We were at 9 weeks, had heard our Peanut's heartbeat, and were devastated. Even though the pregnancy was a bit of a surprise that required some financial finagling, we were going to be welcoming baby #2 by Christmas, and were hesitantly excited.
I couldn't really touch this blog until now. I didn't have anyting to say, really. But then I thought about the journey I have been on since I miscarried and I thought I should share.
A part of me was amazed at how quickly my blood sugars returned to normal afterwards. I kept testing for a few days after the official miscarriage began, and then sporadically until I had my next cycle. Normal, sometimes a tad high after we dined on "things-thou-shouldst-not-eat", but manageable, and not a cause for concern. I was concerned I had slipped into the Prediabetes or even Type 2 world, and was scared it was now going to be a full-time reality, not just a pregnant one.
I scheduled a visit with my doctor, of course, and he checked off every box on the bloodwork sheet when we discussed my overall health. He figured a physical might not be a bad idea to do, given we might find a problem, you never know. He checked B12 levels, since a deficiency in this vitamin can be risky in pregnancy. I think he also checked my iron and cholesterol levels to be sure. He tested me for PCOS (again), we did a random fasting bloodsugar, and did all kinds of hormone tests. Every test known to a doctor was done, I think, except for anything requiring my other bodily fluids I'd rather not mention here. Ew.
We discussed me, which I had expected. Yes, my weight needed to go lower, and my exercise level needed to be higher. Yes, I needed to keep going on eating better, as we had been doing since getting my test back high. He said to take someone with me to testing, since this was a lot of tests to take blood for, especially after fasting.
Whee! 7 vials of blood made the caffeine I put into my system afterwards very effective.
No red flags came up in the bloodwork, thankfully, and no mention of really high levels of fasting bloodsugar made my stress come down a notch or two on the "holycrapmylifeisover" meter. Likely, at my follow-up visit tomorrow, my awesome doctor will caution me that my levels were on the high end of normal, which they were last time we checked, but I was taking matters into my own hands with exercise and better eating already, and wasn't worried. Bring it on, man! *flex*
This whole thing got me thinking, though. Could my early diagnosis and high blood sugar levels have caused the miscarriage? When I was pregnant, I was scheduled to see the Diabetes doctor, but it was set for two weeks after I miscarried, so I was not able to get a perscription for insulin, and my sugars were getting harder to control each day. my levels were so wonky that I couldn't even look lovingly at a carb from across the table. A quarter cup of basmati rice was spiking me from a high 6 to a low 10! Not good. Not good at all.
I wondered - looking back at how difficult it was compared to my last pregnancy - if the lack of ability to control my bouncy blood sugar with diet was a contributing factor. So, with the thought of my GDM being a risk factor to miscarriage in the early days of pregnancy, I opened up the trusty Interwebs, and did some researching.
After looking through the Canadian Diabetes Association and the Public Health Agency of Canada, I found no convincing statistics that linked miscarriage to early onset GDM. It was mentioned, but each had conflicting stats, and thus, I couldn't verify anywhere else. Most mentioned that there was a risk, but identified more with type 2 Diabetes, rather than prediabetes, or GDM. In all cases, the percentage of risk was below 10%, and not a cause for major concern. Huh... ok, lets check some US sites.
US statistics and websites tended to be more fruitful. I did found a more concrete statement* while perusing the the WebMD network. The link to the page is here , with the following quoted from the section titled "Clinical":
I also found this statement on Healthsquare.com:Miscarriages
- In all women with preexisting diabetes mellitus, there is a 9-14% rate of miscarriage.
- Current data suggest a strong association between degree of glycemic control prior to pregnancy and miscarriage rate. Suboptimal glycemic control has been shown to double the miscarriage rate in women with diabetes. A correlation also exists between more advanced diabetes and miscarriage rates. Patients with long-standing (>10 y) and poorly controlled (glycohemoglobin exceeding 11%) diabetes have been shown to have a miscarriage rate of up to 44%. Conversely, reports demonstrate a normalization of miscarriage rate with excellent glycemic control.
Illness
Miscarriages are much less common in the third trimester. Those that occur are more likely to be due to maternal factors, such as an illness in the mother, than to genetic abnormalities in the baby.
Women with poorly controlled diabetes are at great risk for miscarriage. Those whose diabetes is controlled, however, whether it existed before the pregnancy or developed after conception (gestational diabetes), are no more likely to lose a pregnancy than other women. A woman may not know that she has diabetes, however, until it is discovered during a search for the cause of repeated miscarriages. The routine blood and urine tests given during pregnancy are an effort to identify this problem while it still can be remedied.
Other diseases and conditions linked to increased risk of miscarriage include systemic lupus erythematosus (SLE, or lupus), high blood pressure, and certain infections, such as rubella (German measles), herpes simplex, and chlamydia. Experts disagree about the role of hypothyroidism, or an underactive thyroid gland, in miscarriage, but it's likely that a severe case increases the risk.
With conditions such as diabetes, treating or controlling the problem can improve the odds of a successful pregnancy. Special monitoring may also be required.
This was the first I read that my uncontrolled high levels might have contributed to the miscarriage. Should I feel guilty? Did I, because of my frustrating, unruly pancreas, cause my miscarriage?
I wasn't sure I wanted to put that heavy guilt burden on myself. I am no different than most women who go through miscarriage. You wonder if that bumpy carnival ride was to blame, or if the wand ultrasound technician-sadist who poked holes in your ovaries caused too much trauma, or the hot room yoga you were doing (before you knew you were preggo) made it happen. We look for causes, look for someone or something to blame other than simple nature and randomness of life.
I decided that no, I can't. Sometimes, it is what it is. We take the lesson and move forward, better prepared for the next curve ball. I think any pre-existing or high-risk condition in pregnancy can cause miscarriage, or other problems, it just depends on the individual, and their genetic makeup. Sometimes, even with best effort, things happen.
Next time, I will be better prepared to handle the onslaught of crazy my body will go through. Next time I will expect an early, if not immediate GDM problem, and act accordingly upon the positive pee-stick result. And because of my efforts to eat better and move more now, it might just be easier. I hope. We'll see.
* I can't verify all of this information, so please remember that when researching on the Internet, it is important to find several sources that say the same thing, are reputable, and reference other works themselves. Please take the statements quoted in this email with a grain of salt, and talk to your doctor about your concerns. He'sthe expert, not me.
This is a very thorough and thought-provoking post. I like the balance in your research because you have looked at the possible causes but also realize that these things are usually unexplained. Best to you.
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