Coming off birth control and ACE inhibitor

Pregnancy
1

Hello all,


I just recently had the discussion about trying to start a family with my husband and I'm doing my research.

I was diagnosed at age 7 in 1989 so diabetes is well integrated into my life. I had been told (incorrectly) since I was a teenager that either my children would automatically be diabetic as well (it would be selfish to try) or that I would have a series of miscarriages and possibly overwhelm my body to such an extent that I would die (has anyone else seen "Steel Magnolias"?). When I first moved to Northern Virginia 5 years ago I had an awful endocrinologist who told me I shouldn't even be having intercourse with my husband! (with or without various forms of birth control)


Until recently, even discussing children with my husband has been a faux pas because it gets me so upset. We were looking into adoption and surrogacy but we don't think we can afford those options in this area.

My bloodsugar control has been getting better and I'm feeling good about my health right now. I have been reading a lot of blogs and information on T1D pregnancy. It is opening a whole new world of possibilities to read about all the type 1 women who have been pregnant, even multiple times and are still enjoying a healthy life! Thank you ladies! :D


At my first appointment with my current endocrinologist (about 4 years ago), I told her I wanted a doctor who was more understanding of women and women's issues so we did discuss pregnancy. At the time my A1c was over 8.0 so she told me we had to do better. I have since started on a medtronic pump and I have managed to get my A1c down to 7.1. I have been working hard at trying to get it lower with a new exercise and cooking regime since making a full recovery from foot surgery 6 months ago. I'm having some scary lows but I think along with my CGM readings I can get things under control in the next couple of months.


I had some questions and I was hoping that there is someone here who could answer.

 

1) I have been on birth control medication since I was 19, mainly for anemia but also for acne and other issues. Before going on it I had heavy flow, debilitating cramping, nausea and vomiting during menstruation and severe pms (mainly uncontrollable sobbing). Hopefully this was more related to teenage hormones and not what I can expect when I go off birth control now but I am still worried.

Has anyone had any problems coming off birth control after many years on it?

Any problems with changes in insulin requirements and glucose control after coming off birth control?

 


2) This might be more of a question for my endocrinologist, but I wanted to see if anyone has any experience with it. I am aware that I will have to stop taking my ACE inhibitor when I become pregnant. I was put on it around age 21 because I did have a trace amount of microalbuminuria.

Do we just assume that as long as I maintain good glucose control that I won’t have microalbuminuria during pregnancy? Do I have to have my urine tested for microalbumin throughout pregnancy?

Has anyone experienced kidney damage from pregnancy?

Do I go back on the ACE inhibitor as soon as I have given birth? finished nursing?

 

 

Please tell me about your experiences. Anything would be helpful, even if it isn't good! ;)


 Looking forward to the journey!

2

Hi MJ,

I was on birth control for about 5 years straight with out any breaks before deciding 2 months before my 30th birthday (when I found out my A1C was a 6.2) that I wanted to get off it and start trying to get pregnant.  2 months later (the week of my 30th birthday!) i found out i was pregnant.  It was great news, and contrary to popular belief that it's hard to get pregnant if you've been on the pill for a while, I think your chances of getting pregnant when you get off it are actually better!  When I was a teenager I used to have HORRIBLE cramps, but the two months I was off the pill and had regular periods, everything was very light and there were no bad pms symptoms (well, nothing an advil couldn't cure ;D ).  I think as we get older our periods change as well.  The pill didn't affect my insulin needs either.  

As for the ACE inhibitor, I'm not really familiar with that, but I hope you get the answers you need, either on here or with a doctor.  Good luck trying :)  

3

Your dooms day doctors did not give your accurate information.  Either does "Steel Magnolias".  =)  In the modern era of diabetes management, there's no reason you can't have a successful pregnancy.

I was diagnosed with diabetes at age 4 and had a completely healthy pregancy at age 32.  I'm nothing special, just a normal person with diabetes.

I started an ACE inhibitor when I was about 30 because of trace microalbuminuria.  When pregnant I went off the ACE inhibitor and took another blood pressure med to protect my kidneys.  My kidneys are completely healthy now and I have no diabetes complications after 36 years with type 1 diabetes.  

