High risk mamas?

[AlexisT]

I thought I'd start a thread to see if there were any other high(er) risk mamas here, and have a thread where we can share our experiences. (Please, if you haven't gone through a high risk pregnancy, don't crash this thread to advise us against testing or procedures.)

I have chronic hypertension (baseline 165/105) and a history of superimposed preeclampsia. My daughter was delivered by emergency CS at 37 weeks--I was too sick for induction. Not too terrible but I do get extra monitoring and I'm staying on beta blockers. My MFM said that since my Toprol is controlling my BP there's no reason to switch to labetalol. Plus, this baby is the result of fertility treatment, so I'm being extra careful.

[livacreature]

I'm high risk.  Type one diabetic.  Not controlled as tightly as I would have liked at conception, but things have been pretty darned controlled since.  This is my first, so I'm pretty on edge, but trying not to stress too  much and enjoy it.  I'm very happy and excited, but very nervous too.  It is a lot of work, constantly adjusting everything.  I'm up several times a night testing my blood glucose because it seems to go high at night then crash. 

Thanks for starting this thread.  Even with different medical issues, it is so nice to hear success stories of mamas who have faced medical issues and gotten through it!

[~pi]

Like livacreature, I am type 1 diabetic.

This is my second pregnancy. My first was a healthy pregnancy, no complications, but birth was a trainwreck -- c/s after a long and complicated induced labour. I also found the 'something terrible could happen AT ANY MOMENT' attitude during pregnancy totally exhausting, not to mention the enormous amount of time I spent in appointments, making sure that everything still looked a-ok.

I'm finding it a lot easier the second time round so far. I test a ton, adjust my basals and ratios, and while it's definitely a lot of work, I knew what to expect so it isn't quite the shock it was the first time. I'm also in a different place in my life, and less naive about how the health system works. For my first, I was still a fairly new grad student and just getting started in medical research. Now I'm done my phd and my area of research gives me more insight into medical risk than I had the first time, which I expect will make for slightly easier conversations with health care providers.

livacreature, that (nighttime high followed by a crash) happens to me if I eat anytime in the two-three hours before bed. I just don't do that when pregnant and it makes life a lot easier. A little big of cheese, eggs, nuts, veg, etc. work fine (you know the drill), but nothing that requires a bolus, make sure overnight basals are tuned well, and voila, no problems and no sleep disturbance.

[lifeguard]

I have pcos & thus am insulin resistant - but that seems to be getting worse & worse despite my best efforts. I had gestational diabetes with ds & fully expect to again.

I've actually been testing my bs the last couple days to get a baseline to bring to my ob next week. I'm really hoping to avoid the awful glucose challenge tests. Unfortunately I am finding my fasting is consistently high. The rest of the day things seem to be ok but I can't seem to get that fasting down. Frustrating. That was what I struggled with last time too.

The most annoying part was definitely all the extra appointments & the stress of that (the endo that I saw last time would talk c-sec every. single. time. I saw him leaving me stressed & in tears - grrrr.).

I'm in a different country this time so it'll be interesting to see the difference.

[AlexisT]

I also have PCOS with IR--my sugars were okay last time, but it's been 4 years, and I'm nervous they won't be now.

[emmaegbert]

I had GD with my second, and expect to again this time. I was lucky because I was able to achieve excellent control with diet and exercise. I certainly hope that is the case again, but its 2 1/2 years later... (however, I am also starting out 30lbs less, which ought to help some). I was also lucky that my HBMW was totally supporting me throughout b/c those mainstream folks (and I was seeing midwives!) were super stressful.

Planning a HB this time too, and I am going to talk upfront with MWs before we hire one about how they will help me manage my diet and blood sugar and their approach to GD moms. I probably won't do a GTT, just start monitoring (like Lifeguard). I'm across the country now so I can't have the same MW, which is too bad, b/c she was so incredible- knew a ton about mainstream and alternative health, was GREAT with diet too. I have my old forms for logging food, exercise, sleep and BG, so I can still use those.

