Questions for pre-preg consultation

My husband and I are sure if we're going to try for another (my first pregnancy triggered a 2nd auto-immune disease, so we're weighing whether we're up for taking the risk; and also we aren't sure we can afford it, lol!). But, we've scheduled a pre-pregnancy consultation with another MFM than the one we used last time to start to think about it. (Now that we've realized the huge number of appts involved over the 9 months, we want to use a hospital closer to home.)

What do you think I should ask the guy? My thoughts...

1. If I could use Lantus with him (did the last pregnancy, but it isn't approved for pregnancy)

2. If he'd do another c-sec or a VBAC

3. when he'd induce (I'm assuming 38 weeks, but who knows)

4. if he or the endo would deal w/ my insulin and BG's, and where he wants my a1c to be

I can't really think of anything else b/c the recommendations for the T1 monitoring is pretty uniform. Can anyone think of anything I'm missing? Or is there something you wish you'd have asked? I feel like this is an important appt, but I'm not thinking of what I need to know!

Thanks ladies!!

Just wanted to say... ooooh, that's exciting!!!  :)  I'm waiting to see what my A1C comes back as next week, to know if one of these appointments will be in my near or far future.  Good luck!!

My husband I tried for a few months last fall to conceive, but I have polycystic ovarian syndrome and my chances are slim. Even if I did conceive, I'm still very concerned about what it would do to my kidneys and eyes...I can't seem to get a straight answer from a doctor. My eye doctor at the Wilmer Institute said it would be fine, but no one is really addressing the kidneys and I already have a lot of protein spilling out. I take Altace for that and I know I would have to switch Rx's if I did become pregnant. We are thinking of trying again in a few months but I am afraid of causing kidney failure. Does anyone else have experience with these set of circumstances? 

Kelly, I read a long time ago that some doctors didn't recommend T1's getting pregnant if they have pre-existing kidney issues. But, that was in a book written 10 or 12 years ago, so I'd ask your doctors. They probably have better treatments now.

According to my retinopathist (who I had to see each trimester during my previous pregnancy), the main concern with D/pregnancy is suddenly dropping your a1c down (like from 10 to 7 or 9 to 6) b/c that can damage your retinas. So, as long as you make gradual changes in lowering your a1c's, he's not typically concerned. (Unless you have something else going on I don't know about -- obviously you'd have to check with your dr. (:  )

 

Kim, maybe we'll be in this group together at the same time!!! (; I'm starting a new job in Sept though, so I may be jumping the gun in making this appt. But, my husband and I are trying to figure out if it's even recommended for me in the next couple of years... I'm starting to look at friends' babies like .... "ohhhhh!" which is bad! lol

I have heard that too, about not risking it with the kidneys and until recently I never considered pregnancy, but my endo said that it would be fine but didn't elaborate on the kidney issue- she said to ask the ob/gyn more about it, and the ob/gyn said to ask the endo about it, so I was running back and forth and just got sick of never getting a response!

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Kim, maybe we'll be in this group together at the same time!!! (; I'm starting a new job in Sept though, so I may be jumping the gun in making this appt. But, my husband and I are trying to figure out if it's even recommended for me in the next couple of years... I'm starting to look at friends' babies like .... "ohhhhh!" which is bad! lol

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How fun would that be?? :)  Who knows what will happen, but I'm hoping "what" can happen in the next year.  I'm getting old, darn it.  :D

Yeah, I'm baby-centric too, right now.  All I seem to see are pregnant ladies and babies everywhere.  Maybe I'm just more in tune to noticing them now, but it sure seems like they're following me everywhere I go... haha.

Glad I'm not the only one out there who has baby/pregnant lady ESP right now.  :)

Sarah - I think the questions you have come up with so far are good ones and important.  I am trying to think what I asked the MFM Specialist that I saw in May, but most were very specific to my circumstances.  If I think of any others, I will let you know.  Best of luck at your appointment!

Katie

I too hope I will be in the Prego club here!

I have all of the concerns you guys have which is why I have not even tried yet. I am so paranoid about all of the complications that MAY occur. A friend of mine told me to just do it and not to overthink everything because then I will never try. Having said that, If I already had pre-existing kidney trouble I would be a little more cautious and get a doctor approval and a second opinion to make sure that I was healthy first.