My pregnancy wasn't planned and my A1c was about 7 when I conceived.  I quickly got it down to a 5.1 (there is no motivation like wanting your baby-on-board to be healthy).  I had no bad lows and few highs.  I felt great during my pregnancy and my son was born with a normal blood sugar.  Type 1 diabetes doesn't have a strong genetic link.  Statistically, he has a 2% chance of developing diabetes.  This ADA link has all the info.  www.diabetes.org/.../genetics-of-diabetes.html

Hormone birth control never worked well for me, so I don't have any info on that.  

4

Jenna,

What blood pressure med were you switched to during pregnancy for kidney protection? My PCP advised me to stop taking lisinopril when we start trying but did not mention an alternative.

5

MJ,

I am currently in the research stage as well. I stopped taking birth control pills two months ago after being on them for two years.  We plan to start trying in November.  According to info I've found online, some women are able to get pregnant two weeks after stopping the pill and for others it can take several months for your body to go back to its normal cycle for ovulation. I wanted to have a few months to see what would happen with my cycles.  I've had two cycles so far with a 4 day difference in cycles. As for the ACE inhibitor, I currently take lisinopril for kidney protection. My PCP advised me that its safe to take until we start trying, but I plan to stop it a few weeks before just to make sure it is out of my system or I may see if there is a safe alternative to take while pregnant.

6

I'm sorry, but I can't remember which drug I took as an alternative to Lisinopril.  My son is 8, so it's been a while.  Get another doctor's advice (your OBGYN or an endocrinologist) on alternatives.

I looked online, hoping something would jog my memory, but couldn't find anything specific.  There was this info:

"Because of the possible risk that lisinopril poses to an unborn child, even during the first trimester of pregnancy, you should be sure to let your healthcare provider know prior to taking lisinopril if you are pregnant or thinking of becoming pregnant. He or she will consider the benefits and risks of taking the drug during pregnancy before making a recommendation. In all but the rarest of situations, there are other options for women who are pregnant or could become pregnant while on the drug."

blood-pressure.emedtv.com/.../lisinopril-and-pregnancy-p2.html

I'd take this info to your doctor and get his/her recommendation on these specific drugs.  Don't be discouraged by the researcher's quote.  He's being cautious.  I actually took another drug and had no kidney problems during pregnancy.  

"Therapeutic doses of 8 drugs (chlorothiazide, chlorthalidone, hydrochlorothiazide, atenolol, acebutolol, pindolol, nifedipine, and reserpine) are considered unlikely to pose a substantial teratogenic risk, although the available data for these drugs are "no better than fair, '  Prof. Friedman says, and 'each drug raises concerns of other kinds.' "

www.medscape.org/.../537304_3

7

Thank you for all the replies everyone! It is great to hear that there are alternative bp meds. I am currently on Monopril (my old Canadian endocrinologist's drug of choice) and it says all over the bottle not to take while pregnant or nursing. I skipped a dose when I had stomach flu last year and there was a big difference when I went back on it, i.e. dizzy spells and black over my eyes when I stood up quickly. I can only imagine the difference for my kidneys.

I have been having a hard time balancing exercise and lows--it doesn't matter if I'm 100 or 200, my CGM starts alarming that I'm low after 20 min moderate walking, even when I decrease my basal rate-- but I see my endo in 3 weeks. Hoping to get good news about my A1c!

8

Hi Maggie,

     I hope that this might help you......I am type 1, for 34 years now. My blood pressure was usually normal and I have had no other issues. There was a long period when I did not have health care and I did not have my blood pressure checked. A nurse checked my blood pressure when I was 4 months along and thought it was high due to me being nervous. I did get healthcare although not the greatest type. It was the land of young resident doctors who never brought up pre-eclampsia, I ended up having to be in the hospital for a week because of it and my kidneys were starting to shut down. My son was born a month early and did not want to eat much so he stayed in the hospital for a month. He is very healthy now and so am I.

   I am wondering if this is something you can ask your endo about? I am not sure what caused mine. There have been studies done that people in the northern states get it more often because it is due to a vitamin D deficiency. While I am sure everything will be OK for you I just wanted you to ask because I did not know if by chance you happened to get pre-eclampsia would it be too hard on your kidneys. I took Amlodipine while pregnant to bring my blood pressure down. Best wishes for everything!