Wednesday, April 29, 2009


Thankfully the difficult news is NOT about the baby....but it is about the pregnancy. This is a difficult post for me to write because my hope in starting this blog was to be able to be encouraging and inspiring to other diabetic women out there who weren't sure they could have a successful (dare I say "normal") pregnancy. I wanted to show you that we CAN do it. I wanted to be an example of a complication-free diabetic pregnancy. Unfortunately, as of this week, I can't be that example.

It concerns me that posting this may discourage some of you from getting pregnant....or even that it may just discourage you in general. I really don't want that to be the message here. This is a set-back, but it's not a failure. I am still pregnant with a very healthy baby girl, and am determined that she will be a success. This doesn't change that.

So at the risk of being less-than encouraging, I do feel that it's important for me to remain true to the intent of this blog, and give you the whole story - not just the easy stuff. So here it is....

A couple of years ago I needed laser treatments in both eyes for proliferative diabetic retinopathy. For those of you who don't know what that is (or who need/want a refresher), here's the quick explanation of proliferative diabetic retinopathy and the laser treatments - if you already know this, feel free to skip ahead:

Basically, long-term and/or badly controlled diabetes can lead to problems with blood-flow to the retina. (Note that even people with well-controlled diabetes CAN experience retinopathy, although controlling your diabetes carefully does greatly reduce the chances of this happening. Also note that diabetes care methods are MUCH better now than they were in the 70s, 80s, and even 90s, so those of us diabetes-veterans have lived through a time when it was much more difficult to have tight diabetes control, and unfortunately do have a greater risk of complications like this as a result, even if we have much better control now. Anyway...) When the retina doesn't get adequate bloodflow, it doesn't get adequate oxygen. Because the retina needs oxygen, the brain sends signals to the retina to make new blood vessels to help move the oxygen around. This is called "proliferation" (hence "proliferative diabetic retinopathy"). Sounds good, buuuut....the new blood vessels are weak and fragile. They break easily, and when they do blood leaks into the retina and can cause vision damage. (Also note that not all diabetic retinopathy involves proliferation. In the early stages there may be blood vessel leakage, but no proliferation of blood vessels. I'm not going to go into that here, though.)

Retinopathy is not curable, but it is treatable to help slow (and hopefully stop) the process. Treatment involves getting numbing drops and/or gel squirted into your eye(s), having a glass lens pressed up against your eyeball, putting your face in a machine that makes you feel like you should be on A Clockwork Orange, and then getting a couple of thousand (yes, thousand) of laser zaps on your retina (called pan-retinal laser treatments). It's not as painful as it sounds like it could be, but it is painful, and it's VERY stressful. The light is very bright, and with every zap it takes your breath away and makes your other eye want to roll back in your head. It only lasts a few minutes, but it's pretty low down on most people's list of enjoyable ways to spend a few minutes. :P

The point of the treatment is to kill off a portion of the retina. It sounds counter-intuitive, but it basically allows the less-important parts of the retina to be sacrificed to save the more important central part of the eye (i.e. the macula), and hopefully protect your (my) vision by doing so. You end up with a grid-like pattern of scars on your retina (permanent), and typically a bit of damage to your peripheral vision and your night vision, but the end result is (or should be) that your retina then requires less oxygen, so your brain no longer sends signals to make new (fragile/leaky) blood vessels...reducing the risk of bleeding and vision loss. And that's a quick retinopathy lesson. Now back to our regularly scheduled blog.

So, this past Sunday, I noticed a new "spot" in my vision of my left eye. I got in to see my ophthalmologist on Monday and the news wasn't great. There is bleeding in my retina that my ophthalmologist says is due to more proliferation (i.e. new growth) of the blood vessels. He said the pregnancy (i.e. the growth hormones running rampant in my body) and the slightly elevated blood pressure that I've been having are likely both coming into play here. (I'm not too surprised re: the growth, given that my baby has grown 1.5lbs in the last 2 weeks according to the fetal assessment - a normal level of growth for this stage of pregnancy.) We knew this was a possibility during pregnancy because of the growth hormones, but we had hoped for the best. Everything was going so well before the pregnancy and during the first two trimesters - no sign of proliferation or bleeding since my last laser treatment in September 2007 - but I guess I just didn't quite make it through the third trimester.