The problem is all of these doctors scare the living you know what out of you and there is no proof that you need your a1c to be 6.5 to have a baby. I have known so many women that are in the high 8-9s and had a healthy baby even some with retinopathy too and their eyes are fine during pregnancy. I guess they have to tell you about all of the risks just in case they occur. Women that don't have diabetes have risks too so, everyone can have any kind of complication during pregnancy but you just don't know if and will it happen to you. That is why drives me crazy...

 

I am not really sure what questions to ask the doctors but, I would probably keep making huge lists to ask anything and everything I could possibly think of and just when I thought I was done I would think of a gazillion more. My doctor thinks I am nutts btw, I have been asking pregnancy questions since I got married two years ago and still haven't tried to have a baby yet... Overthink much?

 

Gina, I overthink everything too. My goal is if I have the chance to do it again, is to stress less about every little BG while preg...

I have one of these appointments tomorrow.  :)  One of my bullet points to bring up tomorrow:  "How high hurts the baby?  For how long?  Lows?  Do I really want to know this?"

Yay Kim! I hope it's helpful!

From my experience with my preg, every doctor says something different. The general consensus I got was to aim for 120 2-hour post meals (I know, ha, ha, as if this will always happen!). I guess the main concern with lows is if the Mom passes out, it could cause anoxia in the fetus, but otherwise, I was advised to remain on the lower end of normal.

From my personal experience, highs DO happen when you're pregnant, no matter what you do. According to my endo and what I've read, the main concern is long periods of highs, so just try to be aggressive in getting them down quickly. If I was high when preg, I'd correct with insulin AND take a 10-15 minute walk if at all possible. The walking helped me lower my high, but also let me de-stress about all my anxious thoughts about what the high was doing to the baby.

A T1 friend pf mine from high school (sorry -- a friend WITH T1 lol), has a Dad who is a neonatalogist. He said he rarely sees newborns with d-related birth defects, unless the a1c was very high (9-10+). Obviously, you want to do your best to be careful, but he told me that to calm me down when I was a nutcase when preg. (:

Have a great appt!!!!!

Thanks Sarah!  :)  Those things are good to know - and I know there are probably no "definite" answers to some of my questions - but I guess I want to hear from her what she thinks is realistic and expects.  There have been many times recently where I've gone higher than expected after a meal (a meal I've eaten numerous times before, and I actually dont' start rising until the 2 hour mark...), so it had me thinking.

 

Have you went to the consult yet? My husband and I just went to the high risk ob last month for the first time and my primary questions were:

1. Does being pregnant accelerate complications of T1?

2. What happens to the fetus with a low and high blood sugar?

3. What A1C is the goal and how does it affect the fetus? 

4. What are the risks of my child having T1?

5. What are the risks of my child having a birth defect and what are the most common birth defects? (actually non-diabetic moms have a high risk of birth defects)

 

I saw multiple docs and APN's that day and I did not feel as if they were trying to scare me. I thought that they all answered thoughtfully and honestly. The thing I remember the OB/GYN guy saying the most is, "Sometmes a woman will do nothing right and not have any pregnancy complications and sometimes a woman will do everything right and still have complications with the pregnancy and it is NOT her fault."  I think that kind of sums it up. Control what you can and let the rest be. It was so important to me that he said this, because there is enough guilt when you don't have a child in your belly, let alone when you do. 

Update ... I had my appt yesterday, and it went VERY well. My husband had been on the fence a bit still, and he loved this MFM so much, he wanted to run out and get me pregnant. lolol. Seriously though, this guy was great. My previous MFM was very knowledgeable (why we went to him) but very old school and not a great communicator. This guy we saw yesterday was funny, took his time with us, has an office 5 min from our house, and was good about giving you the info and letting YOU make most decisions.

The BAD news: my previous MFM also delivered. This guy doesn't (and said it was rare my last guy did), so I'd also have to find an OB. I should start a new thread on ths, but for people who used an OB and MFM during pregnancy, was it confusing? Did it work well with having two doctors coordinating the preg?

The GOOD news: This guy doesn't like cut-offs that are arbitrary like a 6.5 a1c or under to try to conceive, or under age 35. Instead, he drew us a graphs of increase a1c/age and the chance of risks, and said we should make an informed decision. He felt that I was so close to the 5's, I should just bump down a little lower to the high 5's when I want to start TTC'ing. But, again, he said he has no cut-off and it's my personal decision. He was very calm about my age. I'm almost 33, and was feeling stressed, like I better deliver by 35. Again, he showed me the higher risks of downs and pre-ecclampsia as you age, but didn't feel like there was some big stress about the 35 cut-off like my endo did. I feel so much more relaxed about it now! Other good news -- he said one successful pregnancy w/ D increases the chance that the next one will go well.

