Gestational Diabetes

According to the American Diabetes Association 9.2% of pregnant women develop gestational diabetes, and after my endocrinologist visit today, I am one of them. Luckily for me, my doctor doesn't seem too worried and thinks I have a mild case which can be treated with meal planning and will go away after I deliver. But with this revelation and the need to double and triple check my portions (although I didn't think my portions were out of whack) and the need for daily glucose testing, I decided to write a post giving all of you some more information about gestational diabetes.

What is gestational diabetes?

According to the American Diabetes Association: Pregnant women who have never had diabetes before but who have high blood glucose (sugar) levels during pregnancy are said to have gestational diabetes. We don't know what causes gestational diabetes, but we have some clues. The placenta supports the baby as it grows. Hormones from the placenta help the baby develop. But these hormones also block the action of the mother's insulin in her body. This problem is called insulin resistance. Insulin resistance makes it hard for the mother's body to use insulin. She may need up to three times as much insulin.

Gestational diabetes starts when your body is not able to make and use all the insulin it needs for pregnancy. Without enough insulin, glucose cannot leave the blood and be changed to energy. Glucose builds up in the blood to high levels. This is called hyperglycemia. If gestational diabetes is not effectively treated and managed, it can have negative effects on the mother and her child, so it is important to consistently consult with your doctor and follow the regiment that is prescribed to you.

How you baby can be affected:

Gestational diabetes affects the mother in late pregnancy, after the baby's body has been formed, but while the baby is busy growing. Because of this, gestational diabetes does not cause the kinds of birth defects sometimes seen in babies whose mothers had diabetes before pregnancy.

However, untreated or poorly controlled gestational diabetes can hurt your baby. When you have gestational diabetes, your pancreas works overtime to produce insulin, but the insulin does not lower your blood glucose levels. Although insulin does not cross the placenta, glucose and other nutrients do. So extra blood glucose goes through the placenta, giving the baby high blood glucose levels. This causes the baby's pancreas to make extra insulin to get rid of the blood glucose. Since the baby is getting more energy than it needs to grow and develop, the extra energy is stored as fat.

This can lead to macrosomia, or a "fat" baby, these are the 15+ pound babies we sometimes hear about. Babies with macrosomia face health problems of their own, including damage to their shoulders during birth, because their size makes it difficult, if not impossible to pass through the birth canal. This results in a large number of gestational diabetes babies being delivered via Cesarean section. Because of the extra insulin made by the baby's pancreas, newborns may have very low blood glucose levels at birth and are also at higher risk for breathing problems. Babies with excess insulin become children who are at risk for obesity and adults who are at risk for type 2 diabetes.

How it's diagnosed

Around week 28 of your pregnancy you will have to schedule a glucose tolerance test at your doctor's office.  At this test the nurse will give you a glucose drink (pretty much pure sugar) for you to drink thirty minutes before your appointment.  After the thirty minutes is finished the nurse will draw your blood and that is it.  You will have to wait about a week depending on your doctor for results.  If the glucose levels are normal then you don't need to continue with any other tests.  If your glucose levels are high, then you will need to schedule a three hour glucose test.

With the three hour test you will need to fast. So from midnight the night before all the way to your test you cannot eat or drink.  When you get to the office the nurse will draw your blood again, this is the baseline to see what your glucose level is before you eat.  You then have five minutes to drink the glucose drink again.  Once you fish the drink, you will be sent to the waiting room to wait.  The nurse will then draw your blood every hour, on the hour for the next three hours.  During this time you CAN NOT eat or drink anything! Once the test is over you can eat, and you will have to wait a week or so for your results.  If your test come back normal then you don't have to do anything else and you do not have gestational diabetes, if the glucose levels are high, then you will need to follow up with a specialist.

Depending on the severity of the glucose levels the specialist will either put you on an insulin regiment, or will inform you that you need to to change your eating habits.  Either way, you will have to take your blood glucose levels several times a day.  If your levels are not that high, and you are successful with your meal plans your doctor MAY choose to cut back on the glucose testing.

How to treat gestational diabetes:

Because gestational diabetes can hurt you and your baby, you need to start treatment quickly.

