My wife has type 2 diabetes. While planning for pregnancy, we consulted an endocrinologist at a reputable hospital in Bangalore. He checked her A1c gave us the go ahead to conceive. Now, my wife is around five to six weeks pregnant. She has been on Glycomet 250 mg (metformin) for the past two months. We consulted a gynecologist and during the ultrasound scan, the fetus appeared healthy (yolk/sac), but the fetus’ heartbeat was not detected. They suggested we have a scan again on May 14.

Meanwhile, my wife’s blood sugars have been 140 mg/dl 7.8 mmol/L] to 200 mg/dl [11.1 mmol/L], one and a half hours after food. We consulted the endocrinologist about these high levels, but he asked us to wait until they located the fetus’ heartbeat before my wife is put on insulin. We are really worried because of her high levels. Might they have already had an adverse effect on the baby? If there were any problems with the fetus, when would we come to know about it them and would there be anything we could do about them? Should we seek a second opinion?

The glucose values are abnormally high and require some attention. Depending on the fasting glucose level, your wife may need a higher dose of metformin or she should start insulin. High blood sugars in the first 8 to 10 weeks of pregnancy can have significant effects on the developing fetus. Spina bifida and heart abnormalities are the most worrisome. However, these do not always occur. Spina bifida can be detected as early as 12 weeks with good ultrasound technique. Heart defects can be seen at 16 weeks (sometimes earlier). However, the best time to examine the heart is at 20 to 22 weeks. Unfortunately, if any of these defects are detected, they cannot be fixed during the pregnancy. Thus, if a viable pregnancy were confirmed, then several ultrasounds of the fetus would be necessary to assess the anatomy. I would like to reassure you that the odds are still in your favor of having a normal baby.

If your current endocrinologist is not providing care to your satisfaction, then I would recommend seeking out one who is familiar with the management of diabetes in pregnancy.

OWJ