We have decided that we like this MFM so much and hated the first 3 months of having a newborn, so we're hoping we can send the baby to live with him for the first 3 months. He can teach the baby Italian (he's Italian), and then we'll take the baby back. JK!

I was hoping you'd post about how the appt. went!  :) 

I'm in the same boat - my OB has referred me to a MFM, which I'll be seeing the first part of September.  I also requested seeing a dietician to see what I'll need to change food-wise, and I see her tomorrow morning.

Sounds like you've got a good one, and it's nice that he had such a good attitude.  I hope mine is that way, too! 

Kim, I hope your MFM appt goes as well as mine did! Ours was so great, I'm worried whatever OB we find would never live up to him. (;

We were going to just start looking for an OB if we got pregnant, but you already found one. I'm wondering if we should look around now too... Hmm. Did your endo recommend finding an OB in advance? The mohel who did our son's bris is an OB in the area, so if we can't find anyone, I'm hoping he'd agree to take me. But, maybe I should call!

It was sort of a process to get to her.  I had previously been going to a P.A. at a G.P.'s office, then decided on my own that I should probably find an OB-GYN.  Tried to see the OB, but she got called out for a delivery, so I saw HER P.A.  (Are you dizzy yet?  I am.)  She told me to make an appointment with the OB when we thought we wanted to "start trying", so that's how I wound up seeing her a bit ago.  The OB then recommended me to see the MFM.  I had no idea you needed seperate people, and I'm actually still not sure what one does or doesn't do, and why I need both.  Hmm.

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It was sort of a process to get to her.  I had previously been going to a P.A. at a G.P.'s office, then decided on my own that I should probably find an OB-GYN.  Tried to see the OB, but she got called out for a delivery, so I saw HER P.A.  (Are you dizzy yet?  I am.)  She told me to make an appointment with the OB when we thought we wanted to "start trying", so that's how I wound up seeing her a bit ago.  The OB then recommended me to see the MFM.  I had no idea you needed seperate people, and I'm actually still not sure what one does or doesn't do, and why I need both.  Hmm.

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It's all making sense to me now why you said your OB wouldn't monitor your BG's. It's because your MFM would do it. I really didn't understand the OB vs. MFM thing until yesterday's appt, and I'm still not sure I understand. According to the MFM I saw, he would do everything with sonograms including: 1) a 12-13 week Downs Syndrome screen, 2) an 18-20 week anatomy scan (the big one where you find out the gender!), 3) the fetal echocardiogram they do for diabetic mommies around 20-22 weeks to make sure the baby's heart is okay, and 4) twice a week non-stress tests / biophysical profiles after 32 weeks. He also said he'd monitor my blood sugars unless I would prefer to have my endo do it. Then, he said the OB would do the in-office appts like measuring your tummy, testing your urine, etc, and do the delivery. I guess my confusion is why I couldn't have an ultrasound tech instead of an MFM, you know? Like why's the MFM necessary if my endo monitors my BG. Hmm... Hopefully someone who went through this will respond!

I know I'm late to respond but there are a few points to consider.

One reason that the complication rate seems to be so low statistically is that most patients/physicians strive for good glycemic control. Over the last 20 years with the improvement in therapies, this has become more feasible and thus the complication rate has dropped. This is such a fantastic advancement! Steel Magnolias came out shortly after my diagnosis. When I look at my boys, I marvel at how far we've come since then.

We are monitored much more closely than normal pregnancies, which also skews the statistics. If all pregnancies were monitored as closely as those involving mothers with diabetes, there would be a much more substantial difference in complication rates between the two groups.

And though you may "know someone who did fine without tight control," I will tell you that the agony of losing a baby is not worth it. Though I am only one person, I've worked with multiple mothers who did not have a good outcome (most recently a still birth due to multiple congenital defects attributed to poor glycemic control). And while I firmly believe in supporting one another, I think its important to support one another in an effort to achieve that goal.

The anecdotes about successful pregnancies without tight control should not serve to perpetuate complacency.

This all seems very gloom and doom but until you experience of are near someone who experiences the poor outcomes, its difficult to imagine. I've been so hesitant to say it but I will put this forth: holding a stillborn infant is something that will forever be etched in my memory. If she were mine, I could not live with myself knowing that I could have prevented it with tighter control.

Its not worth it.