Gestational Diabetes and Macrosomia.

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Gestational Diabetes and Macrosomia.

Postby Erin33 » Mon Mar 10, 2014 12:52 pm

Anyone else going through either or both of these?
I failed my glucose tolerance test and now have to monitor my sugar/carb intake. If I even look at a crouton my sugar spikes. So it's all meat and veggies...which I like but I am bored. Glad I don't have cravings, especially for sweets...I'm lucky in that regard. So I am making it work, not just for my health but for his.
The other issue is that I am 34.5 weeks and he is measuring at 36 weeks. So at 36 weeks we are doing an ultrasound to check his weight and size, especially his shoulder width. At that point we will find out if he will need to come early and/or via c-section.
I'm just curious if anyone is having any similar situations and what's the verdict with your case? I am excited to meet him, so earlier would be fine with me...but ONLY if it means he is healthy enough and ready. I can wait the full amount of time but again, only if it means he is healthy and safe.
#1-Due 04/20/2014 - Angel Baby 04/08/2014
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Re: Gestational Diabetes and Macrosomia.

Postby armywife1980 » Mon Mar 10, 2014 3:32 pm

I am pregnant with #5 and this is my 2nd pregnancy with gestational diabetes. Mine was controlled last time by diet and exercise until the last 2 weeks. I wasn't diagnosed until almost 34wks and my girl was born at 7lb 11oz and perfectly healthy. This pregnancy my guy is measuring ahead by 4wks. I had an u/s at 28wks and he was measuring 32 wks. I just had another this past Friday at 32wks and he's measuring 36wks and estimated to be 6lb 11oz already. The doctor's are NOT concerned as they know that estimates can be wildly inaccurate this far along. DO NOT listen to weight estimates as they can be off by 2lb. Your best bet is to do a trial of labor. If baby is too big your labor will not progress properly. If you are able to control your sugar either by diet or med (I take glyburide) then macrosomia is highly unlikely. Your baby is not measuring far enough ahead to be of a true concern.
Brandie (33) DH (32) Twin Boys (15) DD#1 (11) DD#2 (1yr)
Alyssa Marie 7/20/12 @ 7lb 11oz & 21in long
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Re: Gestational Diabetes and Macrosomia.

Postby armywife1980 » Mon Mar 10, 2014 3:35 pm

Stick to whole grains. You can't completely cut carbs are you will be in constant ketosis and ketones are thought to be potentially harmful to baby's brain if produced in large quantities for extended periods of time. You should be eating 30g of carbs for bfast, 45-60 grams for lunch and dinner and 15g for snack. If your sugar is too high when eating the amount of carbs needed and they are coming from healthy sources like whole grains, veggies etc then you need to let your doctor know so that they can get you some medicine to help with it.
Brandie (33) DH (32) Twin Boys (15) DD#1 (11) DD#2 (1yr)
Alyssa Marie 7/20/12 @ 7lb 11oz & 21in long
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Re: Gestational Diabetes and Macrosomia.

Postby SusanT » Tue Mar 11, 2014 7:50 am

I also have GD with this pregnancy and on insulin. I am currently measuring 1 week ahead but they don't seem to be too concerned at the moment. Armywife's carb intake numbers are spot on, according to the diabetes counselor I met with. You need carbs and can't cut them out. It's just a matter of choosing the right ones.
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Re: Gestational Diabetes and Macrosomia.

Postby armywife1980 » Tue Mar 11, 2014 9:57 am

Here they send you to a nutritionist after a diagnosis :) I don't understand why they would be concerned about macrosomia. If baby is measuring 1.5wk ahead that puts baby in the 60-65% overall in comparison to babies at the same gestational age. Macrosomia is technically babies that are above the 90th percentile. My guy is right on the line at 4wks over. I was scared he'd measure further ahead than the last time but since I've started the glyburide his growth has stayed consistent. I just urge you to PLEASE do your research before allowing an induction or csection. Doctor's do not always give the best advice and what your doctor is suggesting is not in accordance with ACOG recommendations either which is what they should be following.
Brandie (33) DH (32) Twin Boys (15) DD#1 (11) DD#2 (1yr)
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Re: Gestational Diabetes and Macrosomia.

Postby sarahmarie » Tue Mar 11, 2014 7:13 pm

Do not buy into those growth ultrasounds. If you read the detailed report by the radiologist it will always say +/- 2 ibs...

When I was 38 weeks along with DD1 they told me that she was 10 ibs on the growth scan. My doctor talked me into a c-section by scaring me into thinking that she might break her shoulder or my pelvis on the way out. I bought into it because I was scarred by what she told me and so I had a planned c-section at 39 weeks and well DD1 came out 8ibs 4 oz... I was very disappointed in myself for letting my doctors negative words effect my outcome so much and from allowing me to even attempt a vaginal delivery.
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Re: Gestational Diabetes and Macrosomia.

