The thing about this pregnancy, unlike the first one, is that this go around I am diabetic. I can't tell you why or how my body's islet cells continued to function properly under the stress of pregnancy back in 2009, but the reality is I will never have a "normal pregnancy" again. From here on out, all pregnancies I may have are considered to be "high risk" due to the elevated probability for birth defects and other complications caused by insulin dependence.
To be completely honest I've spent much of the past year and half since my diagnosis worrying about the implications of pre-existing diabetes to my subsequent pregnancies. I've done quite a bit of extensive reading on the topic to arm myself with the knowledge necessary to make the most informed decisions about building our family and I feel like I've formed the best possible medical team I can for my location to help me get through it. It still scares me to think that my body can harm the precious thing growing in me, but all I can do is be aware of my own actions and what they mean for the baby.
Comprehensively explaining the complex biological issue of diabetes in pregnancy is best left to the professionals, but for those who are curious the most basic implications are:
- Poor blood sugar control (an HgA1C above 6.0) at the time of conception is likely to cause birth defects in the first trimester as this is the time when the baby's major organ systems (particularly the nervous and cardiovascular systems) are developing.
- As the pregnancy goes on, the placenta acts as a sponge for insulin and makes the mother's body not only insulin dependent, but insulin resistant as well. This means daily insulin requirements can double or even triple just to be able to control the body's glucose response to hormones and ingested carbohydrates.
- Poor blood sugar control in the second and third trimester causes the baby's body to increase insulin production and therefore the storage of glucose. This means that the baby will be putting on extra weight to protect itself from hypoglycemia and can result in an overly large (10lb+) baby.
That being said, my husband (HB) and I worked extensively with my medical team for five months prior to conception to get my blood sugars under tight control and to get all aspects of my medical profile up to best possible condition before adding the complication of pregnancy. I got my HgA1C down to 5.2 (the best number I have had yet) and, God willing, that number reduces the risk of diabetes caused birth defects to normal pregnancy standards. In order to maintain this reduction in risk, the doctors have given me a ceiling of 120 mg/dl or less for my 2 hour postprandial blood glucose readings... which FYI is wicked tight control. So far, I'm doing pretty well by testing 10+ times a day and my numbers have been relatively consistent in the 65-120 mg/dl range with the occasional unexpected high reading. I will say though, my insulin usage so far has gone from roughly 18 units a day to about 45 units a day... we'll see what my ratios and numbers are as the second trimester wears on and the placenta begins to work its oh-so-unappreciated-magic of insulin resistance.
One thing I am really enjoying about being diabetic at this point is that I get a sonogram almost every appt. With GW (my son) I had four ultrasounds throughout the entire pregnancy, but at only 16 weeks along in this pregnancy I've already had four and expect two more in the next month or so. By the third trimester I can expect bi-weekly sonograms and stress test to check in on the baby, so I know he/she is in good hands and I am thrilled that I get to see the development a bit more closely this go around.
The final thing that I think ought to be shared at this point (more to follow over the next several months of course) is that because of the third point listed above, the doctors will not be allowing me to deliver the baby after 39 weeks of gestation (first week of December). This means that based on what they find with the ultrasounds in that final trimester, they will either schedule me to be induced or (if necessary) to have a c-section before the baby is full term. Ideally the baby will stay put as long as possible, but we'll just have to wait and see what happens come November. (I am secretly hoping for a Thanksgiving baby, just don't tell the Doc on call for that day... ha).
All for now. I head to the doctor tomorrow again tomorrow, so I'll report back soon on how Baby is doing.