I’m working toward a pregnancy-safe a1c at the moment before TTC. Just got back on CGM and working hard on consistent, low-carb diet + exercise regimen to stabilize my daily rollercoaster sugars.
I have a great team. I’ve been with my endo for 5 yrs now and I’m not looking to switch. I also found an amazing ob/gyn and high-risk ob/gyn who work together.
The problem being that each doc says “I’ll work with the diabetes” and “I’ll work with the pregnancy” but I’m thinking it would help to have someone who does Diabetes + Pregnancy.
Did you seek a specialist for endocrine + pregnancy? If you’re in the Washington, DC area, can you recommend anyone? I’m hoping that someone with both pieces of this puzzle might have additional insights or advice to help achieve a safe a1c before TTC.
First off congratulations on being pro-active about getting your a1c healthy before TTC. I worked really hard before we started and in 3 months went from 8.5 to 7.2 and my endo gave us the go ahead.
I’m in Canada so I know the health care system is very different, but we don’t really get much of a choice for which doctors are on our team. I’ve been with my endo for about 10 years, when I got pregnant she booked my OB/gyn doctor. She tends to always work with the same one. I have my endo and my high risk OB on my team. The endo deals strictly with the diabetes side, and the OB only with the pregnancy part, but I always see them the same day at the clinic at my hospital, and they share charts with each other. I feel very well cared for.
As for achieving your safe a1c, just keep working at it. I’m on CGM right now as part of a pre-preg planning and pregnancy study. So I was enrolled in the study last June as part of my planning (technically we had been ttc for almost 2 years before this point), and now I’m continuing in the study as a pregnant participant. So far I’ve managed to get my a1c to the low 6’s and maintaining it there (which has been a challenge with all these pregnancy hormones). Not sure how your system works, but I requested an a1c test every month while ttc to help keep me motivated to work hard. Maybe you can do that? It certainly is much easier to do when you can see that all your efforts are working
Katillia, thanks so much for your message! It is heartening to hear that you were able to drop the a1c in just that short time. I’m currently at 8.9 (after having been at a lower number the past few months.) We also feel like we’ve been TTC for over a year, even though we haven’t, just because of all of the doctor visits and tests etc etc. to get ready.
Testing each month was taking an emotional toll on us, so we’re taking a month off before testing a1c again. But it is a good strategy to stay motivated!
Hurray for everyone working hard to be healthy!! My OB was recommended by my PCP because I’m currently looking for a new endo. Once I met with my OB, he referred me to a perinatologist who DOES specialize in diabetes. I first saw her at 13 weeks for an ultrasound and to check for abnormalities. I’ll see her again next week (17 weeks) for another ultrasound, then again at 20 weeks and again at 22 weeks. She’ll be working with me and my OB throughout the pregnancy. Most of my diabetes information comes from her and she’s amazing. After I meet with her, I go see my OB a few days later to go over any other general pregnancy questions. It’s a pretty cohesive team. My perinatologist wasn’t concerned about me seeing an endo regularly throughout my pregnancy because she is able to handle all of those issues.
My CGM was a godsend - I dropped 1% and have managed to stay in the low to mid 6% area before my pregnancy and throughout my first trimester. I’m finding that all of the concern was a lot more worrisome before getting pregnant - I keep getting reassured by my doctors and other d-friends that everything is fine and will be ok.
I’m in Canada. I had an endo (my endo didn’t handle pregnancy so he referred me to his colleuge in the office who has a diabetic clinic at the maternity hospital connected to the children’s hospital; that endo has now taken me on as a regular patient whereas I was supposed to just transfer back after my pregnancy) and an OB who dealt with a lot of high-risk pregnancies. Since I didn’t have a GP at the time, my (new at the time) endo referred me as he has a couple OBs he generally deals with for pregnancy.
My OB was in charge of the baby and me, ensuring we were healthy, and my endo + his team were in charge of my diabetes. My OB did not handle my diabetes, other than to ask if my endo was happy and how my levels had been. My endo didn’t handle me and the baby other than to ask if my OB had any concerns and what the ultrasound looked like (she had one in her office so I got one every visit). They did get all the same lab work and stuff.
