Pregnancy is a long way off for me at the moment, but we do plan to have children in the next few years. I have some questions about it, but don't really want to ask my doc or DSN because we won't be trying for a while - my DSN especially will get very overexcited!
What should pre-pregnancy and pregnancy A1c be?
What are my chances of miscarriage/birth defects?
Can I have a natural vaginal birth?
What should breastfeeding A1c be?
This will be long...prepare yourself!!!
I'm sure you've noticed that at each routine appointment you have your doctor asks you if you have any plans for children yet (he/she has to for women at child-bearing age)...for years I had the standard 'no' answer and then completely surprised my doctor with a 'yes' last year! He booked me in to the pre-conception clinic with my dsn who talked me through all the POSSIBLE problems (not definite problems) that could happen and how it's crucial to be well-controlled before trying.
As far as I can tell from talks and literature is that the reason a lot of diabetics could
maybe have problems throughout pregnancy (for example heart defects and malformation) is due to poor control prior to pregnancy. The earlier you control your sugar levels (it takes time and patience!), the easier it is when you do fall pregnant. The reason for it being that you (probably) won't know that you are pregnant until your missed period - by which time you will already be pregnant so the better the control, the better likelihood of a healthy outcome. I say that, but my Mum's friend had 2 very (but large) babies 30odd years ago who were very healthy and they didn't control their sugars nearly as well then so a lot depends on you.
My doctor wouldn't give me the go-ahead to come off the pill until my HbA1c was below 7...I got it to 6.7 and he was really pleased (from 7.4). From talking to my DSN it would seem that a lot depends on your circumstances, for example how long you've been diabetic as it's harder to control with time as your body changes so much.
I'm now 10 weeks pregnant and have been told that the majority of the diabetics at my hospital have healthy happy babies - although most mothers are induced early so a natural birth isn't off the cards, it's just 2 weeks early! If you are carrying a large baby then a c-section would be likely.
From the moment you tell them that you are pregnant they will monitor you closely. You will be classed as 'high risk' so won't be allowed a home birth (unless you're really lucky in your area!) but the appointments at the hospital are generally every 2 weeks so they can monitor your sugar levels and give advice. Your insulin requirements will increase throughout your pregnancy (possibly more than double the amount required at the end of pregnancy) but you will move back to the normal amount the moment the baby is born. I think at 35 weeks (or less) you will then see them weekly as they will monitor the baby's size etc.
I was told 20 years ago that all diabetics have c-sections so was surprised when they told me differently in January but I don't mind either way, as long as the baby is healthy.
DUK Balance magazine had a really good month specifically for pregnancy a couple of months ago...did you get a copy or perhaps they would send you one? There is also a publication from them (costs about ?4) which answers a lot of questions but I found that I got the best advice from this forum...there's nobody better to give advice than those who have gone through it!
The one other thing I would say though is that DUK give guidelines for ideal readings 1 hour after meals. On speaking to my DSN in a panic last week that sometimes I don't hit it and that I now have lots of hypos because I'm giving myself extra insulin to hit that amount which results in rebounds, it was made clear that they are GUIDELINES only. Just a guide and not the law! I have to set an alarm at 3am every night to give myself extra insulin as I go high in the night...the hospital have no idea why but because I acted on my own initiative they seem pleased that I'm well controlled throughout the rest of the day but only have the highs in the night - which I deal with.
I ended up feeling really bad that I hadn't had a 'natural' birth experience & had struggled with breastfeeding etc - in my experience (which to be fair is all I can comment on) the other 'nct' mums were horribly competitive, weren't very nice about my being diabetic (like it's a choice?!), having a c section or (coincidence or effect?!) having pnd afterwards. I'd really recommend trying to talk to other mums at your diabetic antenatal clinics - I've made some lovely, genuine friends that way!