Diabetes and Pregnancy: The Battle to Have a Baby

When I was diagnosed with type 1 diabetes 23 years ago, I remember being told that having children would be a very difficult challenge.? I was seven years old at the time - still a child myself - and had no interest in becoming a mom.? My own mother was very distressed at this news, but I didn't pay it any mind.? I had other things to focus on:? trees to climb, bikes to ride, and friends to play with.

But as I grew older, I realized that having a child was important to me.? Long before I met my husband or even entertained the thought of getting married, I was thinking about my future child.? Would it be a boy or a girl?? Would it inherit my blue eyes?? My stubborn streak? My diabetes?? Would I really be able to carry a child, despite the fact that my pediatric doctors had said it would be very difficult?

When they tell you "no," it makes you want to work that much harder to succeed.

After my wedding, I worked for over a year to tighten up my diabetes control, tracking everything from my blood sugars to my food intake to my determined attempts at regular exercise.? A few months before trying for a baby, I was advised by my endocrinologist at the Joslin Clinic in Boston to switch over to the diabetes and pregnancy clinic at Beth Israel Deaconess, so I could tighten my control even further in preparation for my future child.

My medical team, knowing my history of struggling for an A1C under 7% without excessive hypoglycemic episodes, advised me to shoot for 7% flat before trying to conceive. After two months, I finally hit my goal, and my husband and I took that leap of faith.?

I worried that it would take months for me to get pregnant, but we had the blessing of a pregnancy in our first month of trying. Actually, we found out at a routine check-up at the pregnancy clinic.

"It's early, so the test might not show a positive result, but we should do one anyway.? But remember, it might not be positive because you wouldn't be very far along."? The CDE gave me a warm smile while the nurse went to test the sample.

We didn't know how long it would take to get the results back, so my husband went to loiter in the waiting room while I waited with my CDE in the hallway, talking about fasting blood sugar goals if I were, indeed, lucky enough to be pregnant at that moment.?

Then the nurse opened the door of the lab and came out with the test in her hand. "Oh, she's definitely pregnant.? Look!" Those two pink lines on the pregnancy test caused me to gasp, and the CDE clapped excitedly.? "We never get to tell people!? They usually come in to tell us!"

My husband heard the commotion from the waiting room and came over, his eyes shining.? I wish I had told him with even a scrap of grace, that I'd whispered, "We're pregnant!" or "We're having a baby!" or even, "Oh my God!"?

"It's on!" is what I said. (Super classy.)

During the next eight months, diabetes management was the focus of most of my life.? I have never stalked my blood sugars with more rapt attention than I did while I was carrying my daughter.? Every fasting blood sugar was logged and analyzed, and I wore my Dexcom CGM every day to help me keep tabs on my numbers.? There were dozens of ultrasounds, two fetal echocardiograms, bimonthly lab work sessions, and countless appointments with CDEs, my endocrinologist, and the high-risk OB/GYN team at the pregnancy clinic.? Nothing mattered more than keeping myself healthy so that my baby would be healthy.

There were many scary moments. When I was seven-and-a-half weeks along, there was an afternoon of bright red spotting.? I spent the day in the emergency room, praying for the safety of my baby while they scanned me with the ultrasound machine.? Every high or low blood sugar gave me pause as I frantically worked to correct the numbers and protect my growing child.? And when my medical team advised me that a C-section delivery was best, due to my diabetic retinopathy, I felt defeated.? Like any parents-to-be, my husband and I worried incessantly, prayed consistently, and loved our child-to-be intrinsically.?

The last few weeks of my pregnancy were very stressful.? In addition to managing pre-existing type 1 diabetes, I ended up with pre-eclampsia and spent the last month of my pregnancy on bed rest in the antepartum suites of Beth Israel in Boston. ??

"We're going to do our best to keep your baby inside of you until you hit 37 weeks, okay?? That's the best chance for a healthy baby and a healthy momma.? We're going to work together to keep you both okay," my OB/GYN said, holding my hand the morning after I was admitted.

