I've been concerned with my high A1c at conception and was relieved to find there are no markers for trisomy or down's with the nuchal fold test but won't learn my actual numbers (probabilities) until next week. I am measuring perfect to my due date based on my conception date.
Glad to hear all looks good. I was unaware that high blood sugars created a greater risk for trisomies and other genetic abnormalities which is what the NT looks for.
High a1cs at conception actually increase the risk for spina bifida, heart defects and other congenital birth defects. I had the nuchal fold testing because my husband already has a child from a previous marrage with Down's and I have a son from a previous marriage with a severe congenital heart defect, these combined with my our ages puts us in a higher risk category so I do as much screening as possible without getting too invasive (I declined the CVS.) I found out about my son's heart defect at 26 weeks and was able to plan for his open heart surgeries before birth which as very helpful. He's 9yrs old now and has had three major open heart surgeries.
Ok, I was concerned about heart and spina bifida, but my OB said that the 20 week anatomy scan would tell us that so we declined the nuchal. Although I was just 12 weeks on Tuesday so we could reconsider.
Yes, You have about another week for the Nuchal fold testing but it wouldn't much matter if you didn't want to opt for a cvs or amnio if the results showed markers. Mine didn't show any markers so I declined the CVS but will have an amnio if the blood screen shows my chances are high. Because of my older son, I will see a pediatric cardiologist at 20 weeks for a fetal echocardiogram to check for congenital heart defects. My older son has a defect that involves him missing half of his heart that requires multiple heart surgeries to reconstruct his heart over time. I had a baby 15 months ago that had no problems at all despite my high early a1c with that pregnancy. I managed to bring my a1c down to a 5 during my last pregnancy and I'm hoping I can do the same this time too.
Just got the call from the perinatologist, based on my age, my chances of Down's were 1 in 72 but the blood screen done in conjunction with the nuchal fold scan brought the number down to 1 in 2100. Trisomies are 1 in 10,000. I will go in at 15 weeks for the sequential quad screen that will screen for neural tube defects and screen for heart defects at 20 weeks.
While I would welcome the reassuance of knowing that there was a lower risk of a trisomy, I have heard so many stories of women who got a higher risk result and then had perfectly healthy babies. I am pretty high strung right now; this will be our first child (I will be 36 in Jan) and I had a miscarriage in April so after weighing the options I was not sure I wanted to go through extra worry if not needed, especially knowing that we would not terminate the pregnancy based on results.
I know it is sometimes a bit controversial. My husband and I decided we would test for things where there was a meaningful intervention, much like was the case with you son and his heart defect. When I spoke to my OB based on that he recommended waiting for the 20 week anatomy scan. Was he off base? I am very concerned about spina bifida and heart defects and suspect that both of those might have meanigful interventions. If there a benefit to knowing now versus at 20 weeks?
For me, knowing about the spina bifida and other defects now "might" make a difference in whether or not I would terminate. I don't know that I would but I guess I'd like to know and have the option. My husband's son with Downs has a pretty severe form and is non-verbal at 13. He has many health issues with it and very developmentally delayed. My son with the heart defect has had three major open heart surgeries will need a transplant at some point and if I knew I was carrying a child with another serious problem, I think I might feel like I was taking away something from them. My husband also has another grown child and grandchild and we also have a 15 month old. If it were another heart defect, I would not terminate because I know there can be a good quality of life in that situation but I also know it would take quite a bit of planning and preparation. There is no heart surgeon where we live. We travel from Louisiana to Miami, Florida for my son's surgeries. There are surgeons closer, in Texas but I researched each hospital and chose the surgeon I felt was right for my son and his particular set of defects. So, all that being said, I guess I feel like I need to know exactly what I am dealing with so I can make decisions and prepare for what we're dealing with. The screenings give me choices of whether or not to do more invasive testing and the invasive testing gives me definite answers so I can make appropriate decisions. If I knew termination was off the table for me, I probably skip the first rounds of testing and wait until 20 weeks too. I feel bad admitting all of this because I am generally someone who leans toward a pro-life stance but I've also been given a set of circumstances that make these decisions about more than just me but my family and other children I am committed to. I am a stay at home homeschooling mom and our resources are limited.
I backed off my insulin this past summer to lose weight. In the process I let my blood sugar suffer but was able to take off 40lbs. Of course as soon as I took off the weight, I got pregnant (unplanned) and in my initial bloodwork discovered my A1c was 9.7. I found out I was pregnant at 4 weeks and immediately tightened up my blood sugars with 10-12 shots a day of 500 units of humalog (thats my regular dose) and another 200 of lantus (also my regular dose) but am so insulin resistant, I struggle with good control so I went on a pump. I'm now on u500 insulin and have good control but I worry I didn't get the numbers down fast enough for the pregnancy so I've worried a lot from the start.
The decision to test for things that have a meaningful intervention is completely understandable and I know there are those out there that would disagree with my line of thinking but I really am trying to make the best decisions I possibly can for my family at this point. I completely understand your reasoning and think it's a good choice. Knowing beforehand about my son's heart defect helped me so much in the research I needed to do to get him the best treatment possible. He's a wonderful little boy, bright and intelligent and even athletic. It is amazing what his surgeons were able to do to give him a very nearly normal life.
Thank you for the honest, and meaningful thought out response. While I am not sure I could make those decisions myself, I can understand your reasoning.
I guess I am in a slightly different boat. Right now it is just me and my husband and I was fortunate that my A1c in July was 5.8 and I saw my endo 4 days before I found out I was pregnant and it was 5.9. So I have had some better control. . . the first time I was pregnant in March my A1c was 7.7 but i miscarried. We concieved 2 days before I learned out my A1c. I very rapidly got my sugars under better control but the baby had some chromosomal abnormalities. I have had A1C's much worse I recall 12-13s. I suffer some insulin resistance but actually I started metformin after my miscarriage and it significantly improved my control.
I am glad you have positive looking news in your future. You have my thoughts and prayers.
Thank you! I had two losses prior to having my older son but we are unsure the reason other than I tend to have low progesterone. I had chromosonal testing with an amnio when we discovered my son's heart defect and found nothing else wrong. I wonder if I had diabetes back then and didn't know it. I was on the borderline with my gdd test which is why my midwife sent me for the additional ultrasound that found his heart defect. Your a1c's for this pregnancy sound pretty good. It should comfort you to know that there isn't much of a risk factor of an a1c under 6 at conception for neural tube defects or heart defects. Congrats on the new pregnancy and I hope all goes well for you.