Treatment for gestational diabetes aims to keep blood glucose levels equal to those of pregnant women who don't have gestational diabetes. Treatment for gestational diabetes always includes special meal plans and scheduled physical activity. It may also include daily blood glucose testing and insulin injections.

If you're testing your blood glucose, the American Diabetes Association suggests the following targets for women who develop gestational diabetes during pregnancy. More or less stringent glycemic goals may be appropriate for each individual.

• Before a meal (preprandial): 95 mg/dl or less
• 1-hour after a meal (postprandial): 140 mg/dl or less
• 2-hours after a meal (postprandial): 120 mg/dl or less

You will need help from your doctor, nurse educator, and other members of your health care team so that your treatment for gestational diabetes can be changed as needed. Sticking with your treatment for gestational diabetes will give you a healthy pregnancy and birth, and may help your baby avoid future poor health.

Source: American Diabetes Association

Pregnancy Week 29

And the growing continues! Your little one now weighs in at nearly three pounds and measures about 17 inches!  Wile he is getting pretty close to his birth LENGTH, your little guy still has some more weight to pack on.  Over the next 11 weeks, he'll more than double-or even triple his weight!!! And as the weeks pass, and your baby continues to grow in weight and length, he will begin to run out of room in there, and things will become a lot more snug.  This will result in you feeling less kicks and more pokes from elbows or knees, and you will probably see more rolling lumps on your tummy as well!

Don't be surprised if you start to see varicose veins making an appearance on your legs, they are very common in pregnant women.  Varicose veins are swollen blood vessels that usually appear for the first time during pregnancy, especially if your mom or grandma had them.  So, if you want to know your chances at getting varicose veins, check out the gams of the women in your family to get a pretty good assessment of what you will see during your pregnancy.  The severity of varicose veins can vary from person to person.  Some ladies experience only a minor case of achiness and swelling, while others experience the full blown pain and bulging of blue veins, which usually occur from the ankle to the upper thigh. Again, if you want to get an idea of what's in your future in regards to varicose veins, talk to your mom and grandma to see how they fared.  To help reduce the severity and/or pain of varicose veins you should watch your weight (as much as you can), keep your blood flowing by doing light exercises such as walking and swimming, and avoiding heavy lifting as much as possible.

Week 28

Week 30

Pregnancy Week 28

At 28 weeks you are starting the third trimester, you have made it to the home stretch!  With this milestone, your little one is also settling into the head down position, and getting ready for delivery! By this time your little one is approximately 2.5 pounds and almost 16 inches long! Along with the increase in weight and length, you bundle is quickly adding new skills to his repertoire.  These skills include: blinking, coughing, sucking hiccuping, and taking practice breaths!!!  Something even more amazing, your little ones sleep cycle now includes the REM (rapid eye movement) phase, which means that he could be dreaming while inside your belly!

While it's great that your bug is beginning to settle into the head down position, the potentially painful part is that his head, and the weight of your uterus may now be sitting on your sciatic nerve, which runs through the lower part of your back, buttocks, and legs. This new pressure may cause pain and tingling in  your lower back, buttocks, and legs. This pain usually radiates down the back of your legs to your toes.  The best thing to do for sciatic nerve pain is take it easy and wait for your little bundle to wiggle his way off of your sciatic nerve.  

Week 27

Week 29

What the Heck Goes into a Birth Plan!?

So depending on where you are in your pregnancy, you may be getting ready to write your birth plan, but even if you're not ready to start writing it's always a good idea to start doing research as early as possible.  Nowadays, there are so many different theories and options for what kind of birth you are going to have.  Will it be 100% natural and "crunchy", will it be 100% medicated and "sterile", or a combination of both. Vitamin K shot, or not? Bath immediately after or not? There are so many options and choices you need to make (yep, parenting decisions start before birth) that it only makes sense to do as much research as you possibly can to make the decisions to give you the type of birth you really want.  But, it is important to understand that birth plans are NOT written in stone, they are a depiction of your ideal birth, and give the hospital or birthing center staff an outline of what you are trying to accomplish, but be aware that things may change.

