… a Challenge Overcome
The young bride could barely believe her ears. This was now the fourth physician that she had visited in her hometown. In unison, they advised her “Twenty-two years of type I diabetes, Madam, you should forget about having children!”. The figures indeed were grim as quoted to her. Maybe up to 30% of offspring of diabetic mothers to be born with some form of congenital deformity, some children were lost and occasionally even mothers were lost.
She was, however, used to traveling for medical care. A long drive to a distant medical center brought her different information. In the twenty-fourth years for her diabetes, a 7lb. 5oz. baby girl was born with a near perfect birthing score. Within days of the child’s fourth birthday, the planned birth of her young brother occurred. This pregnancy was only marred by single episode of severe hypoglycemia at 5 a.m. in her twelfth week. His weight was within a few ounces of his sisters. His birthing score was in the top tenth percentile and, of course, his grandparents were equally proud of the new arrival.
What made all the difference? Data with animals have shown that it was indeed high blood sugars before and immediately after conception, which gave rise to the fetal malformation rate. Hence, tight glucose control using home glucose monitors and waiting until the glycohemoglobin was near the normal range before conception became the key to reducing fetal malformations. High blood sugars in the months leading up to delivery were found to be the solution to the abnormally large yet, physiologically immature babies that had previously been dreaded as the “diabetic cherubs.”, whose normal births, could be so difficult and whose delicate lungs sometimes did not allow adequate oxygenation. Tight glucose control in the last few months, therefore, has been a great secret to normal birth weights and relative freedom from the premature incubator requirements.
Other Helpful Developments
Of course, time sequences have been telescoped by the passage of years. The new obstetric ultrasound systems allow careful monitoring of the developing baby for abnormalities of form while increasingly sophisticated non-stress tests allow the obstetric team to evaluate the developing child’s physiological function and his vital link to material supplies of nutrition and oxygen, the placenta. There was a period when a successful diabetic pregnancy was estimated to cost over $27,000. Much of this amount was spent keeping the mother in the hospital so that multiple daily glucose estimations could be undertaken. The home glucose monitor has even solved that problem. The twice successfully mother, highlighted above was able to spend her whole pregnancy at home with the family.
Successful pregnancy in Type I diabetes mellitus is clearly a challenge now to be viewed as capable of being overcome. The dangers, however, or not to be underestimated since tight glucose control can lead to periodic bouts of low blood sugar, at times, needing assistance from others, whether by the use of Glucagon or intravenous glucose from the paramedic team. As in any pregnancy, maternal factors can stack the odds, particular problems with high blood pressure or abnormal kidney function. The young mother embarking on pregnancy with Type I diabetes, must also accept the possibility that her retinal eyegrounds may be slightly more at risk for the period while young child is developing. Although a successful outcome is generally expected, she will find herself labeled a potentially high-risk pregnancy and may need to accept more frequent visits to the obstetric team so that medical reassurance can be appropriately matched with medical surveillance.
Well-Meaning Medical Advice
Sometimes even medical advice, well-meaning as it was, can lead to complications for the mother-to-be. Another mother had been told at the age of eighteen as she went to college, “No young diabetic lady should ever bear a child”. Hence, she was persuaded to have her Fallopian tubes tied. Ten years later when she finally married the field had changed significantly that a successful pregnancy was quite a reasonable risk. For this second mother, however, it had to be preceded by microsurgery to reconnect her Fallopian tubes. Thankfully, she conceived within eight weeks of her surgery, and now she joins other mothers in awaiting the happy event. The waiting is filled with all the usual preparations of a young mother and her family; however, is punctuated by some extra blood sugar estimations on her home meter since the required numbers during the pregnancy are tighter than those deemed acceptable under home living conditions. The family, the obstetric team, and her pediatrician are prepared for a happy event, the statistical chances of which are heavily stacked in the favor of a normal delivery, normal child and had to birth outcome..
Authored by: Brian Tulloch, M.D.