The hospital stay was very taxing, both emotionally and physically.? I wanted to be an example of a healthy diabetic pregnancy, and I felt like I was failing with every passing day.? I wanted to have my baby without surgical assistance, full-term and without complications.? I was furious at diabetes for making my pregnancy feel less magical and more clinical, and I was upset with my body for creating a difficult environment for my growing baby.?

But, despite these challenges, April 15, 2010, dawned sunny and bright.? My husband and I were brought to the operating room, and what seemed like just moments later, the sound of my daughter's cry pierced the air.? The medical team cleaned and swaddled my child and then brought her pouting self over to me.

"Oh, my baby.? It's you.? I'm your mommy.? I love you."? I remember murmuring the same sentences to her, over and over again, marveling at the fact that this tiny baby had just been tucked inside of my body, and now she was breathing the same air as I was, nestled between her mother and father for the first time in all of our lives.

Even though it took about 40 minutes for the surgical team to close me up and finish the surgery, I was completely absorbed by my child.? Her long eyelashes and her tiny nose.? I thought about how hard I had worked to make my baby healthy and strong.? How hard I would continue to work to ensure that she, and I, and her daddy, would have a long, healthy life together.?

Diabetes wasn't part of these moments.? My heart didn't have room for anything that hurt.? There was nothing to focus on but this incredible moment, the moment that my daughter became part of our family.?

Diabetes may have impacted much of my pregnancy, but it didn't touch my daughter.? She is strong, healthy, and the greatest joy I have ever known.? Women with diabetes have healthy babies all the time, and I'm proud to be an example of that fact.

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In pregnancy, a large waistline and high triglycerides: Early screen for gestational diabetes

ScienceDaily (Oct. 4, 2010) ? A large waistline and high triglyceride levels in pregnant women could be an early screening tool for gestational diabetes, according to a study published in CMAJ (Canadian Medical Association Journal).

Gestational diabetes is a significant public health concern, with potential negative effects on women and their babies, yet tests to diagnose are costly, time-consuming and unpleasant for pregnant women. As well, results are not available until relatively late in pregnancy, at about six months. Previous studies have shown that obesity before pregnancy is linked to an increased risk of gestational diabetes. There is a need for early, simple screening tools, especially with the trend of increasing obesity around the world.

In a study of 144 French-Canadian women under age 40 from Chicoutimi Hospital in Quebec, Canada, researchers found that an increased waistline and high triglyceride levels were linked to higher glucose intolerance levels in later pregnancy. Nineteen of the women had a previous history of gestational diabetes and 143 of 144 had a normal fasting glucose in their first trimester.

"We found that the simultaneous presence of abdominal obesity and hypertriglyceridemia in the first trimester is associated with a significantly increased risk of glucose intolerance later in pregnancy," writes Dr. Diane Brisson, Universite de Montreal and Chicoutimi Hospital with coauthors.

They note that the sample size was modest and homogenous but suggest further research with larger, more diverse populations.

"Measurement of waist girth in combination with triglyceride concentrations in the first trimester of pregnancy may be useful in the improvement of early screening for gestational diabetes," conclude the authors.

Editor's Note: This article is not intended to provide medical advice, diagnosis or treatment.

Story Source:

The above story is reprinted (with editorial adaptations by ScienceDaily staff) from materials provided by Canadian Medical Association Journal, via EurekAlert!, a service of AAAS.

Journal Reference:

Diane Brisson, Patrice Perron, Simon-Pierre Guay, Daniel Gaudet, and Luigi Bouchard. The "hypertriglyceridemic waist" phenotype and glucose intolerance in pregnancy. CMAJ, September 2010 DOI: 10.1503/cmaj.100378

Note: If no author is given, the source is cited instead.

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Metabolic status before pregnancy predicts subsequent gestational diabetes, study finds

ScienceDaily (Oct. 13, 2010) ? Cardio-metabolic risk factors such as high blood sugar and insulin, and low high density lipoprotein cholesterol that are present before pregnancy, predict whether a woman will develop diabetes during a future pregnancy, according to a Kaiser Permanente study in the current issue of the American Journal of Epidemiology.