For my birth plans I always put that unless it is a medical emergency where either my life or the life of my child is in immediate danger, ALL medical decisions must be discussed with me and my husband and that we be allowed to discuss our options in private before a decision is made.  I didn't have any issues with my birth plan not being followed at my first birth, which was a hospital birth, and I don't foresee an issue with this birth since it's at the same hospital.  It is very important to tour the hospital or birth center you are planning on delivering at, for two reasons. First it will give you an idea of what you need to bring when you pack your hospital bag, and second it will give you insight on what practices your hospital has for delivery, what options they give you (birthing tub) and if they are open to more natural birthing methods.  All of this information will help you to make your birth plan, and if your hospital is completely against the birth you want (most hospitals are moving towards becoming more accepting of natural births) you will then need to decide if you want to stay with the hospital or find a different option.

 I suggest working on your plan for several weeks; do your research, type it up, come back to it a week later and make any changes, discuss it with your doctor and make any changes you want after that. You should shoot for your birth plan that is 1-2 pages long, anything longer than that may be too detailed and micromanaged.  If you do this you are more likely to become disappointed with your birth, and nothing is guaranteed.  If you have micromanaged your birth plan down to the detail you are setting yourself up for failure.  You want your birth plan to express your overall goals for your delivery and list any important features that are key to your birth.  Once you plan has been written you need to print out about 4-5 copies and put them in your hospital bag. You want enough copies to give to your OB, the midwife/doula if one is present, and any nurses that will be present (keep in mind that you might not have the same nurse throughout labor and delivery due to shift changes) so you want to make sure you have enough copies for anyone that will be at the birth.

What should be in your birth plan?

You first want to list any allergies, or medical issues you have as they may become pertinent during your birth.

LABOR:

• Who should be allowed in the room during labor
• How do you want changes of your birth plan to be handled
• If you're unable to make decisions who should do it for you
• Do you want an epidural or not
• Is it okay for staff to ask you if you are in pain, can they use the 1-10 scale
• Can staff offer you pain medication or not.
• If there is a birth tub do you want to use it, how soon after arrival.
• Do you want freedom of movement during birth
• what does that mean to you
• walking around
• changing positions in bed
• What kind of fetal monitoring is okay with you
• Continuous
• Intermittent
• What would you like to happen if your labor stalls?
• wait to see if it starts up again naturally or get intervention
• Do you want to drink and eat during labor or not

DELIVERY:

• Do you want freedom of movement during delivery
• what does that mean to you? Any specific positions you want?
• Is it okay to push based on counting (the doctor counts 1-10 while you push and you push throughout the entire time) or do you want to push based on your feelings (no counting)
• Are you okay if your perineum is cut if needed, or would you prefer to tear.
• Do you want to pull your baby out?
• Are you okay with the use of forceps, vacuums, etc?

CONTINGENCIES:

• What do you want to happen in the case you have to have a c-section.
• Who should be with you
• how soon do you want to hold your child after the c-section.

POST DELIVERY:

• Is it okay if the cord is clamped immediately or do you want it to stop pulsating first?
• Who is going to cut the cord
• What is the minimum amount of time you want skin-to-skin contact before measurements are taken of you child.
• Do you want your placenta to be delivered naturally or removed?
• Can your baby receive a bath shortly after delivery or would you like to wait
• if you want to wait, how long
• Who will go with your baby, if anyone, during the bath?
• Do you want your child to receive the vitamin K and Hep B shots?
• Do you want your child to receive the antibacterial eye cream?
• Are you planning on breastfeeding? Can the hospital staff provide formula bottles while at the hospital?
• Will the baby sleep in the room with you or in the nursery.
• If you're having a boy, will he be circumcised or not?
• Are you cloth diapering? If so, are you doing so in the hospital or can staff put your baby in disposables?

Those are the main points that should be discussed within your birth plan.  Remember to be as succinct as possible, bullet points usually help with this.  I also like to bold the important parts like the "do's" and the "do not's" so the hospital staff's eyes are immediately drawn to those areas.  Remember that your birth plan is a guideline and there is not guarantee that your birth will go exactly as you want. The birth plan, will help to guide your medical staff so that they can work to try to make sure you get your dream birth.  A great way to help insure your birth plan is realistic is to talk to your doctor/midwife and tour the hospital/birthing center so you know what the policies are so you don't go into your birth with a birth plan that doesn't apply to the rules of the hospital/birth center. I hope this helps all of you and is a good guide to get you started.  If you have any trouble or questions feel free to ask!

