Pre-Conception Planning

Hi there,

Looking for advice/feedback from women who are going through or have been through pre-conception planning.

I am getting married in June of this year and my fiance and I would like to start trying to get pregnant right after. There is a lot of work involved.

I went to a pre-conception counseling meeting in February. I got to meet a OBgyn, endocrinologist, nurses, and a dietician.

  • My A1C is not where it needs to be yet but I am working on it.
  • It was recommended that I start to reduce my caffeine and alcohol intake.
  • I have started trying to wean off of my anti-anxiety medication to see if I can manage without (they said if I want to try to go off of it, now is the time before getting pregnant to see if I can manage without).
  • I began prenatal vitamins in February (which sometimes make me a little nauseous) and I stopped taking birth control 2 days ago.

I am finding all these changes a bit overwhelming at times and wondering about experiences of other women.

Thanks!:slight_smile:

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I went to a prenatal clinic which involved frequent appointments and insulin changes as well as taking a prescribed higher dose of folic acid. There was a lot of testing pre and post prandial and of course recording, which i struggle with. At first I felt I wasn’t getting anywhere in reducing my hba1c to an acceptable level and I too felt overwhelmed and a bit hopeless. I even started to think about surrogacy. Something changed for me one day when someone close to me pointed out how stressed I was and told me they could see it happening for me around Christmas. I broke down during that conversation and let go of a lot of stress. I don’t believe in mumbo jumbo if you know what I mean but I kinda just let myself believe this once that maybe she knew something I didn’t. I suddenly felt more positive and started to see results. By November I got the go ahead from the team to stop contraception and I got pregnant in the December. I have since had 2 healthy children.

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My husband joked that he didn’t realize having a baby required so much planning and waiting!

I had already decided last January to improve my focus on my diabetes, so I got a Dexcom and started paying attention to it, troubleshooting along the way. Just that focus helped me drop my A1C in 3 months from an 8.2 to a 6.6. Then, my husband and I started talking about wanting to get pregnant so I did research and opted to try a LCHF diet to help level out my bgs. My next A1C was 6.1.

The first pre-conception meeting I had was with my endo. Once I had her blessing, I checked with my OB/GYN, who advised me to switch from birth control to condoms for at least 3 months. She also referred me to an MFM who I had a consult with. Around the same time, I started prenatals (if you’re feeling nauseous, try out a different brand). I don’t recall when I started trying to cut back on caffeine, but I went from 2-3 cups per day to 1 cup of caffeinated per day (I just switched to half caffeine, and it’s so nice to be able to enjoy two cups per day).

At that point, they were happy with my A1C, so I had to wait out the birth control withdrawal and a series of blood tests and screenings. We were fortunate and got pregnant right away.

It can be overwhelming, but it’s part of the process. Take deep breaths and take it one day at a time. It seems like healthy pregnancies require smart choices (eg eating healthier than most people do, doing your best to prebolus and keep bgs as much within the ideal ranges as possible, etc.) so getting accustomed to making some sacrifices seems to be good practice (especially if you consider what life will be like after the baby arrives).

Anyways, I’m 5 months pregnant now, so this is what I’ve been telling myself all along. If you want pure validation and “feel good” reinforcement of any decisions, join the FB type 1 and pregnancy group. I have concerns about the permissive attitude the general group seems to have (eg some people intentionally getting pregnant despite high A1Cs, encouraging others not to limit their lives/food by diabetes, not expressing any concern about high bgs, and bashing doctors who express concern about patient behavior, etc.), but in general, they have a point that many diabetics have very healthy babies despite less than perfect control. I prefer to take a cautious approach and try to make as many good decisions as possible to increase the likelihood of a happy and healthy baby.

Again, hang in there and good luck! Try to get into a groove so that making a baby becomes a manageable and enjoyable process.

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Your story just gave me the goosebumps! I am so happy to hear you have been able to have 2 healthy children.

Planning and preparing can be an overwhelming and stressful experience and of course extra stress can put up our blood sugar levels. May I ask what your hba1c was when the team gave you the go ahead? I know here in Nova Scotia, Canada, they want us to be 7% or less.

Thank you so much for your response and congratulations on your pregnancy! :slight_smile:

My fiance is a very positive person (as am I), but I could tell that he did not understand the importance of careful planning and a lot of work on my end. I needed to give him a bit of a reality check and so I brought him to my pre-conception appointment. He seems to have a better understanding now.

