Nov 26, 2014

Dr. Jones: What is the risk of growing in a candy shop? When a woman has diabetes, how does she think about, and what does she think about when is the healthiest time to get pregnant? This is Dr. Kirtly Jones from Obstetrics and Gynecology, at University of Utah Health Care, and this is diabetes month. And we're talking about when to get pregnant if you have diabetes on The Scope

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Dr. Jones: Diabetes is common, and getting pregnant is common. So what should you know if you have diabetes if you're thinking about a baby? We're talking with Dr. Erin Clark a perinatologist, that's someone who specializes in high risk pregnancy, about pregnancy in women with diabetes. Dr. Clark, welcome. We opened with the question of "Is it risky for a fetus to grow in a candy shop?" That is a mom who has really high blood sugar levels.

Dr. Clark: Yeah, I mean preparation in a diabetic pregnancy is absolutely critical because we actually have very good data to tell us that high sugar levels in mom, especially during the critical early phases of development of the embryo, it's actually embryo-toxic. So in mothers who have abnormally high blood sugar levels, poorly controlled diabetes, or undiagnosed diabetes, that they have a much higher rate of early miscarriage, that they have a much higher rate of congenital malformations. Meaning major defects like of the spine, spina bifida, congenital heart disease, among others. We know that in women who have really poorly controlled diabetes those rates of having a malformation can exceed 25%. That's one in four.

Dr. Jones: One in four, a life threatening or a life limiting problem. So you've got someone who's got diabetes, and how do we treat her differently if she's attempting to a pregnancy than we would a man? So we have a man who is 24 whose got diabetes, then we've got a woman who's thinking about a pregnancy, what are our goals for the woman?

Dr. Clark: So, normally, in a healthy woman we say "take your prenatal vitamins for a few months before hand and go for it." In a diabetic mom careful preparation for several months prior to the pregnancy is absolutely critical, because we have to get sugar levels ideally down to normal in order to minimize those 1st trimester risks that we talked about. But also other risks like poor fetal growth and still birth. We recommend that a woman's blood sugars are as close to normal as possible for about three months before she gets pregnant.

Dr. Jones: So what numbers would those be? What's the highest and lowest for that range?

Dr. Clark: Yeah. So we use actually a measure of long term blood sugar control. Something called Hemoglobin A1C, it's basically looking at red blood cells and seeing how they are tagged with sugar. And we can look at how much sugar's on those blood cells and say whether they're at a normal level or not. Less than 6% is a normal value for a Hemoglobin A1C, that requires very strict control, a high level of vigilance for several months before a woman becomes pregnant. But less than 6% is that target range.

Dr. Jones: So that means you should prepare for your pregnancy, you should be extra careful in following your Hemoglobin A1C, you should be talking to your diabetes doctor and maybe your OB doctor so you can make it planned. And do we treat people when they are pregnant? Are we that controlling of their sugar when they are pregnant finally, when they're past those first couple weeks of pregnancy?

Dr. Clark: Yeah, so because we do seek further... even if you make it through the first trimester and you have excellent control, you still need really good control through the rest of pregnancy. For one just for the health of the mother in general. But also it promotes normal fetal growth, diabetics can grow babies that are too big or too small. They have a higher rate of needing to be delivered early or going into preterm birth on their own, they have a higher rate of high blood pressures during pregnancy. All of those risks can be minimized by keeping blood sugar levels in a normal range throughout the rest of pregnancy. So we watch very carefully those blood sugars, and carefully manage them during those months of pregnancy.

Dr. Jones: Well is it harder when you're pregnant? When I think about eating for two, is it when you're pregnant it's harder to keep your sugars under good control?

Dr. Clark: The hormones of pregnancy can throw your whole endocrine system kind of for a loop. So yes, we do a lot of chasing our tail. The hormones that the placenta secretes make your blood sugars naturally want to be higher. We have to generally increase the medication, so that insulin that manage the blood sugars. So yeah, it becomes a trickier game, that requires a lot of attention. And generally it's a high risk pregnancy doctor, and a diabetic specialist who are working together to maintain that good control.

Dr. Jones: So the take home is if you have diabetes your life can be long and fertile. But if you're thinking about a baby, clean out the incubator, make it a clean and healthy place to grow. Get your sugars under control for three months before. Talk to your OB or your high risk specialist beforehand, and your diabetologist. And then things will likely go much better.

Dr. Clark: Yeah, good sugar control means the best chance at a good outcome for mom and baby.

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