Pregnancy Week 27

CONGRATULATIONS! You have reached the end of the second trimester!!!!! WOOT WOOT! This is probably going to be the time when all of the excitement also gets flooded with anxiety, because it is at this point you are preparing your registry, getting ready for your shower, and getting the nursery ready. And if you're like me, the fact that the nursery is only painted and nothing more, is probably sending you into a tailspin.

Also, this week your doctor is going to start measuring your little bundle from head to toe instead of crown to rump, so you are going to see a big jump in the size of your baby. Who is now approximately 15 inches long. The reason for this is before this week your little one was simply to small to get an accurate measure from head to toe. But now that he is packing on inches it is a lot easier for your doctor to get an accurate measurement.  Additionally, this week, your baby may now recognize your voice, so utilize any downtime you have to talk and sing to your belly, you may even notice an increase in fetal movement on certain songs! My daughter always wiggled and jiggled when I sung her a lullaby I made up for her, and it is still her favorite song at bedtime!

Don't be surprised if you are feeling a little puffy. About 75 percent of soon-to-be moms experience edema, or mild swelling of the hands, feet, and ankles, around this time in their pregnancy.  You may notice it throughout the day or only at the end of the day (like I do). If you haven't traded in your heals for flats yet I suggest you do so now because they will only make the edema worse. Seriously, I wore wedges for a total of 15 minutes today for part of our maternity pictures and I was able to leave an indent on the top of my foot from the swelling!  The reason for the edema is because of the build up of fluids in your body tissues thanks to increased blood flow and uterine vein on the vena cave (the large vein that moves the blood from your lower extremities to your heart).  While this puffiness is completely normal, if you don't experience a reduction in the swelling when you put your feet up for a few minutes, let your doctor know so they can make sure there aren't other issues at play.

Some other fun (or not so fun) symptoms you may be experiencing by this time in your pregnancy are: flatulence, occasional faintness or dizziness, restless leg syndrome, nasal congestion, symphysis pubis dysfunction (SPD) which is when the ligaments in your pelvic joints get too relaxed and stretchy, causing the pelvic joint to become unstable, which can cause pain in the pelvic region.  If this is happening discuss with your doctor if wearing a pelvic support belt would help ease the pain.  You may also experience bleeding gums, so brush gently, and changes in you skin, hair, and nails.  Some women report stronger, thicker hair and nails with glowing skin. Others report more fragile hair and nails and skin problems such as acne.  Either is normal, but if you have concerns or questions don't hesitate to call your practitioner.

Week 26
Week 28

Pregnancy Week 26

This week your little one weighs about two pounds and measures nine or more inches! Also this week, you little bug starts to open her eyes!!! Until this time her eyelids have been fused shut while the eye developed.  While there isn't much to see inside you belly, your little one is able to react to changes in lights and sounds. So if you shine a bright light on your belly, or there is a loud noise in your environment, you will most likely see an increase in fetal movements.

By this time you are probably not so happily part of the pregnancy insomnia club.  Sleepless nights have most likely become the norm whether it be from aching muscles, sciatic nerve pain, heartburn, going to the bathroom (constantly) or from all that movement your little one decides to do before bed, it's not a surprise getting a good nights rest has become elusive.  Consider it practice for when your bundle arrives!  To help with your restlessness there are many things you can do during the day and before bed.  I find that eating before I go to bed usually reduces the chances of waking up with the midnight munchies. Also, going to the bathroom right before I go to bed (and making sure to lean as far forward as possible to push out all the urine) helps prevent nighttime bathroom runs.  Also, getting a mild form of daytime exercise and fresh air can also help your insomnia.  I usually go out walking with my daughter, or take her to a park so we both get some exercise and some bonding time (two birds with one stone, yay!)

Some other fun symptoms that you may be experiencing this week are bloating, increased vaginal discharge, occasional headaches, forgetfulness, clumsiness, lower abdominal achiness (from all that stretching), and vision changes.  Keep in mind that these are all normal symptoms during pregnancy.  However if you are unsure of the frequency or intensity of your symptoms, or you just want some reassurance, don't hesitate to contact your doctor or other medical professional for advice.

Week 25
Week 27