gestational diabetes

[pommie]

Just wondered if anyone has had this whilst pregnant. I have been to the hospital and they told me the baby is looking big (they said that about our first) and when they did a glucose test my result was in the 9's (normal should be around 7). Anyway I now have to test my sugar level after each meal and sometimes its below 7 and other times its high (one night it was 12). When i asked the midwife what would happen if i did have it and the baby was showing large, she said nothing, they wouldnt start me off or give me a c section so sounds like i will have to struggle to give birth to a large baby!

[tiddles]

hi there - I believe it is not unusual for gestational diabetes to occur, however I feel they should have given you a bit more info - ask if there is anything you can do to keep control your sugar levels. good you are testing tho - perhaps you could keep a record of times and tests so you might be able to spot a pattern?

[snowboarder]

I'm not sure about gestational diabetes - I was tested for it in my last pregnancy but the result was negative - but my first baby was a chunky one - measured big at 36 weeks and scan at 38 weeks indicated he was above 10lb. The consultant I saw at Kings as a result of this scan scared me to death (first baby!) and recommended a c section. He was big - 10lb 7oz....but...plenty have birthed bigger! It depends how you feel about it but I have always wondered what might have happened if I had tried - I did go into spontaneous labour before the scheduled section. There is a website about birthing 'big' babies - http://www.bigbaby.org.uk/ which if you want to have a vaginal birth should give you some support.

Sorry - wittering on - hope that helps a bit. Good luck!

[pommie]

i am just scared that if the baby is big and i start pushing and the baby gets stuck. Thought it would be easier on everyone to just give me a c section and save the stress of trying to deliver a big baby!

[snowboarder]

From my experience with both babies if they think baby is big they will scan you and you should see a consultant who would assess you. In my case with first baby Leonie Penna said to me the thing they worry about with big babies is shoulder dystocia - when the shoulders get stuck - but in my case she thought I would struggle to birth his head. Funny thing is his head is not now and never was particularly big. I'm sure if they were worried at all you would be offered a C section. I had to fight NOT to have an elective with second baby and he was only 9lb!!

[Saffron]

Not sure what you/they mean by "big"? Baby may be large but still well w/in the range of normal. If Baby is well-presented and labour progresses normally, there's no reason to think Baby can't be delivered vaginally.

I agreee with others, in that you need to ask for more information from your midwives/obs team. You might also want to speak with a counsellor about hypotherapy and/or addressing fears in pregnancy. If your fears are unfounded, overcoming them will be very empowering. If, however, there really is problem, then to have all the info about your options will help you make the best choice.

I have a friend who had gestational diabetes with both her pregnancies. I believe she had inductions with both, but delivered normally. I'm happy to put you in touch with her. xx

[slh2009]

Hi, I had gestational diabetes and did all the blood sugar testing but my baby was not big (I had borderline GD). Have you been referred to a dietician? I found that quite helpful in monitoring what I ate as I had no experience of diabetes.

I do find it a bit odd that the midwife said you would not be induced or have a c-section as this was made clear to me as soon as GD was diagnosed that even though my baby was not big (he was 6lb 140z)I would be induced on my due date followed by a swift c-section if necessary, because I had GD. I was not very happy with that but went along with it as it was my first baby and I didn't feel I could argue with the doctors(although I did get a few days grace and went over my due date!).

Sorry I can't help with advice on a big baby but would recommend trying to get more information on how to control GD.

Good luck!

[sillywoman]

POmmie, I agree with the other posters - you need much more information. If you have GD then my understanding is that you should be referred to the specialist midwifery team, the Ruskin Midwives for all your antenatal care. They will monitor your Glucose levels and act appropriately. GD is a very personal condition in that it manifests slightly differently in each woman and you would need a personal programme tailored to you.

Most forms of GD (roughly 80-90%)can be fairly easily controlled with some simple diet modifications and the Ruskin Midwives would be able to talk to you about this & advise in depth. Once the GD is being controlled then there is very little probability that the baby would grow 'too big', but you shoud have extra growth scans to monitor the baby's growth. If for some reason (and if you follow the specialist MW's advice the I cannot emphasise how unlikely this is) the baby should have uncontrolled growth then it's likely that you would be offered either an induction of labour at approx 38 weeks, or a planned CS depending on circumstances and other health and medical factors.

You might find it helpful to check out the NICE guidelines on 'Diabetes in Pregnancy'(July 2008 CG63)? You can find them at www.nice.ogr.uk

HTH

[pommie]

well they are monitoring me for a couple of weeks. I go back on the 10th to see the midwife again and discuss my results that i have. She said if sugars are too high then i will see the dietician.