So, I had more laser treatments on Monday - 1000 zaps in my left eye. It sucked. A lot. (I didn't get woozy at all, though, which was a BIG problem for me last go-around.) I'm going back next week Thursday for more, but it should just be the two treatments, and he is just doing my left eye. He has a new machine since last time, though, that does multiple shots at once, so 1000 zaps is much faster now than it was before. I guess that's the silver lining on this cloud. It's still pretty miserable, though, and my eye was sore and a bit red/puffy for the next day or so.

So, I suppose the good news is that, since the ophthalmologist feels it's so directly related to the pregnancy, I don't necessarily have to expect that I will continue to have bleeding every few years for the rest of my life. The bad news is that this calls into question how wise it is for us to try for more children in the future as there's nothing to say it won't happen again with another one - maybe even worse next time. The doctor says not to worry about that now - it's not out-of-the-question. We realize that it will depend a lot on how the next 6 weeks go, how the years after this baby go (i.e. when I'm not pregnant anymore) and how my eyes are doing before we would be ready to try for another one. Either way, it will likely be a very difficult decision to make. For now, though, we are focusing on the fact that we have one beautiful baby on the way and are VERY lucky for that. We refuse to let this setback get in the way of our joy and excitement about our little girl!

Another development related to this is that my ophthomologist doesn't want me to push during labour (i.e. to avoid more bleeding of these weak blood vessels in the retina), so I will be asking my OB for a c-section. The baby is still breech, though (and apparently unlikely to turn since she's been in this same position for so long now), so this is likely a moot point anyway.

I'm seeing my OB on Friday and will discuss the bloodpressure issue with him then. We'll have to talk about ways to reduce it....which may or may not involve leaving work early or figuring out some other work option between now and my scheduled mat leave.

So, it was a less-than-good day on Monday, and a frustrating experience - especially so close to the end of the pregnancy. I feel like we ALMOST had a perfectly successful diabetic pregnancy, but didn't quite make it. But this too shall pass. Anyway, just wanted to keep you all updated.

At the end of the week I'll post more about this week and the new fetal assessment pictures (she's got some chubby cheeks!)

Until then, please don't let my experience this week be a discouragement for you. I just really felt the need to share this here.


  1. Hey Bethany---I had a similar experience during my pregnancy; I had laser for the first time in both eyes and was counseled to schedule a cesearean or plan a vaginal birth with forceps and a vacuum extraction. I chose the c-section without a second thought. If your doctor said it wasn't out of the question that you could carry another child, why even think that that might be the case? I'm sorry you feel so disappointed about requiring laser treatment, but I considered it a blip in my pregnancy, not a huge complication. Good luck with the final six weeks!

  2. Hi Lyrehca,

    I think if this was my first need for laser I might feel differently, but I've already had significant "zaps" on both eyes, so my concern is that my eyes may not be able to handle more (i.e. more proliferation and/or more treatments) after this without significant permanent damage. Hopefully that won't be the case - hopefully this is all for this pregnancy, and there won't be any more developments when I'm no longer pregnant, but we can't know that right now, so it's impossible not to consider the various impacts this could have. My doctor didn't say it was out-of-the-question to have more children, but he clearly views it as a potential issue. He just said it's too early to talk about the next one until we see what happens between now and then. I wouldn't say I view it as a "huge" complication, but it's definitely more than a "blip" for me because it means further damage to already damaged eyes...with the potential for more in the future. :(

  3. I hear you--here's hoping your eyes stay quiet from now on!