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High HB1ac and pregnancy outcomes - your stories please

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Worried123

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Dear All
I am new to this forum - I am currently 15 weeks pregnant, 38 years of age. Been trying for years and I had almost given up hope and had become complacent with my folic acid and diabetes management. My local hospital - due to staff shortages - cancelled all my pre-pregnancy appointments. Consequently, I concieved on a relatively high HB1ac of 8.3. Understandably very concerned about congenital abnormalities which occur in the first weeks following conception. I found out I was pregnant when I was at 4 weeks. Luckily I had started taking folic acid a few weeks before I found out I was pregnant so at a best guess I was on folic acid - high dose for about 2 weeks before conceiving. I know NHS recommends a month or even 3 months pre-conception but ....

I would be very very grateful to hear from anyone who has conceived on similar or higher HB1ac and the outcome of the pregnancy - meaning was the baby OK or were congenital problems identified before or after birth?

My biggest concern is spine damage which is increased significantly in women with poorly controlled diabetes at conception. So far I have had several scans. I understand that in the 12/13 week scan abnormalities in skull size/shape and organs such as bowel and bladder are reliably used to diagnose neural tube/spine defects. However nothing has been mentioned to me so far and I have been informed that all looks normal. I have an early anamoly scan at 17 weeks (private scan) and another at 19.5 weeks (nhs scan) but very anxious. I have searced online and the only stories I have come across about pregnancy outcomes in women conceiving on high HB1acs usually 10 plus are related to heart problems picked up by ultrasound or shortly after birth

Would be very grateful to hear from you to better understand what to expect and what all this means
Thanks xxxxxxxxxxx
 
Hi - I conceived my son with a hba1c of 9.6 and he was fine. I wasn't though - I developed advanced retinopathy. I think there is a 1:9 chance of adverse birth outcome with a hba1c that fine.

Now on my second pregnancy concived with hba1c of 7, so far baby seems to be ok but I have just had a retinal bleed at 36 weeks which has put a bit of a dampener on things to say the least.

Not doing this again!

Good luck. If your scans are ok so far chances are everthing is fine. The odds are actually on your side, but because any adverse outcome is obviously a tragedy for all involved that's why the recommendations are as they are ie to conceive with a hba1c below 7.

I spent the whole of my first pregnancy worrying desperately that my son would be ill but he was fine.

Now I am36 weeks just trying to get through the last few weeks and birth ok.
 
In the first trimester high BG is associated with increased risk of malformations particularly the spine but in the second and third trimester you need to keep your blood sugar between 3.5 and 5.5 as otherwise the baby produces insulin for your blood sugar and it causes the baby to get too big (fat). Also if you have high BG when you give birth the baby can go hypo when the cord is cut as it is producing excess insulin but no longer string the high sugars from you.

A diabetes nurse should be reviewing you very week during pregnancy to help you maintain good BG control. See your doctor to get referred if you haven't already


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Hi anti-carb that's great news about ur first pregnancy fingers crossed all will go well with the second one ... Congratulations by the way
It's hard work managing blood glucose in pregnancy sorry to hear u have developed retinopathy I have read that if complications exist people can struggle with them even more when pregnant but hopefully all will be worth it
Do u have annual retinopathy screening in your area ? I have some very minor background retinopathy but doc said that was a sign of having diabetes for so long and not an indication it would develop I have missed my retinopathy screening app for first trimester but plan to go soon
Like ur first pregnancy I have spent every single day worrying stressing out about my scan this week everything crossed for good news
Healthy people make having babies look so easy it's very hard work xxx
 

Hi
Thanks for the info I have my bg reviewed twice a week my hospital introduced a system whereby I upload my bg readings directly from my meter to their database my consultant reviews and then corresponds by email twice a week very helpful I was 8.3 a week or so before I conceived, 8 in a blood test done at 5 weeks and 5.5 at 8 weeks
I have done lots of research but can't find a single mention of neural tube/ spine problems on any forum however it's consistently mentioned in research papers on pubmed. Patient stories so far only highlight cardiac problems mostly in women conceiving on hb1ac 10 or higher hoping all is ok scared about forthcoming scan, relieved its finally here and I will at least know what I need to know and a little bit excited as will find out gender .... Very mixed bag of emotions but very terrified here's hoping for best outcome everything crossed x
 