There was a GD support thread at the time, which was so incredibly helpful for me. Finding other mamas going through the same things just made a huge difference in my emotions and stress. I didn't feel alone and isolated about it... And- Lifeguard- I think we might have missed eachother on that GD thread b/c you were a little ahead of me, but I remember you from it! (It was really, really long, took me several weeks to read the whole thing by the time I joined).

[TeacherMomma]

I am considered high-risk because I have Leiden Factor V, which is a genetic mustation that causes overactive blood-clotting.  With my first I took blood thinners, with my second, I didn't and both turned out fine.  My mom and grandma both have the genetic mutation as well, and had lots of healthy babies- they didn't know about it back then.  So I don't really consider it to be a high risk, but the docs do. 

If anyone else out there has it, all I can say is don't worry too much- my family has had lots of healthy babies and we all carry it!

[thamilton19]

I had a high risk pregnancy after 7 miscarriages between 12-14wks. The whole pregnancy was very difficult I have CIDP which my body attacks my nerves. I had to be in a wheelchair for 4mo of my pregnancy. I was in the hospital weekly for IVIG infusions. I had GD and preeclampsia. I was induced at 35 wks due to extremely high BP. I never dilated so after 36hrs I had a c-section.  After the C-section I needed a blood transfusion then my uterus wasn't clearing the lochia so they wanted to do a D&C on be, but because my son was in the NICU I wouldn't consent because it would be another 24 hrs before I would be able to see him and I was hysterical about not being able to see him. So instead of a D&C the doctors removed the lochia manually which was the worst part of the whole event but allowed me to see my son sooner. My son had several problems that kept him in the NICU for 4wks. The NICU is a very frustrating place because ever thing is about measurable increments up or down multiple times each day, they had a lactation consultant who tried to encourage breastfeeding but the doctors discouraged it for so many reasons in the end to get my son home I had to agree to put my son on formula otherwise they were going to send him to a step down hospital. The doctors make it seem like they are all powerful because if you don't agree with what one of the doctors told me was that I would be going against medical advice and there would be serious consequences for that, to threaten me.

[livacreature]

Ugh, I had a horrible blood sugar day yesterday.  I had my highest reading since finding out I was pregnant (376) due to an issue with my infusion set.  Then I plummeted to 35 and blacked out for the first time in eleven years of diabetes.  It took 32 ounces of OJ, 16 ounces of milk, 1 fistful of glucose tabs, and 2 peanut butter waffles to even get me to break 70.  DH was worried, so was up every two hours testing me to make sure I didn't bottom out again.  I'm trying not to stress over ever abnormal reading, but yesterday sucked!

[AlexisT]

Oh no!

I have to do a GTT today. :( My OB wants to rule out preexisting Type 2. It is theoretically possible that I have it and it was masked by taking metformin and Byetta, although my last A1C was 6.0.

Plus, my BP was 140/85 on Friday, which made me a little nervous--last month it was 115/70. Anything below 140/90 is okay in pregnancy so it's not concerning in that respect, but your BP is supposed to go down in the first trimester, not up... and this happened in my 1st pregnancy too. I actually thought it was a bit low because I've been getting dizzy, but I guess that's something else. I've got an appointment with the internist tomorrow, anyway.

[livacreature]

I hope it goes okay for you, Alexis! 

[lifeguard]

emmaegbert - that gd thread was crazy long but it was also kind of helpful. Maybe someone will need to start a new one!

thamilton - that sounds very stressful. I hope this time around goes much smoother for you.

livacreature - what a terrible day.

Alexis - good luck. I don't really get why it's so important to diagnose type II that may be masked. I mean, even if you do have it, it's well controlled so what's the difficulty? I am worried my doc will feel much the same way.

I see the doc this week so we'll see what he wants to do from here.

[SimpleLove]

Originally Posted by TeacherMomma 

I am considered high-risk because I have Leiden Factor V, which is a genetic mustation that causes overactive blood-clotting. 