I only used my CGM for the first trimester due to the lows and ended up stopping shortly after my second trimester.
lissybee, thanks for sharing! I hadn’t thought to go the route of a perinatologist. I’m hoping the CGM starts showing good results soon (I restarted it a few months ago now) but so far I only jumped up .5 pts to nearly 9. Would love to see a 1+ point drop!!!
My one successful pregnancy I lived in Canada for the first trimester then moved to Arizona where I still live. As soon as I arrived, I was able to find a perinatologist that has a Diabetes and Pregnancy program and it was a godsend! In Canada it was more difficult as you were more co-managed by your endo and PCP until 2nd trimester when you are referred to an OB. I was so happy with the perinatologist I found. That might be your best bet. I did not see my endo until after the pregnancy because it was all managed by one team at the same place.
There must be something like that in DC, that’s a huge metropolitan area! Good luck!!
The hunt for a doctor was a bit frustrating for me as well, but in the end as long as my A1Cs are doing fine I can’t really complain.
With my first pregnancy I didn’t have insurance and ended up at a high risk ob clinic in Chicago. The wait time was horrendous, waiting over 4 hours after my appointment time on several occasions. However, the doctor I had specialized in diabetes and pregnancy together. She was amazing. She was tough on me and I came close to a nervous breakdown several times in an effort to maintain the level of control she expected using finger sticks and insulin pens, but I had a healthy boy at 7 lb 11 oz in the end so, looking back, I love that doctor.
3 years later, I moved to Kansas City, got a pump and CGM, and started seeing an AWESOME endocrinologist to get my A1C ready for TTC. I was going to try to find a doctor specializing in both pregnancy and D and switch away from her, but the first ob dept I went to said that as long as my A1C was under control I didn’t have to be in high risk at all and I started seeing the regular ob clinic while my lovely endocrinologist committed to consulting with me once a week about my sugars. While she’s wonderful, the ob department was severely lacking (one of the residents asked ME what cord blood banking was when I brought it up!!).
I made the difficult decision to change doctors at 28 weeks pregnant, with less than 3 months to go. I (1) found every hospital my insurance would cover and narrowed them down to 2 hospitals via internet research and asking friends/family about their experiences at these hospitals, (2) I scheduled labor/delivery tours at these hospitals and made a long list of questions to ask regarding not only delivery but how these hospitals work with high risk pregnancies (some hospitals didn’t have tours so I called their labor/delivery department and asked the questions over the phone). In most cases the nurses know how the ob/endo/high-risk-ob departments all work together at each institution so you’ll get to know what they offer.
I ended up having to go with a high risk ob clinic that would take me away from my endo in exchange for managing both conditions for the last 3 months, which I don’t like, but my first appointment with them is in 2 days so we’ll see how it goes. The other hospital’s ob team rejected my “application” to deliver there because they hesitated to take on a T1 patient (despite my A1C being pretty well-controlled).
I’m in Baltimore, Maryland. My endo does not handle patients while they’re pregnant. I see a maternal fetal medicine team at the hospital (where I work, actually). They manage my diabetes and all fetal monitoring (anatomy scan, fetal echo, NSTs, etc…). I go to an OB who handles the routine side of pregnancy. MFM and OB share notes from my visits with each other to keep everyone on the same page. I will deliver at a different hospital than where my MFM docs are. I could have used the MFM docs at the hospital where I will deliver, but I was happy with the care I received from the MFM docs in my last pregnancy so decided to use them again.
I was relieved that MFM looked at my blood sugars online via CareLink. All the other OB offices in my area wanted me to keep a paper/pencil log of my blood sugars. I was not willing to do that since they could get a better picture of trends and such by looking at it online.
Thank you for all of the supportive information and encouragement! It really does help to read through your replies.
I’ve seen a high-risk OB (who was great) but I’m looking now for a perinatologist/MFM who specializes in T1D. Hoping that I can find someone who is also practicing at one of the hospitals in the area with a highly ranked NICU. Lots of searching, but it’ll be worth it in the end!
