Managing Diabetes During Early Pregnancy: To Terminate or Not?

The patient has pre-existing diabetes and is currently five weeks pregnant, seeking to undergo a medical abortion?

Hello, Dr.
Huang.
I was diagnosed with diabetes six months ago and have been continuously using oral hypoglycemic medications, and I am also overweight.
A couple of days ago, I found out that I am five weeks pregnant.
However, I have been taking medication during these five weeks.
My endocrinologist advised me to terminate the pregnancy and referred me to another large hospital's obstetrician for an abortion.
However, the doctor at the large hospital believes that even though I have been taking medication for five weeks, the situation is still manageable.
He noted that my HbA1c was 11% at the time of diagnosis, which he considers too high, and he is unwilling to prescribe medication for the abortion.
I have been controlling my blood sugar for six months, and my levels have decreased, although they have not yet reached the standard range.
The endocrinologist believes that taking oral hypoglycemic medications for five weeks is very harmful to fetal development and strongly recommends termination.
I really don’t know what to do right now.
=_=

Xiao Ru, 30~39 year old female. Ask Date: 2017/08/25

Dr. Huang Jianzhong reply Obstetrics and Gynecology

I was diagnosed with diabetes six months ago and have been continuously using oral hypoglycemic medications, and I am also overweight.
A couple of days ago, I found out that I am five weeks pregnant.
However, I have been taking medication during these five weeks.
My endocrinologist advised me to terminate the pregnancy and referred me to another large hospital's obstetrics and gynecology department for a termination procedure.
However, the doctor at the large hospital believes that even though I have been taking medication for five weeks, the situation is still manageable.
He noted that my hemoglobin A1c was 11% at the time of diagnosis, which he considered too high, and he was unwilling to prescribe medication for the termination.
However, I have been managing my condition for six months, and my levels have decreased, although they have not yet reached the standard range.
The endocrinologist believes that taking oral hypoglycemic medications for five weeks is very detrimental to fetal development and strongly recommends termination.
Answer: Go to the high-risk pregnancy clinic at the medical center.

Reply Date: 2017/08/25

More Info

Managing diabetes during early pregnancy is a complex and sensitive issue that requires careful consideration of both maternal and fetal health. In your case, you have been diagnosed with diabetes for six months and have been on oral hypoglycemic medications. Now that you are five weeks pregnant, you are facing conflicting advice from different healthcare professionals regarding the continuation of your pregnancy and the use of medication.

Firstly, it is essential to understand that diabetes can significantly impact pregnancy outcomes. Poorly controlled blood sugar levels, particularly in the first trimester, can lead to various complications, including congenital anomalies, miscarriage, and other adverse effects on fetal development. The American Diabetes Association recommends that women with diabetes achieve optimal glycemic control before conception and maintain it throughout pregnancy. Your HbA1c level of 11% at the time of diagnosis indicates that your blood sugar levels were not well controlled, which poses risks during pregnancy.

The concerns raised by your metabolic physician about the potential effects of continuing oral hypoglycemic agents during pregnancy are valid. Some oral medications, such as certain sulfonylureas and metformin, may not be recommended during pregnancy due to potential risks to the fetus. However, metformin is sometimes used in pregnant women with diabetes, particularly in cases of gestational diabetes, as it has been shown to have a relatively favorable safety profile.

The conflicting opinions from your healthcare providers highlight the importance of a multidisciplinary approach to managing diabetes in pregnancy. It is crucial to have a healthcare team that includes an obstetrician, an endocrinologist, and possibly a maternal-fetal medicine specialist who can work together to develop a personalized care plan for you. This plan should consider your current health status, the control of your diabetes, and the potential risks and benefits of continuing the pregnancy.

If you are considering terminating the pregnancy, it is essential to have a thorough discussion with your healthcare providers about the implications of this decision. They should provide you with information about the risks associated with both continuing the pregnancy and terminating it, allowing you to make an informed choice.

In terms of managing your diabetes during pregnancy, if you choose to continue, it is vital to monitor your blood sugar levels closely and adjust your treatment plan as necessary. This may involve switching from oral medications to insulin therapy, which is often considered safer during pregnancy. Additionally, dietary modifications and regular physical activity can help manage blood sugar levels effectively.

Ultimately, the decision to terminate or continue the pregnancy should be based on a comprehensive understanding of your health, the potential risks to you and your baby, and your personal values and preferences. It is essential to seek support from healthcare professionals who can guide you through this challenging time and help you make the best decision for your situation.

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