Diabetes, would it change prenatal care or birthing plans?

[airmide_m]

I'm a little out of place here because I'm not actually pregnant but I am still hoping to be, and I thought this would be the most appropriate area for this question.

I have Hashimotos hypothyroid and am overweight. I do my best to eat a low carb and low sugar diet Traiditional Foods type diet, but I do have a sweet tooth and am not always perfect at nutrition. But I think my weight problem is mostly due to the hypothyroid, since I was able to lose 40 pounds and keep it off 2 years till they switched my medications. Then I gained 20 pounds back in a month (with no diet or exercise changes) and gradually gained back the other 20 over the next coupe of months. Really unless I stick to a zero carb, zero grain, zero sugar diet, I seem to gain weight.

My doctor says he thinks I have prediabetes, but I think he's being kind of stupid and won't test me. He said something about the tests being inaccurate, but obviously some people manage to get diagnosed! I'd really like to know one way or the other.

But then I was thinking...I want to have a homebirth. How much would having an official diagnosis of diabetes change my ability to homebirth, or encourage doctors to try to push a C section?

And how is diabetes or prediabetes handled during pregnancy? In any case I want to do what would be best for the baby. I've read that some medications may not be safe during pregnancy. But I also know sometimes not properly medicating something during pregnancy can be equally or more unsafe (like asthma for instance).

I'm wondering if I would be put on any medications to help the situation if it's found I do have diabetes or something related, and how much those might help or hurt during a pregnancy. Also if it would just be managed by diet alone anyway during pregnancy, I'm debating whether or not I'd want an official diagnosis on my record if it could cause any unnecessary interference with my plans.

Does anyone have any experiences or advice to offer? Thanks!

[somegirl99]

Originally Posted by airmide_m

My doctor says he thinks I have prediabetes, but I think he's being kind of stupid and won't test me. He said something about the tests being inaccurate, but obviously some people manage to get diagnosed! I'd really like to know one way or the other.

I'm sorry I can't help with the pregnancy questions, but I think you should get a new doctor.

[lifeguard]

If the doctor doesn't believe in the glucose tests (& lots of people do think they are a pretty poor test) he can test your a1c levels which gives an average of your blood sugars over the last 3 months. Alternatively if you can get your hands on a home glucose meter you could test your own levels periodically through the day for a few days & see what is going on.


With diabetes you may automatically be considered higher risk - but this really depends on your care provider.

It sounds like you are probably at higher risk of developing gestational diabetes. The care providers in my area automatically risk women out of home births with gd. Gd may or may not be managed alone by diet alone (a lot of women have good success that way but some of us do not despite our very best efforts) & it's good to be realistic that you may have to do more to manage it (ie. insulin, etc.).

It seems strange to me that your doctor doesn't want to test for diabetes I must admit. My doctor does it every year with my annual exam because I have pcos & am insulin resistant & I'm glad that we are on top of it.

[staceychev]

Originally Posted by lifeguard

With diabetes you may automatically be considered higher risk - but this really depends on your care provider.

No experience with diabetes, but with Hashi's you may be considered high risk, too. My midwife (CNM not homebirth) had me see a maternal fetal med doc a couple of times during pg and also verified that I was under an endo's care, otherwise the practice would have transferred me to an OB. That may have been a combination of the thyroid and my age (37), though.

[umsami]

I had gestational diabetes through three pregnancies, which didn't resolve after the third, so now I'm officially type 2.

Most midwives will not take you if you have diabetes; however, the practice I see will take you as long as you are not on insulin. Unfortunately, lots of Moms who can control with diet/exercise when they're not pregnant, do need insulin during their pregnancies.

Another thing that often happens with GD and Type 2(not sure about TYpe 1), is that they want to induce you at 39 weeks. Regardless, your third trimester usually has lots of NSTs and BPPs. You'll also typically get a level 2 u/s at 20 weeks... and a fetal echo around 24-26 weeks. Your thyroid levels are also crucial.... especially during the first trimester... so you'd want to work closely with your endocrinologist on that.

The thing is, if you do have diabetes... or even prediabetes.... you need to know. It can cause a lot of problems for your baby and yourself--especially if it's not well controlled. At minimum, your doctor could run a HbA1c... that would tell him how your blood glucose control has been over the past 4 months (life of a red blood cell). If the number is over 6, then you are probably diabetic... although mine is considered normal (5.3%) and I'm still diabetic.

You could also go off to Wal-mart and buy one of their RElion meters and strips... and test your own fasting and blood glucose levels. If your fastings are over 90 when pregnant, or your post-prandials (after meals... 2 hours) are over 120... then you're probably diabetic or have gestational diabetes. For non-pregnant people, over 100 fasting is considered pre-diabetes... and over 126 is diabetic for fasting.

I'm assuming you see an endocrinologist for your Hashimotos... your endocrinologist should be able to arrange at least the HbA1c... possibly a 2 hour GTT.... especially if you tell him that you're considering becomign pregnant and are concerned.