I am someone who drinks a LOT of coffee everyday but I have been trying to cut back slowly because I know that once I’m pregnant, 1 cup is all I will be able to have. I also love wine and have a couple of glasses per night and so I am trying to work on reducing that as well. I want to have the best shot possible for a healthy baby (and me) when the time comes.

I appreciate you sharing your story and your advice!

Hi Natalie, I think it was 6.7 and by the time I had my booking appointment with maternity hospital it was 6.5. These are figures I never believed possible for me as despite over 3p years experience (or maybe 30 years bad habits!) I was never able get my hba1c down that low. I live in ireland so I’m sure there are differences but if you ever have any questions feel free to ask. Alison. :laughing:

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Good for you! Thank you. :smile:

I did preconception counseling in December. I was told my A1C should be less than 6.5 (it was 6.2). I started prenatals last August. I’m using MegaFood Baby and Me, which doesn’t have any yucky ingrediants and hasn’t upset my stomach. I have cut down on caffeine but not completely eliminated it. I also enjoy my wine! I have cut down to a couple glasses a week. My ob/endo lectured me more about eating more carbs. I follow a strict Paleo diet and even though I still get around 100 carbs a day she was adament it needs to be 150.

I have also been wearing Dex for a couple months. It was hard to get used to, but the data is invaluable. And I’ve learned how certain carbs affect my blood sugar.

Good luck!

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A lot of doctors insist on high carb.

But there are also a lot who understand that normal blood sugars are what is important for a healthy pregnancy. Your baby doesn’t get your carbs, it gets your glucose from your blood sugar. Glucose can also come from protein and is far easier to manage in terms of not having highs.

There are many stories now of successful low carb/ paleo and even keto pregnancies.

I believe key is getting the required essential amino acids (protein), fatty acids (fats) , vitamins and minerals (from non-starchy vegetable sources, as well as meats, eggs, nuts, full fat dairy if you take it), etc. Note there is no requirement for essential carbs. Carbs are just CHO (carbon, hydrogen, oxygen), and your body can make glucose from protein which is N-CHO (N is amino acids).

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I also had doctors (and CDEs) insist that I would be starving my baby by sticking with a very low carb diet. The next time one of them makes a similar statement, I’ll be ready with a retort of: “what specific test results would suggest that my baby is not getting the proper nutrients? Let’s keep running those tests and if one comes back abnormal, then we can discuss my diet.” Until then, basically, my A1C is great (5.1) and the baby is developing normally, so I don’t see a reason to change what I’m doing. (Although, in full disclosure, I was sticking to the Dr. Bernstein 30 carbs per day, but started to introduce some additional carbs when I was having consistent ketone readings at my OB appointments. Not a concern since my bgs were within normal range, but still… I’m trying to stay around 75-100/day and so far it has eliminated the ketone readings.)

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Agree. I’m not pregnant yet (TWW) but am willing to put up a fight about it. Besides, as I told my doctor, I don’t do it for fun, I do it because I have a lot of food allergies and it has improved my blood sugar drastically.

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Just a word (or novel?) about low carb during pregnancy. I feel very strongly that low carb is absolutely safe during pregnancy. I base this not only on my personal experience of recently having a very healthy pregnancy and baby on low carb (about 60g a day, sometimes as low as 30g, never more than 80g, by my estimates) - normal A1Cs and delivery at 39 + 5 after labor started spontaneously the day before. Baby weighing 6lb, 11oz, 9 on Apgars, normal blood sugars, and never left my side (can’t wait to do it again), but also on the extensive literature research I conducted as a molecular and cell biologist (Ph.D.) and biochemist (B.S.) I am now planning a book outlining a low carb lifestyle during pregnancy with diabetes… to present some evidence, please see this article, which is very easy to read, but also has a list of references if one wants to dig in: http://www.lowcarbdietitian.com/blog/guest-blog-post-is-it-safe-to-go-low-carb-during-pregnancy

Having said that, while I managed all my own diabetes changes during pregnancy, my Endo was supportive of low carb, and mfm never asked (just looked at my flat Dexcom reports). If I had a doctor who disagreed I would consider them uneducated: behind on continuing education, and I would fire them