Hi Worried. I haven't had retinopathy screening for several years now as my condition is far too advanced for that, I go straight to see the consultant. Retinopathy can develop in pregnancy (usually towards the end) plus if your hba1c is lowered quickly as can often happen during pregnancy this can accelerate things. I don't mean to worry you but I went from only background retinopathy to advanced PDR within less than 2 years - it can come on very fast. I almost couldn't have another baby, but was told with extra laser I should be ok. Well I've not been as I just had another bleed a few weeks ago although who knows how bad it could have been without the extra laser. Hopefully I should come through ok and it will all be worth it to have another baby but it's a big worry and stress. So the hba1c recommendations are not just for the baby, but for the mother. Although I'd take this happening to me over something happening to the baby any day.
Best of luck with it all and good luck for your scan let us know how you get on
 
 
I have been advised no higher than 4.5 before meals and around 7.5 one hour post meal. My blood glucose results from my meter get checked twice a week by my consultant via email I have 8s and 9s but my team have said above 4 and less than 10 is fine



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In fact the target blood glucose readings that doctors advise diabetic women of during pregnancy are those of non-diabetic women so basically they want you to be non-diabetic essentially which of course is near impossible to maintain
I would be very surprised and in complete admiration of anyone who has maintained normal readings from preconception to delivery
It's a worry being diabetic and pregnant
Even for healthy women having a healthy baby is hard work and then we have this added layer of difficulty and hard work but I keep pushing myself in the hope of a healthy baby at the end of it



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In my first pregnancy I was given very strict (unobtainable) targets of before 5 before a meal and no more than 7 one hour after. Well it just made me go hypo all the time. This pregnancy I am with another doctor who says no point going hypo all the time trying to reach targets as you will just get rebound highs. He said it doesn't matter if you test one hour or two hours after and to try to have it under 7.8.

I've been working to that target throughout and my hba1c has been around 5.5 and so far the baby seems ok and no probs growth wise so I do wonder if the doctors that push the very strict targets are right. I've always thought there is no point giving people targets which are unobtainable or going to cause more problems than they solve as it will just make people feel bad when they can't get it right.

Incidentally my son was born very small 5.5lbs at 38 weeks and I do wonder if that was because I was having several hypos a day and my control was too tight.
 
Yes I have read on other forums about women who have had high versus low hb1ac across different pregnancies I recall one woman said she had been ok when she was slightly higher than she should have been but her placenta broke down mid pregnancy when she had textbook ideal control she too suffered from lots of hypos I am worried all the time but part of me also thinks that at the end of the day I am not a healthy person I am a diabetic and to strive for near perfect non-diabetic levels is near impossible and probably not so good for me lets see what happens
 
Hi there, after being told we wouldn't conceive naturally I was surprised but delighted to find myself pregnant at 35, however I hadn't been taking folic acid or being super controlled with my blood sugars.

Hba1c at conception was 8.6, worked hard to keep blood sugars in normal range throughout, by no means perfect t as insulin resistance in the second and third trimesters meant insulin doses quadrupled!

By the end of pregnancy hba1c was 5.8, Alice Rose was born induced and with help of forceps after induction at 38weeks and 4 days, perfectly healthy and weighing 7lb 11oz. Her blood sugars did drop too low in the first 24 hours but some milk (formula) brought them back up fairly quick, so there's no need for all diabetics babies so go off to special care. I am also Breastfeeding, doable ad a type 1.

The 2 things to focus on are 1) control them now, it matters and you and baby will have a much easier and healthier time of it. 2) if you do no 1, you have pretty much the same risk as a non diabetic of any complications. "Higher" risk is not the same as "high risk". And a lot of the risks are very small to begin with. There is a Facebook group called "The Sugar Mummy" where there are lots f type 1 ladies pregnant, new mothers or tying to conceive.

Hope that helps!

