my diabetes affect the health of me and my child? (I always have flashbacks from Steel Magnolias!) Can a pump be used throughout the entire pregnancy? Are the number of children I can have limited because of my diabetes?

I have also heard there is a higher incidence of miscarriage in women with diabetes. Is this true? Is breastfeeding possible? How does this affect the insulin regimen? What are the chances that my child will have diabetes? I want nothing more than to be a mother, and my dream is to have 3-4 healthy children. Please let me know what I need to do to achieve this dream.

The primary guideline is to keep your blood sugar as near normal as possible, particularly prior to conception and during the first 8-10 weeks of pregnancy. This is the most critical time of embryo development when developing organs are most sensitive to high blood sugars.

Mothers diabetes are at higher risk of developing preeclampsia. If you start the pregnancy with no eye or kidney disease, then you should be fine. Sometimes these conditions can progress if there are already changes in your retina or kidneys.

Babies of mothers with diabetes are at increased risk of abnormalities such as heart defects and spina bifida, but with good glucose control, this risk can be minimized.

An insulin pump can be used during the pregnancy. You are not absolutely limited in the number of children you can have, but after you see how much work it is you may want to reconsider your goals. With good glucose control, the miscarriage rate is probably about the same as in women without diabetes. Breastfeeding is fine and encouraged. Due to increased need for calories you may be on higher doses of insulin. The risk to your children of developing diabetes is unpredictable since there are so many different causes.

OWJ

[Editor’s comment: See Planning a pregnancy , at the Diabetes Monitor, for some additional thoughts.

WWQ]