[pommie]

Also they told us my daughter was looking on the large side and she was born a day early weighing 7lb 11oz. They dont take into consideration that the father is 6ft 2ins and an ex rugby player so surely genes come into it too

[Saffron]

7lb 11oz sounds completely average, no? In the Western world, the average is 7.5lb, with a range of 5-10lb considered normal.

Also, regular ultrasound scans aren't necessarily very accurate for estimating Baby's weight, which is probably why drs/MWs tend to err on the cautious side for women with GD or other growth problems in the foetus. I don't know if the newer 3-D type scans are better maybe?

(On the subject of genes, I'm not sure how this is manifest in newborns... My husband is 6'1", and there are lots of tall people in both our families. Little Saff was born 54cm -- avg is 35-50cm! From my scans and size of bump, midwives thought she would be small/normal, but she was nearly 9lb (and I'm barely 5'6")!! From my NCT group, I had the 2nd largest baby, and yet I was the only one with no stitches and no interventions. I was also the only one who did perineal massage. Anecdotal, I know, but there is real clinical evidence to support the benefit of perineal massage. See this website for more info: http://www.epi-no.co.uk/ .)

Best of luck with whatever choice you make, and have a happy pregnancy. xx

[buggie]

It's more your sugar levels/diet to worry about than current assumed size of the baby. Your levels are above normal & this is more indicative.

Were you seen in the GD clinic at Kings yet? (presuming you've had a glucose tolerance test - once done never forgotten bleugh!!) If yes then surprised they've left you with what seems vague advice :(

I had diet controlled GD in my pregnancy - Was tested after a high random glucose at 28wks (if you search "gestational diabetes" in the search box you'll prob see posts I made at the time).

I had to test my blood sugar before brekkie & 1 hr post my 3 main meals aiming to be below 7 (especially tricky in the morning as hormone levels highest).

You'll have few extra scans so that growth can be monitored & the placenta (sugary blood can cause damage to it). Plus post-birth bubs'll need it's blood sugars checked for 24hrs post birth to check your sugar levels haven't affected their levels/they normalise.

Hope all makes sense soon x

[Strawbs]

I was diagnosed with gd at 32 weeks. I was to.d I was going to have a massive baby and was induced at 38+3 as became insulin dependent, Toby came out at 7.13lbs so little!!! You should. E referred to the diabetes clinic and they will monitor you weekly and scan you a few times.. The care for the rest of your preg will depend on how your gd is managed ie diet , tablets ( the worst option!!!) or insulin.. At st thomas' insulin means induction automatically.. the high risk. Idwife team are brilliant who took care of me.

I was quite ill with it but the minute he was born it was gone and he was perfectly fine. If you need to chat I'm quite happy to meet you for a coffee..

One other thing I seemed to be able to handle sweet things ok but not carbs so watch out for both..

X

[pommie]

buggie

im not under kings but have not seen anyone in the GD department. Just did the glucose test (yes it is yukky!) and thats when they said my result was 9. Anyway got to keep an eye on my sugar level for a couple of weeks then go back and discuss them with the midwife to see where we go from here. I have had a couple of really high reading (in the 11's and 12's) but cant understand why.

I feel worse in the morning, feel lightheaded and a bit shakey.

Baby has a few other health problems so dont want anything else to be wrong

[prm]

pommie, I also had gestational diabetes and although I was quite shocked / upset at first it was actually not that bad at all. As others have said a lot of people can control it with diet, which I didn't find that hard to follow (in fact it helped me to be healthy and not put too much weight towards the end of my pregnancy). You have to stay away from hardcore sugars & sweets but apart from that you can eat pretty much anything and eat carbohydrates in small quantities. You will have to see how your own body reacts to different foods and quantities (when you test your blood sugars after eating - which once you get used to the routine is really easy). If you were at Kings you would get seen every week at the Diabetic Clinic to monitor your sugar levels and review your home results and you would have extra scans towards the end of the pregnancy to check the baby is not getting too big - but if you are following your diet and your tests for sugar levels are coming back ok I really don't think you have anything to worry about (my baby was completely average size and smaller than they had estimated). Exercise also helps and if you were to need insuline, as far as I understand that would control the baby is not getting too much sugar & shouldn't get too big. So in summary I would just advice you not to worry, it really isn't that bad. Best wishes with the rest of your pregnancy!

[BB100]

Sorry to hear about you having GD, I haven't read through all the posts but I had GD with my first and had blood sugars of 30+ for months (didn't know and was fobbed off by the midwife even though I was drinking 10-20 litres of water a day) but still had a small baby (6lb 5oz). I was induced two week early though.

