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July 22nd, 2008

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08:06 pm - worrying and some questions
So I'm due in August and have questions regarding a conversation I had today with my endo. Sorry if these are basic questions, but I'm new to this whole diabetic and pregnant way of life.
I had a non-stress test last week. Baby is healthy, strong, and active. He is measuring pretty big at this time- just over 6 lbs at 33 weeks, and he is in the 90% for size. I saw the OB afterwards, and I also talked to the technician who was doing the test. She sensed that I was nervous when she mentioned baby's size, and assured me that baby is healthy, and that diabetic women have big babies. I saw the OB after, who also told me the same thng. She also explained that there can be a margin of error, and that things looked "really good" for her point of view. Okay, fine. Today, I saw my endo, who wants my morning readings below 90, because of baby's size, and she also took the opportunity to point out that "we don't want baby getting too big, that's really not good for him or for you at this point." Um, okay. I didn't think anything of it at the time, but now that I am home, I am so stressing out about that comment. My OB felt that things were okay, and she had previously explained to me that big babies sometimes meant shoulder dislocation or injury for baby. But what other risks are there? Will my baby have some type of birth defect as a result of being big (Gd forbid!!). Am I freaking out now about nothing? I'm already so emotional right now at the idea of becoming a mom, am nervous and excited. But am I missing something here? Will a big baby mean that he's unhealthy? Because up until today, I didn't think so. But now I'm a wreck.
Current Mood: anxiousanxious

(9 comments | Leave a comment)


[User Picture]
Date:July 23rd, 2008 01:04 am (UTC)
I was an undiagnosed Gestational diabetic for my first child. When she was born (via c section because she was persistent breech, which I BELIEVE was partially due to her being larger than normal) she was 10 pounds 12 oz. She was in low blood sugar and was kept in the NICU for 5 days on IV's to stabilize her sugars. She had hip dysplasia due to the breech presentation and being so tightly smooshed in utero.

These are mild things in the long run. I dont mean to make you paranoid by any means, but I think things like this are somewhat consistent with diabetic babies?
[User Picture]
Date:July 23rd, 2008 01:10 am (UTC)
I knew about the potetial for baby to have low blood sugar upon birth, and that they will check baby's blood sugar and make sure he doesn't need sugar water or formula to regulate his sugar levels. Baby is no longer breeched, he flipped last week. You're not makning me paranoid, it's good for me to know these things. I appreciate it! I was under the inpression from her tone today that there were other things I wasn't aware of. I see my OB this Friday agin, so I'll ask her more in depth questions.
[User Picture]
Date:July 23rd, 2008 01:26 am (UTC)
Unfortunately, diabetes can be a wild card - I was in perfect control throughout my pregnancy (all a1c's below 5.8 and my insulin needs increased but not drastically), but at 37 weeks, 2 days my son was born via c-section after 4 hours of pushing. He was 9 pounds, 21 1/2 inches. I have been a type 1 diabetic for almost 22 years.

I was told that the standard of 90 in the morning was so that you do not have to "fight" to come down from a high in the morning all day long - as your ability to utilize insulin decreses in later pregnancy it can be harder to control glucose levels, getting a good start can (sometimes) make things easier throughout the day. Also, higher blood glucose levels make the baby produce more insulin - the extra sugar and the extra insulin cause the baby to gain more weight......so it becomes a vicious cycle. Also, the insulin being produced by the baby in response to the mother's blood sugar can cause him/her to have low blood sugar after birth.

For any baby that is considered "big" there are some risks - a prolonged vaginal birth, the need for c-section, hip dysplasia, shoulder displacement.

All you can do is do your best to keep your readings as tightly to normal as you can. It's stressful and emotionally draining, I know. Take care!

