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August 28, 2002

Family Planning

Question from San Diego, California, USA:

I'm a very healthy 30 year old with type 1 diabetes since age 12 who has had no complications thus far, and last year, I had a fairly uneventful pregnancy with twins until 32 weeks gestation. At this time, I developed severe preeclampsia requiring hospitalization and leading to almost complete renal failure. My twins were born just three days later via emergency C-section and had to spend three weeks in the NICU growing and maturing. My hemoglobin A1cs throughout my entire pregnancy were in the 4.5-5.5% range. Now that our twins are seven months old, my husband and I would love to add to our family. Do you think the problems I had with my last pregnancy were attributed more to the fact that I was carrying twins or the fact that I have diabetes? I don't think my husband could survive another delivery like the last.

Answer:

The problems with your last pregnancy were probably due to both the diabetes and the twins. Both are risk factors for preeclampsia. Twins, on the average deliver around 36 weeks, and one of the biggest problems is preterm labor.

As long as you do not have any evidence of vascular disease such as kidney or retinal damage, then the risk of preeclampsia is only mildly elevated. Hopefully, with the next pregnancy you only have one baby. Otherwise, with close surveillance and care with a high-risk pregnancy specialist, you will most likely do well.

OWJ