I also have Factor V Leiden. I was only recently diagnosed when I went to talk to an OB about TTC. It explains most of the issues I had with my first birth (emergency c-section, IUGR, no amniotic fluid). I'm going to start taking the blood thinners (Lovenox) very soon. Injections every day- a little nervous about that, but I want to have a healthier baby/birth this time if I can help it.

I want to be treated high-risk this time so I don't mind the label. I'm focusing on a VBAC but am being open-minded about the path to get there.

[~pi]

Best of luck, Alexis. Hoping for no type 2 for you.

livacreature, ugh. I hate the swings, even when they aren't quite that dramatic. That must have been really scary for your DH. For what it's worth, I find that I need to really stay on top of set changes during pregnancy. They just seem to go bad much more quickly. I have never been able to get a good explanation as to why that might be, but it's definitely true for me, and I know other women experience it as well. I am normally pretty laissez-faire when it comes to set changes ('hey, it's day seven and you're still working -- awesome, let's keep going, then!') but when pregnant I put reminders on my calendar to change 3x a week.

[AlexisT]

Originally Posted by lifeguard 

Alexis - good luck. I don't really get why it's so important to diagnose type II that may be masked. I mean, even if you do have it, it's well controlled so what's the difficulty? I am worried my doc will feel much the same way.

The issue is that it would've been masked and controlled when I wasn't pregnant... but it wouldn't be now, because I'm off my meds. Management of T2 is different for pregnant and not-pregnant, too--docs differ in their approach to oral meds, but i would still need to control my diet more carefully, monitor my sugars, and might wind up on insulin.

Hopefully, I'll be okay. I think I am, and I won't mind the baseline. The glucola is disgusting, though!

[mama81]

I am high-risk as well and like you AlexisT my issue is hypertension.  I developed severe preeclampsia at 38 weeks with DD#1 and my blood pressure never returned to normal post-pregnancy.  Throughout my pregnancy with DD#2, my blood pressure was fairly well controlled until 37 weeks, when I was induced after failing the 24-hour urine test and some really wacky BP readings. 

So far my BP has been pretty good.  I'm taking labetalol.  Hoping for the best!

[famofour]

Hi ladies,

I have Lupus (SLE) and just found out today that I also have APS, or *antiphospholipid antibody syndrome (defined at bottom). I am totally stressed out about this added hurdle in my pregnancy. I am reading so many scary things about it, and wonder just how common things like still-births and mental health problems actually are?

Anyone else with an autoimmune disorder or knowledge of this? My rheumatologist suggested low molecular weight heparin at my last appointment, but I wanted to wait. I really hate all this. Grrr.

*Antiphospholipid Antibody Syndrome or APS is an autoimmune disorder in which the body recognizes certain normal components of blood and/or cell membranes as foreign substances and produces antibodies against them. Patients with these antibodies may experience blood clots, including heart attacks and strokes, and miscarriages. APS may occur in people with systemic lupus erythematosus, other autoimmune diseases, or in otherwise healthy individuals.

APS is also known as APLS, APLA, Hughes Syndrome or "Sticky Blood."

[lifeguard]

Alexis - that makes sense. I'm not off of the metformin & am pushing to stay on it for the whole pregnancy. I realize I may have to switch to insulin later but if I can avoid it this time that would be terrific.

[livacreature]

I went for my viability ultrasound today because this bub wasn't exactly meticulously planned and they said everything looked great.  I'm measuring 6 w 1d which is a week behind what they initially calculated, but I already knew I ovulated later than that and the heartbeat sounded good.  So relieved!  

On the frustrating side my pump kept saying it wasn't primed today.  Finally it stopped.  Not sure what the deal was.

I imagine switching to insulin during pregnancy would be intimidating with all the changes your body is going through anyway!  

FOF: I've never known of someone with APS.  How did they screen for it?

[famofour]

LivaCreature: They can actually screen for the antibody. They usually do two to three screening 6-12 weeks apart to determine APS.

My OB made me feel much better today about everything. I start heparin injections tonight. Fun.