GD and pregnancy

20 posts / 0 new
Last post
Mom2ThreeKiddos's picture
Joined: 09/15/09
Posts: 1380
GD and pregnancy

Becasue it is on my mind I thought I would share. I read this article today from Henci Goer. It really sums up my feelings on GD. Based on my numbers even eating my normal breakfast my 2 hour numbers are just slightly high. But guess what, most women experience some level of glucose intolerance in the 3rd trimester. I really question this whole diagnosis. My fasting level this morning was 77 (has been ranging from 80ish - 90is). And from everything I read the fasting number is more indicative of true diabetic status. I am sooo not allowing them to section me at 38w no matter what they say.

mommys's picture
Joined: 05/08/06
Posts: 6264

Do you have a link to the article?

Are you eating a good GD-type diet?

That is a good fasting number.

Mom2ThreeKiddos's picture
Joined: 09/15/09
Posts: 1380

Doh I intended on putting it in my first post, but I didn't

http://www.ivillage.com/gestational-diabetes-3/6-a-129187

I am following the GD diet somewhat. I am being pretty good. Some days my levels are sooo low though and I feel crappy.

Joined: 09/27/09
Posts: 2

Good article! I've been trying to do as much research as I can on GD since my OB has decided to slap me with that title with zero proof that I even have it; she's making assumptions because my last baby was "big", although I have never tested positive for it before during any of my pregnancies!

Mom2ThreeKiddos's picture
Joined: 09/15/09
Posts: 1380

Hey Rose, all my kids have been big too. You know sometime it is just genetics. LOL

Joined: 05/24/05
Posts: 944

A friend of mine was labeled with GD because of a borderline number on the one-hour glucose tolerance test. Her numbers were great for the duration of her pregnancy. It's so frustrating when they make such a big deal about something that is nothing. And wanting to section you at 38 weeks is definitely a big deal!

Joined: 12/10/05
Posts: 1681

"Momof3lilMonkeys" wrote:

Good article! I've been trying to do as much research as I can on GD since my OB has decided to slap me with that title with zero proof that I even have it; she's making assumptions because my last baby was "big", although I have never tested positive for it before during any of my pregnancies!

That's horrible! My kids have all been really big (but so has every baby for 4 generations - not one under 8lbs 13oz). It's why I've done the GD test though - so I can PROVE I don't have diabetes and guarantee no body will unnecessarily poke my baby, feed her formula, or try to induce me!

How awful is it that we have to defend ourselves and our big babies!

Joined: 12/10/05
Posts: 1681

Great article! Thanks!

Amber_daisy's picture
Joined: 10/17/06
Posts: 567

Also read this one: http://www.ivillage.com/gestational-diabetes-common-sense-approach/6-a-129188

It's also by Henci Goer on GD.

You might want to get your hands on The Thinking Woman's Guide to a Better Birth as well.

I decline GD testing in pregnancy. I personally feel like GD is a diagnosis in search of an illness. I don't believe testing for it is benign.

Mom2ThreeKiddos's picture
Joined: 09/15/09
Posts: 1380

Oh I have read The Thinking Womens Guide. It was required reading for DONA and Hypnobabies. :). I would have to pull it out and read that part again though as I have read soooo many books in such a short timeframe.

momW's picture
Joined: 09/29/09
Posts: 5634

Why in heaven's name would they section you at 38 weeks for GD, Christy? I'm really curious as to the reasoning. I had a knock down drag out with the high risk OB during my last pregnancy where I got the dreaded GD stamp about when and how I would be delivering. (oh, such fun times!)

I've been doing more research about the legitimacy of the testing and diagnoses now. When I was pregnant, I was absorbed in the "how to control it so I don't have to agree to a c/s" phase so I never really thought about questioning the actual diagnoses.

Here is my question to you or anyone: After I had the baby, the nurse that was keeping track of my numbers said okay, now you need to check your sugars randomly for a while just to make sure you are okay. She said my numbers 1 hour post meal should be below 200. I had to keep them below 120 while I was pregnant. Why can they be so much higher non-pg than pg? Even the two or three times during my pg when my sugars went crazy (heeellllllooooo Olive Garden Lol my fasting numbers were always fine and I never got above 200.

Starflyr's picture
Joined: 10/20/07
Posts: 428

Because high numbers when you're pregnant affect the baby as well.