[User Picture]
Date:July 23rd, 2008 01:32 am (UTC)
thanks! My a1C hasn't changed all that much- 6.1 or 6.2 throughout pregnancy. We're going to have the -section discussion soon.
Thanks for your support. This is all very overwhelming.
[User Picture]
Date:July 23rd, 2008 02:11 am (UTC)
my a1c was in the 5's and I was a GD - it wasn't really all that bad and was controlled by diet alone. My son at 32 weeks (I went into pre-term labor) was 6 lbs 3.2 oz. I was then on bedrest until 36 weeks when I had him, and they were guessing he would be around 9 lbs - he was 8 lbs 7oz. My perinatologist recommended a c-section, and my OB said I could try without one since my last child (without diabetes) she delivered was 8 lbs 11oz and I had no complications. Now had I went full term - I think I would of probably needed a c-section this last pregnancy due to his ever increasing size. I had big babies before I had GD, now when I had GD it just added even more to their already large size. Best of luck in regards to everything! :-)
[User Picture]
Date:July 23rd, 2008 06:31 am (UTC)
my control was so-so during pregnancy. they kept saying Emily was measuring big but when she came out about a week and a half early, she was 7 lbs, 11 oz, which to me is not a big baby. I did end up having a c-section but it was because she wasn't going to fit through my hips. the c-section got infected the week following her birth and I was sent back to the hospital. Emily at her 2 year well baby visit in May had moved from the 25 percentile in weight to between 25-50 and the same was true for her height. oh- when she was born, they took her to the NICU to check monitor her. she was bigger than the babies that are normally in there and they didn't have a hat that was big enough for her head --- hehe! they were going to keep her for 24 hours but she was doing so well, they brought her to me by mid-afternoon (she was born at 5 am-ish). all this to say-- I wouldn't worry :)
[User Picture]
Date:July 23rd, 2008 01:45 pm (UTC)
Ugh. I HATE how doctors worry women about the size of their babies. If you're measuring on schedule (YOU, not the baby!), then put it out of your mind and continue having good control. There is a large margin of error when it comes to measuring an unborn baby's weight. Diabetic women with poor control have big babies due to poor control for the most part, *if*, and only *if*, their babies size isn't due to simply being a large baby. Some women have large babies. Its a fact. Your baby could be big because you make big babies and no other reason. Of course you don't want to add to your baby's weight by having high blood sugar, but other than that, your baby's size is as individual as the next person's.

So, to sum up, unless you go on a sugar binge in the next few weeks, even if your baby is 6lbs now, you will be fine. Enjoy the last few weeks of your pregnancy!
Date:July 24th, 2008 03:48 am (UTC)
I liked the way we handled my last pregnancy, and it's how I expect we'll handle this one: endo takes care of/treats my t2, ob handles the pregnancy. Of course, we have to add synthroid to the mix this time and the ob may have a bit more to say on that than the other medications.

I found my ob by asking my endo's nurses, so they are used to working together.

Think of it this way: we have our diabetes treated by an endo because, very often, a regular GP or family doc doesn't quite grasp all the ins and outs of the so-very-interconnected endocrine system. Same goes for pregnancy -- GPs and family docs are capable of managing and delivering but we still feel better going to someone that specializes in GYN.

[User Picture]
Date:July 24th, 2008 01:53 pm (UTC)
Hi! Congratulations on the impending arrival! I'm a Type 1, and just had a baby girl in February. All of the above posters have provided you with good advice. I'll just add my voice to the chorus to tell you not to worry too much. A diabetic pregnancy, as you know, is a great deal of work, but it sounds like you're doing exactly what you should be, and as my OB told me, that is all anyone can ask of you. Some of the baby's size comes from genetics, too!

My experience was that my endo team was overly cautious, and my OB, who specializes in diabetic and other high-risk pregnancies, was a little less alarmist, and was *always* right on the mark. My baby girl measured large at about 35 weeks, and I was so worried. Despite having an aic of 5.4-5.8, I was convinced I'd end up needing a c-section. But my OB told me to do my best to keep my BS in the range outlined by the endo, and most importantly, NOT TO WORRY. She was absolutely right. My beautiful girl ended up at a birthweight of 7 lbs, 6 oz. Her BS was a wee bit low when she was born, but not so low that she needed to go to the NICU. We gave her a wee bit of formula (it didn't affect her ability to nurse at all!) right after she was born to bring it up, and it was fine by the next day. Labour was long (29 hours!) but the delivery itself was a piece of cake. No shoulder dislocations or injuries; only a tiny little tear for mom.

If I could go back and tell my pregnant self anything from my current point of view, having gone through the whole thing, I'd compliment myself for my vigilance, but most importantly, I'd tell myself to relax and bit and enjoy the most wonderful time of my life! And so I wish that for you now, too!

Good luck!

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