First appointment with midwife - GD again

I met with my midwife for the first time in this pregnancy on Tuesday.

There wasn't much to say, as I was then only 9 weeks 6 days. My uterus seems
to be at the right place, but we didn't get a heartbeat. Probably in 4 weeks
we will.

As with Pregnancy no. 1 I declined the nuchal fold screening. I had a few
blood draw taken, including one for my thyroid, which my midwife can now
check without a doctor' slip.

This time I really wish I can give birth at the Birth Centre in a nice and
cosy environment. I could also decide to give birth at the hospital
accompanied by my midwife as they now have arrangements with the hospital -
that's a new option to me.

We of course discussed my first pregnancy, and especially the fact that my
baby was so huge (so was I, as a matter of fact), that I had so much
amniotic fluid and that all of it led me to being induced. I was adamant I
will do everything in my power to avoid living through the same thing over
again.
In the course of the discussion I did mention GD. I was not screened for it
during Preg. no. 1, so no one knows, but of course all the doctors who saw
me at the hospital after delivery kept nagging me about it. And so did my
aunts, my mom and everyone who have heard the term gestational diabetes.

I agreed to take a test at week 24. I know, Ericka, it would be easier to
pass earlier, but I am not so convinced anymore that gestational diabetes
doesn't exist... I've thought long and hard about it. I also found out that
two of my aunts were diagnosed with GD over 20 years ago and they are today
diagnosed with Diabetes type 2. So even though they are not the closest
relatives I have, they still count in my gene pool.

I my case, I prefer to feel safe than sorry. However, I will not go to the 1
hour test but jump right ahead to the 75 ml - 4 hour test. There is really
no need for me to do 2 tests: I'll pass the biggy or I won't. My midwife
recommended a diet to me, which is right now very easy to follow as I am
constantly nauseated and never eat for pleasure but only for sustention. The
problem may only be that I don't eat enough, but I'm sure this will get
corrected later on. We will see in the future.

Besides that, all is fine and I was very happy to see my midwife again. She
is accompanied by a student, but fortunately this time the student will stay
until the very end of my pregnancy (I had to deal with 3 students during my
first - hey, if you want midwives, you've got to help their studies!). We
discussed how we'd go about things if I happen to live in the suburbs when
labour starts, and I was quite reassured.


--

Isabelle
Mom to Mlle C, Nov. 27, 2004
Expecting Little One on June 7, 2006

Zaz wrote:

We of course discussed my first pregnancy, and especially the fact that my
baby was so huge (so was I, as a matter of fact), that I had so much
amniotic fluid and that all of it led me to being induced. I was adamant I
will do everything in my power to avoid living through the same thing over
again.
In the course of the discussion I did mention GD. I was not screened for it
during Preg. no. 1, so no one knows, but of course all the doctors who saw
me at the hospital after delivery kept nagging me about it. And so did my
aunts, my mom and everyone who have heard the term gestational diabetes.

Yeah, they do that. On the other hand, most women
who have macrosomic babies do *not* have GD, so it's not
really a strong indicator. Throw in the polyhydramnios and
it is a stronger association, though. My second baby was
9lbs 6oz, but my third (didn't change anything about diet
or anything like that) was only 8lbs 2oz, which rather
took the wind out of the sails of those who were insisting
I must have had GD last time and was going to have a real
whopper in the third pregnancy.

I agreed to take a test at week 24. I know, Ericka, it would be easier to
pass earlier,

Better 24 weeks than 28 weeks, anyway.

but I am not so convinced anymore that gestational diabetes
doesn't exist...

I've never claimed that it doesn't exist, only
that diagnosis is inconsistent, poor outcomes may be related
to something different, and treatment doesn't seem to help
much in terms of the outcomes that are of real concern.
(E.g., if you make the babies smaller but don't lower the
rate of dystocias, have you really done anything particularly
useful?)

I've thought long and hard about it. I also found out that
two of my aunts were diagnosed with GD over 20 years ago and they are today
diagnosed with Diabetes type 2. So even though they are not the closest
relatives I have, they still count in my gene pool.