They increase their insulin production and it has detrimental effects on the cardiovascular system, including remodelling of the heart and blood vessels and they also end up having intermittent hypoxia in utero due to the reactions to the high glucose

I know that a lot of people dont think it's a big deal, and I DO agree that sometimes OBs are overzealous in diagnosing it...

BUT, I have also taken care of 14 lbs babies born at 39 weeks with immature lungs that are in the NICU for weeks on CPAP and a glucose drip due mom being an undiagnosed gestational diabetic.

They (the babies) are at significantly higher risk for type 2 diabetes, heart disease and obesity as well than non IDMers. They also can end up with learning disabilities, etc, due to the hypoxia.

Not to mention the polycythemia that can develop in an attempt to compensate for the hypoxia...which can lead to all kind of issues both prenatally and post-natally.

GD is real. And it can be VERY harmful.

But I do think that proper diagnosis is important - not a random freakout over 1 high number once.

Star

momW's picture
Joined: 09/29/09
Posts: 5634

"Starflyr" wrote:

Because high numbers when you're pregnant affect the baby as well.

They increase their insulin production and it has detrimental effects on the cardiovascular system, including remodelling of the heart and blood vessels and they also end up having intermittent hypoxia in utero due to the reactions to the high glucose

I know that a lot of people dont think it's a big deal, and I DO agree that sometimes OBs are overzealous in diagnosing it...

BUT, I have also taken care of 14 lbs babies born at 39 weeks with immature lungs that are in the NICU for weeks on CPAP and a glucose drip due mom being an undiagnosed gestational diabetic.

They (the babies) are at significantly higher risk for type 2 diabetes, heart disease and obesity as well than non IDMers. They also can end up with learning disabilities, etc, due to the hypoxia.

Not to mention the polycythemia that can develop in an attempt to compensate for the hypoxia...which can lead to all kind of issues both prenatally and post-natally.

GD is real. And it can be VERY harmful.

But I do think that proper diagnosis is important - not a random freakout over 1 high number once.

Star

I do know that there are true risks for a GD baby with a mother that is not under control, but why is there such a HUGE difference between the numbers that are okay when not pg and the numbers that are okay when pg?

Mom2ThreeKiddos's picture
Joined: 09/15/09
Posts: 1380

If a mom has a baby that is 14 lbs she is most likely diabetic prior to pregnancy and didn't know it. Most women have some level of insulin resistance in the 3rd trimester. For you to be classified as diabetic you have to have a fasting glucose number (confirmed with a repeat test) of over 125. The cutoff for the 3 hour GTT is 95. For a type II diabetic having a blood glucose of over 200 is a sure diagnosis. The risk factors that you mentioned are for women with actual diabetes not GD.

From the article I linked:

The theory that GD could have the same adverse effects of diabetes was faulty on its face, because GD does not share the risk factors of either type of true diabetes. In Type I diabetes, extremes of low and high blood sugar early in pregnancy can cause malformations or miscarriage. GD women make normal or above-normal amounts of insulin and have normal blood-sugar metabolism in the first trimester (22). Either Type I or II, long-standing diabetes can damage maternal blood vessels and kidneys, causing hypertension or kidney complications. These can in turn jeopardize the fetus. Gestational diabetics do not have long-standing diabetes. The one problem GD shares with both types is that chronic hyperglycemia can overfeed the fetus, resulting in a big baby. This is generally defined as a birth weight of more than 8 lbs. 13 oz. (4,000 grams) or a birth weight in the upper ten percent for length of pregnancy (large for gestational age).

Read More http://www.ivillage.com/gestational-diabetes-3/6-a-129187?p=2#ixzz1ELMjyrB9
Sign up for iVillage Special Offers

My issues is exactly yours. If you look at the monitor they gave me, it says fasting should be less than 110 and 2 hour should be less than 140. My doc has me at fasting less than 100 and 2 hour less than 120. They are more restrictive. I have had one fasting number over 100 and not one over 110. I am not a diabetic. I do have risk factors since my mother is type II and my sister is borderline. Sigh!

Starflyr's picture
Joined: 10/20/07
Posts: 428

"momW" wrote:

I do know that there are true risks for a GD baby with a mother that is not under control, but why is there such a HUGE difference between the numbers that are okay when not pg and the numbers that are okay when pg?

Because immature/developing tissues are much more sensitive to the detrimental effects of glucose than mature tissues are.

trying to think of a good analogy....

Say you are pouring a concrete block that will be a building support.

