Dr. Marjorie Greenfield
Specializing in pregnancy and birth.
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 Ask Dr. Greenfield
Diabetes in Pregnancy | | | QUESTION | | | Dear Dr. Greenfield,
I am a 41-year-old mom of two ex-preemies who were born at 25 weeks and 27 weeks gestation, 2½ years apart. They are success stories!
Both babies were born early due to an incompetent cervix. In both pregnancies, I had gestational diabetes that was discovered around the 23rd week. Now, I am nine weeks pregnant and diabetes was discovered in about the sixth week. I began treatment with insulin and diet, which has been working very successfully, but am concerned about the developing fetus prior to the time I started treatment. Are there any tests I can take right away? Have you ever seen or heard of fetal deformities due to diabetes so early in pregnancy? Any answers or suggestions would be great!— Trying to be Positive in Silver Spring | | | ANSWER |
October 4, 2001 | | | Dear Trying to be Positive,
It's great to hear about healthy ex-preemies. It sounds like you've gotten great prenatal care, superb neonatal care and had some good luck all the way around, too. While your question is about diabetes, I'm sure you are aware that your age and obstetrical history also put this baby at some risk.
You are right in your concern about the effects of diabetes on the developing embryo. Birth defects are more common in infants of diabetic mothers, and are inversely proportional to her glucose control during organ development. This means that the better the glucose control in the early first trimester, the less likely the baby is to have birth defects. That said, most diabetics have healthy babies who are free of major medical problems.
One way to check your glucose control is to get a blood test called hemoglobin A1c, or glycosylated hemoglobin. This test can actually look at where your sugar level has been over the past few months, and can give a rough estimate of the environment that the fetus saw early in gestation.
Based on your age alone, amniocentesis will be offered to you to check the fetal chromosomes. At the same time they will check the alpha feto-protein level in the fluid, which can evaluate for neural tube defects and other anatomical problems.
Amniocentesis plus the ultrasound that is done simultaneously can give a lot of information about your baby's anatomy. Hopefully these tests will provide you with some reassurance that all is as it should be.
Best of luck to you. Take good care of yourself and your baby-to-be!— by Marjorie Greenfield, M.D. |
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