Have you been screened for diabetes or pre-diabetic
conditions in between the pregnancies? If you are a
borderline diabetic when not pregnant, then you very
well *could* have significant issues with glucose metabolism
(which could also be associated with polyhydramnios). If
that is a possibility, then frankly, you may not want to
wait until 24 weeks to be tested. If you are an undiagnosed
true diabetic, then blood sugar control in the first trimester
is *really* important. If you had perfectly normal blood
sugars while not pregnant, then later testing isn't so
much an issue, but if not, 24 weeks is really too late
to find out, ideally.
On the other hand, type 2 diabetes is very lifestyle-
linked, as are bad outcomes with gestational diabetes. What's
the chicken and what's the egg? Perhaps being overweight
is linked to both the type 2 diabetes *and* gestational diabetes
*and* the bad outcomes. Studies tend to do a pretty poor
job of teasing all that out. Nearly 50 percent of gestational
diabetics go on to develop type 2 diabetes...but most
gestational diabetics have the lifestyle factors that
are associated with type 2 diabetes as well.
Odds are that gestational diabetes is a reflection
of an underlying issue that's related to other issues.
But when it comes to deciding whether to treat for it,
you have to ask what good it's going to do. It's as
clear as can be that if you're a true diabetic, or
near-diabetic, blood sugar control is very, very important
starting from the beginning of the pregnancy. If you're
a gestational diabetic, the picture is much more murky
and you likely have perfectly normal blood sugars for
most of the pregnancy. Treatment for pregnant true
diabetics is clearly valuable. Treatment for gestational
diabetics is much less clearly useful.

I my case, I prefer to feel safe than sorry. However, I will not go to the 1
hour test but jump right ahead to the 75 ml - 4 hour test.

? Isn't it usually a 50g 1-hour test, a 75g 2-hour test,
or a 100g 3-hour test?

There is really
no need for me to do 2 tests: I'll pass the biggy or I won't. My midwife
recommended a diet to me, which is right now very easy to follow as I am
constantly nauseated and never eat for pleasure but only for sustention. The
problem may only be that I don't eat enough, but I'm sure this will get
corrected later on. We will see in the future.

Getting enough to eat is important.

Best wishes,
Ericka

"Zaz" wrote in message
...
I met with my midwife for the first time in this pregnancy on Tuesday.


i must have missed an announcement post, congrats. time is flying!!!

chris

Zaz wrote:
I met with my midwife for the first time in this pregnancy on Tuesday.

We of course discussed my first pregnancy, and especially the fact that my
baby was so huge (so was I, as a matter of fact), that I had so much
amniotic fluid and that all of it led me to being induced. I was adamant I
will do everything in my power to avoid living through the same thing over
again.
In the course of the discussion I did mention GD. I was not screened for it
during Preg. no. 1, so no one knows, but of course all the doctors who saw
me at the hospital after delivery kept nagging me about it. And so did my
aunts, my mom and everyone who have heard the term gestational diabetes.

I agreed to take a test at week 24. I know, Ericka, it would be easier to
pass earlier, but I am not so convinced anymore that gestational diabetes
doesn't exist... I've thought long and hard about it. I also found out that
two of my aunts were diagnosed with GD over 20 years ago and they are today
diagnosed with Diabetes type 2. So even though they are not the closest
relatives I have, they still count in my gene pool.


I had a 'huge' first baby (10.5 lb), and had passed the GD test then.
Since I was going for a VBAC for my second, they wanted a smaller baby
(not that it was up to them!). So I agreed to do the GD test early in
the first trimester and again in the second. Passed with flying colors
both times.

I also saw a nutritionist, who put me on a modified diabetic diet,
mostly making sure I didn't eat too many carbs, and made sure they
were good ones. It was very well balanced and healthy. I also cut
way back on my dairy consumption getting my calcium from other
sources.

I still gained about the same, but baby 2 was nearly a pound less
(9lb 7 oz). I don't know if how I ate did it, or if she was just
destined to be smaller.

FWIW,

Mary W.

In message , Ericka
Kammerer writes

Have you been screened for diabetes or pre-diabetic
conditions in between the pregnancies? If you are a
borderline diabetic when not pregnant, then you very
well *could* have significant issues with glucose metabolism
(which could also be associated with polyhydramnios). If
that is a possibility, then frankly, you may not want to
wait until 24 weeks to be tested. If you are an undiagnosed
true diabetic, then blood sugar control in the first trimester
is *really* important. If you had perfectly normal blood
sugars while not pregnant, then later testing isn't so
much an issue, but if not, 24 weeks is really too late
to find out, ideally.