I expect you are feeling light headed in the morning because your blood sugar has dropped over night. Try to eat some toast or cereal or digestive biscuit before you get up.

If your sugars are going up to 11 or 12 then that is part of the GD as the pregnancy is suppressing your insulin production. If it goes over 17 then make sure you see your GP as your body will start producing ketones. In fact if you are worried about delivering a big baby also see your GP because a friend of mine was fobbed off by a midwife at Kings and her baby got stuck (15yrs ago though).

You can also get information about GD from the Diabetes UK helpline and they can post you some reading material. It might help you not to worry too much.

[sillywoman]

BB100, just curious - why do you suggest she sees her GP if she's worrying about delivering a big baby? What is it that they can do?

Also not sure how your "friend of mine was fobbed off by a midwife at Kings and her baby got stuck (15yrs ago though)" story is useful or helpful to Pommie?

Maybe I'm missing something though?

[Saffron]

GP could give you a referral to a dietitian (but the MWs ought to be doing this anyway). As other have said, this type of diabetes can often be controlled by diet alone.

(If insulin production is low, why would blood sugars drop overnight, unless you are taking exogenous insulin (which I don't think the OP mentioned requiring yet)? Or maybe that is just my misreading it??)

xx

[sillywoman]

Yes Saffron I did wonder whether that's why BB100 suggested GP, but like you I would assume that the MW's would do this, not least because GD would surely need referral to a specialist dietician not just a general one?

It seems like an odd thing to do to recomend a pregnant woman seek advice from a general practitioner rather than a pregnancy specialist (MW or Obs). 'Specially when many posters have already advised to seek specialist help. I was (& am still) puzzled as to why BB100 suggested it? Thought maybe there was something GP's could do that I wasn't aware of?

[Saffron]

Maybe if you feel like you have confusing or conflicting advice from the specialists, your GP can help you to sort through it? I guess it's never really wrong to ask your GP for help. There were definitely times when I felt like I was being bounced around among specialists (for other pregnancy issues, not GD), but MWs were mostly able to sort things for me. Agreed you should see a specialist dietitian if one is availale, whether referred by GP or MW. xx

[buggie]

Saffron - the insulin levels with gestational diabetes are the same, it's the extra hormones produced by the placenta that inhibits its effectiveness (& thus is reversed immediately following the birth).

Having known few other friends with GD during their pregnancies, care and support offered varies wildly from trust to trust - even blood sugar testing varies. It's only myself & my NCT friend who didn't end up on medication/insulin & wonder if that's due to the close monitoring/support Kings gave us both.

[pommie]

i am due to see the MW in a week or so and she said that depending on my home test results will determine whether she refers me to a dietician.

Thanks everyone for your posts, will let you know how i get on

[greeners]

Hi, just reviving this thread with a quick question about GD - I have no reason to think I have it but out of interest, what is the policy in this PCT for testing for it? All I had was a blood test at my 28wk midwife appt where I was told not to eat anything too sweet beforehand 'like a big mars bar'! I know that in some other PCTs, all women are routinely given the GTT with the sugary drink etc... I know there is a screener to assess your risk (think it is higher BMI, ethnicity, close relative with diabetes, high birth weight baby previously - none of which are relevant to me). The only thing that could possibly be relevant is that I had IVF due to PCOS which can be linked to insulin resistance, but which I don't appear to have based on a Pre-pregnancy blood test.

[Strawbs]

I dont know about policies but I had a blood test like you at 28 weeks and I was clear, then 30 weeks in hindsight I started to feel very unwell (I put it down to getting bigger and just well being pregnant!) at 32w my midwife noticed I wasnt myself plus I had indicators in my pee and was measuring 36w and then I had my GTT etc.. I was with Tommies and insulin dependant so was transferred to the high risk midwives who were outstanding.. I was then induced at 38+3.

x

[sillywoman]

I'm not aware of any trust in the UK who tests routinely for GTT, though each trust has it's own policies they are usually based on the NICE guidelines. As you know the GTT test isn't the pleasantest of experiences and it would be a bit mean, not to mention a huge waste of money to test every pregnant woman for it.

In Lewisham women from certain higher risk categories will be offered GTT at their booking appointment - the categories you listed, plus any history of polycystic ovaries would be seen as an indicator too. Otherwise it's offered if any of the risk factors arise during the course of the pregnancy. I guess that's what happened to Strawbs? Each hospital/trust has it's own specialist team of Midwives who would look after you once you'd been confirmed with GD. At Kings it's the Ruskin group.