Alice is now 4 months and thriving
 
I unfortunately had pretty poor control with my son, pre-conception. Think my HBA1c was about 14. Long time ago though, i was very lucky, he was 6 lb 8 oz, 2 and half weeks earlier delivery by c-section. He's a strapping 22 yr old at Uni now. HBA1c was 10 when I got pregnant with my daughter, she's 15 and doing ok! If I had my tome again I'd try harder with my control. Am sure you'll and baby will be fine.
 
hi
it doesnt matter whether diabetic or not - first pregnancies are always scary.
when i had my first my control was terrible prepregnancy and i didnt know until i was 6 weeks or see anyone until i was almost 12.
my HB was well over 10.
i wasnt taking folic acid. i was drinking too much
my son is perfect.

with number 2 it was different as control was much better but not as good as they recommmend. However they told me i wasnt pregnant at the fertility and wrote to my gp to say it was a phantom pregnancy. I was so upset i got very drunk 2 weekends running,

was finally confirmed i was pregnant at 14 weeks.

the baby's blood sugar will always be higher than yours which is why they need to keep yours down. at birth baby often ends up in special care needing glucose for a hypo as the body sends masses of insulin to bring it down when it is born - and isnt used to controlling for itself. This does not mean you have done something wrong.
Both my kids are perfect.
That makes it sound like blood sugars dont matter - which is not what i am saying. People will always report the bad stories as they have to try and prevent reoccurnece. But try and enjoy your pregnancy. It is easier second time round. Just dont think you can get into a pattern as it is changing day by day.

be prepared for a day or 2 of difficulties when baby is born and it has to learn to do it for itslef. they are soon over. Babies do tend to be bigger and are usually delivered earlier as diabetic mothers dont make a hormone so are prone to still birth after 28 weeks. babies of diabetics tend to be poor feeders so again many people end up bottle feeding. Just be prepared for these things and dont feel like you are a bad mother. it is normal. I felt terrible when number 1 wouldnt feed but was ready with number 2. I expressed and he had it in a bottle. easy.
 
Hi everyone
Thanks for sharing your personal experiences, I really appreciate it
Have been feeling very down and definitely feel reassured after reading everyone's posts
Its a worry indeed wish my endocrinologist had explained all these risks to me ... my doctor told me 8.3 was a bit high and I needed to bring it down but at the same time said good luck with the pregnancy hope you get pregnant soon, making it sound as though my hb1ac was OK. Since finding out about the higer risks I def will make more of an effort if ever i am lucky enough to get pregnant again. In fact NICE guidelines state that if a women presents at clinic with a high hb1ac the doctor should advise her to take contraception and wait until her hb1ac is below 6%!!!
I have the worse luck when it comes to health. I really hope that I join the many of you with such wonderful positive experiences
I have my scan on Friday - 2 days and counting
Really stressing and worried hope all is OK
Dont want to let myself think its all OK incase it isnt ... so preparing for the worst but hoping for the best
Thanks again everyone
Will let you know how I get on
Desperately hoping for good news
xxxxx
 
I'm really surprise that NICE guidelines say to be below 6 before conceiving - can you post the link?

I was around 7 for conceiving my 2nd and that was deemed ok by my consultant.

But any diabetic ladies getting pregnant particularly with high hba1cs - please be aware of the retinopathy risk too.

I'm 37 weeks now and just had a massive bleed in my eye, will prob have to give birth unable to see clearly out of one eye now. I was looking forward to the birth so much, now I am just wondering how I'll get through it all and what will happen with my eyes.

So it's not just about the baby but the mum too. Incidentally I didn't have any serious retinopathy, only background, until I had my son and now it's got worse with my second. Pregnancy can really put a spanner in the works.
 
Hi I think they actually state something around 6.1%. The guidelines were last reviewed in March 2008. However since last year NICE has been reviewing the 2008 guidelines and plan to provide updated guidance soon. I believe that some healthcare professionals now mention hb1ac of 7% or lower is acceptable to start trying for a baby, my midwife also mentioned that NICE would possibly be revising their guidance based on a hb1ac of about 7%. The fact is that the hb1ac of 6.1% or lower is actually the hb1ac of a non-diabetic person. Also the target blood glucose levels we are advised of during pregnancy are also those of a non-diabetic person so basically up until now the thinking has been that to reduce risks of congenital abnormalities, miscarriage and impact to mother's health, diabetic women should essentially mimic hb1ac and target blood glucose levels similar to those of a non-diabetic woman. The 2008 guidelines are quite detailed but there are summaries throughout. I was trying to attach the PDF here but failed - hope this link works

http://guidance.nice.org.uk/CG63/NICEGu ... df/English
 

Hi just come across this thread. I'm in a very similar situation now to you at the time just interested in the outcome of your pregnancy?? Thank you x
 
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