Yeah, what Ericka said.

Don't wait till 24 weeks for a formal test; go and get yourself a meter
*now* and start testing.
--
Mogget

Allow me to skip some...

"Ericka Kammerer" wrote in message
. ..
Yeah, they do that. On the other hand, most women
who have macrosomic babies do *not* have GD, so it's not
really a strong indicator. Throw in the polyhydramnios and
it is a stronger association, though. My second baby was
9lbs 6oz, but my third (didn't change anything about diet
or anything like that) was only 8lbs 2oz, which rather
took the wind out of the sails of those who were insisting
I must have had GD last time and was going to have a real
whopper in the third pregnancy.

I agreed to take a test at week 24. I know, Ericka, it would be easier to
pass earlier,

Better 24 weeks than 28 weeks, anyway.

but I am not so convinced anymore that gestational diabetes doesn't
exist...



I've never claimed that it doesn't exist, only
that diagnosis is inconsistent, poor outcomes may be related
to something different, and treatment doesn't seem to help
much in terms of the outcomes that are of real concern.
(E.g., if you make the babies smaller but don't lower the
rate of dystocias, have you really done anything particularly
useful?)


Sorry, I didn't mean you said that. I have a problem with the very idea of
diagnosing diabetes within a few weeks in a pregnant woman but taking years
in a real diabetic.

I've thought long and hard about it. I also found out that two of my
aunts were diagnosed with GD over 20 years ago and they are today
diagnosed with Diabetes type 2. So even though they are not the closest
relatives I have, they still count in my gene pool.

Have you been screened for diabetes or pre-diabetic
conditions in between the pregnancies? If you are a
borderline diabetic when not pregnant, then you very
well *could* have significant issues with glucose metabolism
(which could also be associated with polyhydramnios).

During my whole pregnancy all my blood sugars were normal, as they were
after the baby was born. I did not check in the year that followed, only
right after the birth.

On the other hand, type 2 diabetes is very lifestyle-
linked, as are bad outcomes with gestational diabetes. What's
the chicken and what's the egg?

That's the reason I want to try the diet...


I my case, I prefer to feel safe than sorry. However, I will not go to
the 1 hour test but jump right ahead to the 75 ml - 4 hour test.

? Isn't it usually a 50g 1-hour test, a 75g 2-hour test,
or a 100g 3-hour test?

I may have the number of grams or millimiters wrong, but I know it's a 4
hours test. It's done at the Jewish Hospital in Montreal, and from what I
gathered they are quite the specialists in diabetes in my area.


The
problem may only be that I don't eat enough, but I'm sure this will get
corrected later on. We will see in the future.

Getting enough to eat is important.

Oh, I know that! I eat as much as my stomach can take in.. and keep in!


Best wishes,
Ericka

They always want to think I'm going to have GD. With baby #3 the OB
was shocked that I didn't have it given the size of #2 (11.5 lbs.) and
he seemed actually disappointed that I passed the test! He was going
to put me on the diet anyway but I switched to a midwife. :-) After
William, my current OB was making noise about my perhaps being
borderline diabetic and I just got fed up and said, "Can't it be that
big babies just run in my family?" (my father was 11 lbs., I was 10 lbs
3 oz., my husband was over nine, my sister's babies were both over
nine). He admitted that is probably all it is in my case.

Leslie

During my whole pregnancy all my blood sugars were normal, as they were
after the baby was born. I did not check in the year that followed, only
right after the birth.

you having said that makes me think that you either just have big babies
(what's the family history?), or that Mlle C was abnormal for a different
reason, but not because of GD or borderline non pregnant diabetes. I've
certainly known at least 1 other person with a big baby and polyhydramnios
who passed all the screenings both pregnant and non pregnant, so there are
other reasons for it happening, it's just GD seems to be the most common.