The study suggests that metabolic screening of all women before pregnancy, particularly overweight women, could help identify those more likely to develop gestational diabetes mellitus, known as GDM, in a subsequent pregnancy and help them take preventive steps prior to conception.

Women who develop GDM during pregnancy are more likely to develop Type 2 diabetes after pregnancy, previous research has shown. GDM is defined as glucose intolerance that typically occurs during the second or third trimester and causes complications in as much as 7 percent of pregnancies in the United States. It can lead to early delivery and Cesarean sections and increases the baby's risk of developing diabetes, obesity and metabolic disease later in life.

The study is among the first to measure cardio-metabolic risk factors before pregnancy in women 18-30 years of age without diabetes who later became pregnant and reported whether they had developed GDM. The research provides evidence to support pre-conception care for healthy pregnancies as noted in a 2006 report by the U.S. Centers for Disease Control and Prevention. That report suggested that risk factors for adverse outcomes among women and infants can be identified prior to conception and are characterized by the need to start, and sometimes finish, interventions before conception occurs.

"Our study suggests that women may benefit from a focus on care before conception that would encourage screening for metabolic abnormalities before pregnancy, rather than only during pregnancy. Because weight loss is not advised, and the medication and behavioral treatment options are more limited during pregnancy, the time to prevent gestational diabetes is before pregnancy begins," said study lead investigator Erica P. Gunderson, PhD, an epidemiologist and research scientist at the Kaiser Permanente Division of Research in Oakland, Calif. "Screening and treatment of metabolic risk factors before pregnancy to prevent GDM may help reduce its lasting adverse health effects on children, by possibly improving the uterine environment," she added.

Researchers studied 1,164 women without diabetes before pregnancy who delivered 1,809 live births during the course of five consecutive exams from 1985-2006 as part of a Coronary Artery Risk Development in Young Adults study. Participant characteristics -- including lifestyle, socio-demographic, medical conditions, medication use, family history of diabetes, pregnancies and births and GDM status, as well as clinical assessments, body measurements and blood specimens -- were obtained at baseline. Follow-up exams used standardized research methodologies, including self- and interviewer-administered questionnaires.

Impaired fasting glucose, elevated fasting insulin and low HDL-cholesterol before pregnancy were associated with higher risk of GDM. Of the 1,809 live births studied, 154 (8.5 percent) involved a GDM pregnancy.

Among overweight women, 26.7 percent with one or more cardio-metabolic risk factors before pregnancy developed gestational diabetes versus 7.4 percent who did not have cardio-metabolic risk factors.

Although obesity and belly fat are antecedents to insulin resistance, pre-pregnancy obesity was not independently predictive of GDM after taking into account cardio-metabolic risk factors. Researchers also found no association between pre-pregnancy blood pressure or hypertension and risk of GDM, possibly due to the low prevalence of these conditions in healthy women of reproductive age.

Co-authors of the current study include Charles P. Quesenberry, PhD; Juanran Feng, MS, and Stephen Sidney, MD, MPH, all from the Kaiser Permanente Division of Research; David R. Jacobs, PhD, the Division of Epidemiology and Community Health, School of Public Health, University of Minnesota; and Cora E. Lewis, MD, MSPH, Division of Preventive Medicine, University of Alabama at Birmingham.

The study was funded by the National Institutes of Health, the National Heart, Lung and Blood Institute, the National Institute of Diabetes and Digestive and Kidney Diseases and the American Diabetes Association.

Editor's Note: This article is not intended to provide medical advice, diagnosis or treatment.

Story Source:

The above story is reprinted (with editorial adaptations by ScienceDaily staff) from materials provided by GolinHarris International, via EurekAlert!, a service of AAAS.

Journal Reference:

Erica P. Gunderson, Charles P. Quesenberry, Jr, David R. Jacobs, Jr, Juanran Feng, Cora E. Lewis, Stephen Sidney. Longitudinal Study of Prepregnancy Cardiometabolic Risk Factors and Subsequent Risk of Gestational Diabetes Mellitus: The CARDIA Study. American Journal of Epidemiology, 2010; DOI: 10.1093/aje/kwq267

Note: If no author is given, the source is cited instead.

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