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And I am definitely not the only one. There are hundreds of women doing this and achieving great results, and thanks to the internet I know them :slight_smile:

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I am in no way qualified to say but it doesn’t make sense to me why a doctor would think low carb is bad for baby as long as mother is taking in enough calories and nutrients. We certainly weren’t eating a high carb diet in cave man days and we did alright as a species! I really struggled to manage post prandial spikes after carbs at breakfast during pregnancy and ended up switching to high protein low carb for that meal. I probably could have benefited from doing that for all my meals but alas I am very very fond of carbs :laughing:

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I’d like to second what so many have said here already. I was totally ignorant going into my third pregnancy. Was diagnosed with gestational diabetes around 26 weeks, LADA post delivery. Was insulin dependent right from the start but because I felt so paranoid about not harming my baby, I listened to the doctor who, as it turns out, knew very little, He just never could understand why holding to a max bs of 120 was so difficult for me on a diet of 100+ carbs/day. You can imagine what a roller-coaster it was then to require so much insulin and to try to remain balanced (I didn’t have a CGM, of course).

If there was one thing I would want to go back and do differently, it would be to eat fewer carbs so that the insulin roller coaster wouldn’t have been so dramatic with big swings and low lows. Also, of course, I would have pushed for a CGM.

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I failed to mention that the ketone balance was difficult to strike (my husband just reminded me), so I did struggle to find the right carb balance and avoid ketones.

ETA: our baby did wind up with some severe protein allergies, so one other thing I might consider toying will is my protein intake. In retrospect I wish I had trusted my gut and aimed a little lower there.

Thanks, Erica! I have an appointment tomorrow morning with my Endo to go over my most recent blood work …fingers crossed that I’m at least in the lower 7 range for now. I was 8.2% in November when last tested.

I don’t tend to eat a lot of carbs throughout my day - not really on purpose - but I do find it easier to manage my blood sugars with lower carb intake of course.

I asked the team last time whether or not they would recommend I try continuous glucose monitoring while pregnant and they said it’s really a personal choice. Some women find it very helpful, while others it will drive crazy. I think it would definitely be worth a shot though!

I get so much comfort by having the CGM, particularly while driving. While it’s not always accurate and the low bg alarm goes off more often that it should (the Dexcom is very accurate but I find it can be off by 10-15, which can be the difference between a normal bg and a low bg alarm. Seeing the trend lines is what is most helpful to me. Plus, if you’re on low carb, you’ll experience less spikes, so that will hopefully mean less alarms (rise/fall, high bg, etc.).

I think the CGM itself does make a difference. I had the Medtronic CGM first and they’ve definitely made improvements since mine, but I had so many alarms and the readings were never accurate and it would often fail/stop working. So I never used it. The Dexcom has been such a different experience and I’ve been using it nonstop for over a year now, which had a major impact on my A1C.

If your insurance covers it, it’s worth giving it a shot.

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I’m so excited about your post! What is the status of your book? I would love to get my hands on it!

I’m currently working on getting pregnant and eating keto was HUGE for me at lowering my blood sugars, even though I had no idea that was what it was called. I have Hashimoto’s also, but was never strict about gluten consumption since it never bothered me or gave me symptoms. But finally realized I needed to buckle down and so I quit gluten in late August, gave up all gluten free stuff by the end of the next week or so, just because they always tended to raise my blood sugar a LOT. So I’ve been lchf since early-mid September. I remember that I went almost 4 straight days with a flat line on my Dexcom. O.O That was such an awesome feeling. I was down 11 lbs and feeling good, even without much exercise (walking on the treadmill for about 20 mins a day). Then I did an egg fast and something got screwed up somewhere. I’ve been sticking to the same way of eating but having issue after issue! I guess I got knocked out of ketosis, but I’ve been struggling for over a month now to get back into it.

My last A1c was 6.2 but I’m guessing it will be closer to 7 at my appointment in January. I’m not too worried about the actual number, because I know women can get pregnant with higher A1c’s and also that I will work my butt off to get it down if I need to, but just wanting to get back to that awesome feeling of flat blood sugars. And then of course lose more weight and get pregnant. I told my husband its like the harder I try, the worse things get. I’ve been so frustrated and have had several breakdown’s about it.