My first was small, everyone assumed that that was just me, I carry small
babies, as he was just above the 2.5kg definitition of small babies no one
followed it up any further, he was signigicantly smaller than any other
babies in the family, but then I'm also naturally I different build to all
the women who have had babies, I have the same build as some of the men and
women who haven't had children. Turned out that is probably not the case as
number 2 popped out 3lb bigger, am I concerned, no, yes DS probably was IUGR
(I've since discovered other indicators of this), but like diagnosing GD,
diagnosing IUGR doesn't improve outcomes, tends to be pressure to induce at
37weeks then causing premature issues if baby isn't ready. Had they decided
he was IUGR there would have been pressure on me to have monthly scans, then
non stress tests towards the end and so on....

Anne

Anne

"Anne Rogers" wrote in message
...
During my whole pregnancy all my blood sugars were normal, as they were
after the baby was born. I did not check in the year that followed, only
right after the birth.

you having said that makes me think that you either just have big babies
(what's the family history?), or that Mlle C was abnormal for a different
reason, but not because of GD or borderline non pregnant diabetes. I've
certainly known at least 1 other person with a big baby and polyhydramnios
who passed all the screenings both pregnant and non pregnant, so there are
other reasons for it happening, it's just GD seems to be the most common.

I think so too, but there has only been 9 months between delivery and this
new pregnancy... So it's hard to tell, as my doc said a full blown diabetes
test takes more than that to be deemed conclusive.

(snip)

Zaz wrote:
Allow me to skip some...

"Ericka Kammerer" wrote in message
. ..

I've never claimed that it doesn't exist, only
that diagnosis is inconsistent, poor outcomes may be related
to something different, and treatment doesn't seem to help
much in terms of the outcomes that are of real concern.
(E.g., if you make the babies smaller but don't lower the
rate of dystocias, have you really done anything particularly
useful?)

Sorry, I didn't mean you said that. I have a problem with the very idea of
diagnosing diabetes within a few weeks in a pregnant woman but taking years
in a real diabetic.

And I didn't mean to be testy ;-) I just want
to be really clear, since although I *do* want people to
think about and research this issue, I don't want anyone
to think it's a no brainer in either direction. There are
issues, but they're just complicated.

Have you been screened for diabetes or pre-diabetic
conditions in between the pregnancies? If you are a
borderline diabetic when not pregnant, then you very
well *could* have significant issues with glucose metabolism
(which could also be associated with polyhydramnios).

During my whole pregnancy all my blood sugars were normal, as they were
after the baby was born. I did not check in the year that followed, only
right after the birth.

If you know that your blood sugars were normal
during pregnancy, then the odds that she was big because
of GD is quite small. As I said, most macrosomic babies
are born to mothers without GD. Maternal weight and maternal
weight gain, on the other hand, is much more closely
associated with birth weight. Still, once you're pregnant,
you shouldn't do much about maternal weight and there's
only so much you should do about maternal weight gain :-/
Obviously, eating well is a good thing, but you're only
going to affect the weight or the waight gain minimally.
Now, I weighed more when I started my third pregnancy
and I was much sicker during it, so even though I didn't
restrict my intake at all (ate whatever I could when I
was sick, and ate whatever I wanted of relatively
healthy foods when I wasn't sick) I ended up gaining
very little during that pregnancy. I gained the most
with #1 and he was the smallest, the least with #3
and she was in the middle, and in the middle with
#2 and he was the biggest ;-) Just goes to show, I guess ;-)

On the other hand, type 2 diabetes is very lifestyle-
linked, as are bad outcomes with gestational diabetes. What's
the chicken and what's the egg?

That's the reason I want to try the diet...

Sure, absolutely eat well. No one needs a
boatload of simple carbs all day long ;-) There are
elements of the diabetic diet that would be good for
all of us. Some of the nutritionists recommend a diet
that is very calorie restricted (particularly if they're
just lifting a diet recommended for true diabetics, who
often do need to lose weight). You just want to be on
the lookout for that.

I my case, I prefer to feel safe than sorry. However, I will not go to
the 1 hour test but jump right ahead to the 75 ml - 4 hour test.

? Isn't it usually a 50g 1-hour test, a 75g 2-hour test,
or a 100g 3-hour test?

I may have the number of grams or millimiters wrong, but I know it's a 4
hours test. It's done at the Jewish Hospital in Montreal, and from what I
gathered they are quite the specialists in diabetes in my area.

Are you sure it's not a 3 hour blood test with
four blood draws (beginning, one hour, two hour, three hour)
which will obviously take longer than 3 hours by the time
you've gone through all the procedures?

Take care,
Ericka