If you pour it outside during nice weather, when there is no wind, it will be much stronger and longer lasting than a concrete block that you pour outside in the middle of a sandstorm.

ETA: I will find the articles for the research done regarding GDM, I did a LOT of reading in the journals when I was pregnant the first time, as I did have it. I only have access to the journal database at work and its alittle busy as it's cold and flu season. I will get to it as soon as I can, maybe today, but probably next week.

momW's picture
Joined: 09/29/09
Posts: 5634

"Starflyr" wrote:

Because immature/developing tissues are much more sensitive to the detrimental effects of glucose than mature tissues are.

trying to think of a good analogy....

Say you are pouring a concrete block that will be a building support.

If you pour it outside during nice weather, when there is no wind, it will be much stronger and longer lasting than a concrete block that you pour outside in the middle of a sandstorm.

ETA: I will find the articles for the research done regarding GDM, I did a LOT of reading in the journals when I was pregnant the first time, as I did have it. I only have access to the journal database at work and its alittle busy as it's cold and flu season. I will get to it as soon as I can, maybe today, but probably next week.

Thanks. One of the biggest problems I had when I was researching GD was I could not get access to the actual research articles because I didn't have access and some of the research is relatively new. Ticked me off!

Amber_daisy's picture
Joined: 10/17/06
Posts: 567

"Starflyr" wrote:

Because high numbers when you're pregnant affect the baby as well.

They increase their insulin production and it has detrimental effects on the cardiovascular system, including remodelling of the heart and blood vessels and they also end up having intermittent hypoxia in utero due to the reactions to the high glucose

I know that a lot of people dont think it's a big deal, and I DO agree that sometimes OBs are overzealous in diagnosing it...

BUT, I have also taken care of 14 lbs babies born at 39 weeks with immature lungs that are in the NICU for weeks on CPAP and a glucose drip due mom being an undiagnosed gestational diabetic.

They (the babies) are at significantly higher risk for type 2 diabetes, heart disease and obesity as well than non IDMers. They also can end up with learning disabilities, etc, due to the hypoxia.

Not to mention the polycythemia that can develop in an attempt to compensate for the hypoxia...which can lead to all kind of issues both prenatally and post-natally.

GD is real. And it can be VERY harmful.

But I do think that proper diagnosis is important - not a random freakout over 1 high number once.

Star

I disagree. Moms who are likely to test positive for "gestational diabetes" have underlying type II diabetes, and have other risk factors for poor outcomes that are unrelated to gestational diabetes. And the fact remains the treating for "gestational diabetes" has NOT been shown to improve outcomes. The diagnosis does, however, increase moms' risk of having a c/s, despite the size of the baby. There is also a risk of overtreatment, resulting in SGA babies.

Doctors need to stop relying so heavily on tests and start talking to their patients and really assessing them. My first and only OB appointment was 5 minutes long. FIVE MINUTES! In that time he palpated my belly, listened to the heartrate, and berated me for declining the GTT. According to the SOGC, having a non-testing policy is acceptable since there is no evidence that treatment results in improved outcomes...and I knew this and researched it before hand). He didn't ask me anything about my diet or water intake or activity level. He just tore a strip off me and sent me on my way. I never went back. I started going to a GP who talked to me about my life, my diet, my appointments lasted 30-60 minutes. She was perfectly fine with my declining the test since she knew the SOGC guidelines and the studies they're based on. This time I'm seeing a midwife who had me do a 3 day food diary and talks to me at every appointment about my diet, my water intake and my activity level. She also gave me advice on things I could do to better my diet, even though it was already really good.

This is what is needed.

Mom2ThreeKiddos's picture
Joined: 09/15/09
Posts: 1380

"Amber_daisy" wrote:

I disagree. Moms who are likely to test positive for "gestational diabetes" have underlying type II diabetes, and have other risk factors for poor outcomes that are unrelated to gestational diabetes. And the fact remains the treating for "gestational diabetes" has NOT been shown to improve outcomes. The diagnosis does, however, increase moms' risk of having a c/s, despite the size of the baby. There is also a risk of overtreatment, resulting in SGA babies.

