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Pregnant With Diabetes Type1, Anemia And High Blood Pressure. Sonogram Showing Abnormal Fetal Growth. What To Do?

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Posted on Sat, 30 Jun 2012
Question: My girlfriend is a type 1 diabetic, anemic, high blood pressure and at the moment she is 20 weeks pregnant. She went to a specialist for a sonogram and the dr. said that he wasn't able to see the baby's ribs and all in beneath, immediately saying something is wrong with the baby. We have a huge concern since he said that he was not able to see the stomach? Baby's head and heart are in good condition and arms
doctor
Answered by Dr. Mahesh Koregol (8 hours later)
Hi,

Thanks for your query. I have seen the reports.

I am sorry to read that your baby has been diagnosed to have congenital anomaly. I understand your concerns.

Congenital malformations are more common in infants of diabetic women than in children of non-diabetic women. Risk of having a congenital baby is about 18% higher than normal non pregnant women. Two-thirds of birth anomalies involve the cardiovascular and central nervous systems. Neural tube defects occur 13-20 times more frequently in diabetic pregnancies, and genitourinary, gastrointestinal, and skeletal anomalies are also more common.

It is notable that no increase in birth defects occurs among the offspring of fathers who have diabetes or the offspring of women who develop gestational diabetes after the first trimester. This suggests that periconceptional glycemic control is the main determinant of abnormal fetal development in diabetic women.

There is also elevated MSAFP in your girl friend. Ultrasound pictures you have sent does not show ribs in them. Hence I am sorry to say that there appears to be neural tube defect in your baby due to diabetic status of your girlfriend. Please get the ultrasound repeated after 2 weeks and if the same problem persists, your girlfriend may have to undergo termination of pregnancy.

I understand this is a bad news. But these anomalies are known to occur in diabetic women. I pray to god to give strength and support to you and your girlfriend to go through this painful period.

I hope I answered your query. I will be available to answer any other queries you have.

Regards,
Dr. Mahesh Koregol

Above answer was peer-reviewed by : Dr. Shanthi.E
doctor
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Follow up: Dr. Mahesh Koregol (12 hours later)
We went for a second sonogram, and the dr. there told us that the position the baby is inn makes it difficult to predict if anything is wrong with the baby. He as well said within a month they will determine is anything is wrong, What are the pros and cons, which I believe you have already explained the cons to me?
doctor
Answered by Dr. Mahesh Koregol (18 minutes later)
Hi,

Thanks for writing back.

I understand that sometimes position of the baby makes it difficult to see the complete picture of baby. But please visit the doctor again after about a week when probably the position would have been good enough to view ribs and vertebra.

I have already explained to you in detail about the possibilities. I explained about the cause and possibility of neural tube defects. If diagnosis confirms this, you will be advised to terminate the pregnancy.

I hope I answered your query. I will be available to answer any other queries you have. Please accept my answer if no more question and close the discussion.

Regards,
Dr. Mahesh Koregol

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Mahesh Koregol (1 hour later)
prenatal (1 x day)
levothyroxin 50 mcg tab (2 x day)
ferrous sulf 5he tab url (1 x day)
vitamin d 50,000 unt cap (1 x week)
methyldopa 250mg (1 x day)

These are her medications, I as well read about Folic Acid Pathway is this something that might be able to help us?
doctor
Answered by Dr. Mahesh Koregol (7 hours later)
Hi,

The medications what she is taking are fine. Folic acid helps in initial few weeks of pregnancy (upto about 8 weeks) when baby's organs are forming. But not now. The organ formation of the baby has completed. So unfortunately it is not of much use at this stage of pregnancy.

I hope I answered your query. I will be available to answer any other queries you have. Please accept my answer if no more question and close the discussion.

Regards,
Dr. Mahesh Koregol
Above answer was peer-reviewed by : Dr. Yogesh D
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Dr. Mahesh Koregol

Infertility Specialist

Practicing since :2000

Answered : 3837 Questions

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Pregnant With Diabetes Type1, Anemia And High Blood Pressure. Sonogram Showing Abnormal Fetal Growth. What To Do?

Hi,

Thanks for your query. I have seen the reports.

I am sorry to read that your baby has been diagnosed to have congenital anomaly. I understand your concerns.

Congenital malformations are more common in infants of diabetic women than in children of non-diabetic women. Risk of having a congenital baby is about 18% higher than normal non pregnant women. Two-thirds of birth anomalies involve the cardiovascular and central nervous systems. Neural tube defects occur 13-20 times more frequently in diabetic pregnancies, and genitourinary, gastrointestinal, and skeletal anomalies are also more common.

It is notable that no increase in birth defects occurs among the offspring of fathers who have diabetes or the offspring of women who develop gestational diabetes after the first trimester. This suggests that periconceptional glycemic control is the main determinant of abnormal fetal development in diabetic women.

There is also elevated MSAFP in your girl friend. Ultrasound pictures you have sent does not show ribs in them. Hence I am sorry to say that there appears to be neural tube defect in your baby due to diabetic status of your girlfriend. Please get the ultrasound repeated after 2 weeks and if the same problem persists, your girlfriend may have to undergo termination of pregnancy.

I understand this is a bad news. But these anomalies are known to occur in diabetic women. I pray to god to give strength and support to you and your girlfriend to go through this painful period.

I hope I answered your query. I will be available to answer any other queries you have.

Regards,
Dr. Mahesh Koregol