1. What results did the placenta pathology find?
Instead of sending the placenta to disposal as hazardous waste as is typical of most hospitals, Dr. Bronsky sent my placenta to the lab for pathological analysis in hopes of more in depth answers to why my AFP levels were abnormal, the extent of the abruption and why my blood sugars were atypically trending low. Unfortunately, the report wound up being predominantly uninformative, save one factor: the placenta's weight. Apparently a typical, healthy placenta for a typical, healthy pregnancy weighs nearly 1800 grams or, at a minimum, 1/6 the weight of the baby at birth - which in GV's case would have been about 600 grams. This placenta weighed 298 grams.
The only thing Dr. Bronsky definitively said on this topic was that he is shocked that GV was as large as she was at 6 lbs 14 oz because such complications usually present issues of growth restriction -- which if you remember was the concerns we had with possible placenta calcification. Guess this goes to show that placenta deterioration was an issue, not because it was prematurely breaking down but rather because it was abnormally petite.
2. What happened to the epidural?
There is no way to know why the epidural failed. Dr. Bronsky said that there were clearly some mistakes made by the nursing staff in that they didn't attempt to fix the issue quickly or call anesthesiology to have them evaluate what was occurring. But given how quickly GV arrived their intercession would have likely been irrelevant in this case anyway.
3.a. Are additional pregnancies safe?
Assuming my blood sugar is under tight control prior to conception, Dr. Bronsky believes there are no reasons why future pregnancies would be inadvisable. Granted, they will all be complicated and high risk because of my preexisting diabetes, but my safety and the well being of potential babies is not inherently in jeopardy based on what he saw with this pregnancy.
3.b. Are there different timing requirements between pregnancies for a diabetic?
No, diabetics don't need to wait x number of months longer than non-diabetics to conceive again. However, like with all women, it is advisable that new mothers wait twelve months before trying so as to permit their bodies time for full recuperation before attempting the physical stress subsequent pregnancies.
4. At what age should I stop having babies due to compounding diabetes and age risks?
Knowing that pregnancies are considered to be high risk for women over the age of 35 due to an increased risk for birth defects, low birth weight, and macrosomia, Dr. Bronsky explained that while it's not exactly advisable the reality is that it all depends on how things go between now and then. If over the next several years pregnancies go smoothly and I continue to stay healthy, then there is no reason post age 35 pregnancies can't happen safely. Alternatively, if pregnancies become more difficult and present more serious complications, then fewer pregnancies, even before age 35, may be called for.
5.a. Will multiple pregnancies as a diabetic increase my risk of diabetes complications?
No, but the longer that my body is exposed to the disease of diabetes, regardless of the number of pregnancies I may have, the more likely I am to have complications. Fortunately the better controlled my diabetes the less probable complications are.
5.b. Will multiple pregnancies as a diabetic increase the in utero risks for future fetuses?
No, the number of pregnancies I have as a diabetic is irrelevant to the degree of risk future babies may face. The complications of previous pregnancies, however, will potentially increase this risk factor and should be considered after the completion of any additional pregnancies. See question 11.
6. Will the complications from this pregnancy be likely in future ones? And can I do anything to proactively prevent them?
All of the complications I faced with this pregnancy are possible - and to one degree or another, more likely - in future pregnancies, but there isn't a definitive way of predicting what complications may or may not happen again. Seeing as this will be discovered on a case by case basis, there isn't anything I can do now to prevent x, y or z complication except to be as healthy as diabetically (diabolically?) possible.
7. Is there anything I can do differently in future pregnancies that will prevent complications?
8. Can we expect my blood sugar to behave similarly in future pregnancies?
No. It could be the same, it could be better or it could be worse. (Hmph)
9. Should I assume that the next baby will arrive faster that GV did?
10. Is there anything I should do perpetually to prepare for any possible future pregnancies?
Beyond keeping my diabetes in check with a stellar HgA1C, the only thing I can do regularly is take a folic acid supplement. Since the majority of critical organ development happens almost immediately upon conception daily pre-pregnancy doses of folic acid decreases the likelihood of birth defects and ensures proper neural tube formation.
11. Will I always be a class B diabetic or will that change?
Yes it will change, but background information first: there is a scale called the "white classification" used by perinatologists to classify diabetic women into various explanatory groups based on their diabetes and the risks associated with it. I currently fall under the "class B" group as I am a person who was diagnosed less than ten years ago and after the age of twenty. In eight years, however, I will become a "class C" diabetic because my exposure to diabetes will be greater than ten years and in eighteen years I'll once again be "upgraded" to a "class D."
|The White Classification was created by Priscilla White in 1949 |
to partially predict the course of treatment for a pregnant diabetic
and the chances of newborn survival.
And there you have it...
I'll admit to being extremely relieved that this appointment didn't shatter my dreams of a large family. I've long been fearing that one complication or another may push me over the edge in terms of risk, but for the time being I'm alright and that is all I can ask for. I'm not sure how many kids we ultimately want in the end (maybe four? maybe five? maybe twelve? ... just kidding... sort of), but God willing however many healthy babies we can have we'll get - after that there's always adoption, HB willing.