Doctors need to stop relying so heavily on tests and start talking to their patients and really assessing them. My first and only OB appointment was 5 minutes long. FIVE MINUTES! In that time he palpated my belly, listened to the heartrate, and berated me for declining the GTT. According to the SOGC, having a non-testing policy is acceptable since there is no evidence that treatment results in improved outcomes...and I knew this and researched it before hand). He didn't ask me anything about my diet or water intake or activity level. He just tore a strip off me and sent me on my way. I never went back. I started going to a GP who talked to me about my life, my diet, my appointments lasted 30-60 minutes. She was perfectly fine with my declining the test since she knew the SOGC guidelines and the studies they're based on. This time I'm seeing a midwife who had me do a 3 day food diary and talks to me at every appointment about my diet, my water intake and my activity level. She also gave me advice on things I could do to better my diet, even though it was already really good.

This is what is needed.

I totally agree. Plus the reproducability of this test is not reliable. That is one reason for type II diabetes they rarely even use it anymore.

cindyanns's picture
Joined: 02/20/10
Posts: 775

A automatic section at 38 weeks for GD? I'd question your doctor on that one. I had GD (it was a VERY correct diagnosis in my case), was insulin dependent, had incredibly scary and abnormal swelling in my legs, and no one even mentioned a c-section until after I was 38 hours into labor, I had an infection, I was pushing involuntarily at 7cm, and my daughter was under stress and had her first bowel movement. Even then they said I could go for a couple more hours if I wanted to.

GD =/= c-section unless there's an emergency.

If you think they incorrectly diagnosed you, I'd call the doctor and have them retest. Or tell your doctor it's ridiculous for them to want to give you a c-section at 38 weeks and you refuse. There are several other ways to allow you to have a natural labor, even with GD.

Though my natural labor kind of sucked and ended in c-section anyway, at least I was given a chance!

Joined: 12/10/05
Posts: 1681

"Mom2ThreeKiddos" wrote:

If a mom has a baby that is 14 lbs she is most likely diabetic prior to pregnancy and didn't know it. Most women have some level of insulin resistance in the 3rd trimester. For you to be classified as diabetic you have to have a fasting glucose number (confirmed with a repeat test) of over 125. The cutoff for the 3 hour GTT is 95. For a type II diabetic having a blood glucose of over 200 is a sure diagnosis. The risk factors that you mentioned are for women with actual diabetes not GD.

This is a tangent, but that isn't necessarily true... I had a 12lb (and a 9lb 13oz, 10lb 6oz, and 10lb 6.5oz) baby. I have done the GD test every time, because I want to prove I don't have GD. My urine has never had ketones in it and my weight gain has always been good (I gained 32lb with the 12lb baby). I get annoyed because everyone assumes I has uncontrolled diabetes.

"Amber_daisy" wrote:

I disagree. Moms who are likely to test positive for "gestational diabetes" have underlying type II diabetes, and have other risk factors for poor outcomes that are unrelated to gestational diabetes. And the fact remains the treating for "gestational diabetes" has NOT been shown to improve outcomes. The diagnosis does, however, increase moms' risk of having a c/s, despite the size of the baby. There is also a risk of overtreatment, resulting in SGA babies.

Doctors need to stop relying so heavily on tests and start talking to their patients and really assessing them. My first and only OB appointment was 5 minutes long. FIVE MINUTES! In that time he palpated my belly, listened to the heartrate, and berated me for declining the GTT. According to the SOGC, having a non-testing policy is acceptable since there is no evidence that treatment results in improved outcomes...and I knew this and researched it before hand). He didn't ask me anything about my diet or water intake or activity level. He just tore a strip off me and sent me on my way. I never went back. I started going to a GP who talked to me about my life, my diet, my appointments lasted 30-60 minutes. She was perfectly fine with my declining the test since she knew the SOGC guidelines and the studies they're based on. This time I'm seeing a midwife who had me do a 3 day food diary and talks to me at every appointment about my diet, my water intake and my activity level. She also gave me advice on things I could do to better my diet, even though it was already really good.

This is what is needed.

I have seen sick babies as a result of uncontrolled GD. It doesn't matter to the baby whether the cause the unstable blood sugars is GD, Type 1, or Type 2 - either way the baby gets too much insulin and that can cause problems with lung development and post partum hypoglycemia.

I agree the focus from the doctors should be health and the emphasis (for all woman) needs to be healthy eating, exercise, etc, as opposed to slapping on a label and scheduling the c/s. Treatment and care should be customized to the patient. If a woman fails the GD screen, but then manages to keep her sugars well regulated, then there is no reason to treat the pregnancy from an illness perspective.

(also, I think some doctors are very outdated. I know lots of women with GD who deliver vaginally without discussion of c/s or panic about induction)