Postby spirited7777 » Fri Mar 14, 2014 1:07 am

on the other hand, shoulder distotia is best avoided surely??
me: 35 df: 30
ttc #1 - 2-13
bfp - 5-13
m/c - 6-13 - 10w0
6 month ttc break
bfp - 11-1-14 - new yrs oops/shocker - first time lucky after break
26-3-14 - first ultrasound (13w6), measuring 4 days behind, everything else looks great. 4d image strongly suggests it's a boy, he looks like dh already! go team blue! :)
2-4-14 - 2nd ultrasound - measuring perfect - 14w6 - short legs making me think it might be a girl after all!

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Re: Gestational Diabetes and Macrosomia.

Postby armywife1980 » Fri Mar 14, 2014 6:00 pm

http://www.aafp.org/afp/2001/0701/p169.html

ACOG does not recommend section or induction for a baby that is expected to be large. The doctor should be following these guidelines. A suggested section for a baby NOT measuring even close to over the 90th percentile is asinine on the physician's part and not in keeping with what the body that governs them says. Shoulder dystocia occurs in plenty of infants that are not macrosomic due to positioning. A trial of labor should be allowed and this doctor is way off the mark.
Brandie (33) DH (32) Twin Boys (15) DD#1 (11) DD#2 (1yr)
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Re: Gestational Diabetes and Macrosomia.

Postby spirited7777 » Sat Mar 15, 2014 10:55 pm

i've had 2 friends had to have c-section, one because baby wasn't big but her pelvis was too small. the other, the baby was big (she is 5'11), and they just thought it was safest. i'm sure it all depends on the case, but hopefully you'd trust your doc enough to be able to take his or her advice on something like this....

i should add that this is in the UK where they avoid c-section if they believe a natural labour is at all safe and possible. our c-section rate is about 20% of all births, as opposed to in the US where i believe it's closer to 45%. (dont quote me).
me: 35 df: 30
ttc #1 - 2-13
bfp - 5-13
m/c - 6-13 - 10w0
6 month ttc break
bfp - 11-1-14 - new yrs oops/shocker - first time lucky after break
26-3-14 - first ultrasound (13w6), measuring 4 days behind, everything else looks great. 4d image strongly suggests it's a boy, he looks like dh already! go team blue! :)
2-4-14 - 2nd ultrasound - measuring perfect - 14w6 - short legs making me think it might be a girl after all!

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Re: Gestational Diabetes and Macrosomia.

Postby armywife1980 » Mon Mar 17, 2014 1:01 pm

Measuring 1.5 wks ahead is no where near big though and she didn't mention any pelvis dimension issues which the doctor wouldn't be aware of unless a pelvic exam was done. One cannot tell just by looking at someone. ACOG is an American thing so in the UK they might have different guidelines. Here, it's made very clear in the guidelines that c section and/or induction is not indicated unless baby is suspected to weigh 10lb or more in mothers with diabetes or 11lbs or more in mothers with no diabetes. They also make it very clear that weight estimates are very unreliable. Her doctor needs to follow that unless there are extenuating circumstances surrounding it. Unfortunately, doctors here aren't always out for the patient's best interest. During my clinicals in OB I heard several times OB's discussing inducing or sectioning patients solely for the physician's personal convenience plus people are litigious here. One is always better off researching and making an informed decision rather than just taking the doctor's word for it. I've learned this the hard way in both personal experience and during nursing school.
Brandie (33) DH (32) Twin Boys (15) DD#1 (11) DD#2 (1yr)
Alyssa Marie 7/20/12 @ 7lb 11oz & 21in long
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Re: Gestational Diabetes and Macrosomia.

Postby Erin33 » Mon Mar 17, 2014 9:43 pm

Thank you all for your replies, some good info. I should have been more clear that what I was looking for was experience on these issues. Mostly because I knew nothing and wasn't given a lot of info at my visit. During my visit she saw my GT test and then also said I was measuring larger than normal. She said she wanted me to see a dietician to get my sugars under control and that at 36 weeks we would do an ultrasound to measure him. That is all she said and I didn't bother to ask questions. So when I got home, I of course went to the internet and saw all the stuff about macrosomia and possible c-section due to giant shoulders. So I came here wondering what people had experienced.
I have seen my doctor since then and asked her about what I had read. She scolded me (jokingly) and said to just call and ask her to clarify before getting online. Haha. She is awesome and is on top of it. She said to take the measurements with a grain of salt, that there is about a 20% error rate going either way. And that if it is strongly indicated that I would have a 10+ pound baby by full term, then we intervene. But only with induction not a c-section. The c-section would only happen IF there was something more serious and natural birth was not working.
So I feel better about it, I want a natural birth if at all possible. I am fine with inducing, if the situation calls for it. She is not big on c-sections unless medically necessary. She is all about being as natural as possible. Which is why I switched to her when we got pregnant. The doctor I was previously seeing in the same practice is all about filling his books with scheduled c-sections. Not a good thing. :(
#1-Due 04/20/2014 - Angel Baby 04/08/2014
Me-34
DH -35
TTC #1 since 08/2012 - Successful July, 2013
History of Endometriosis (laparoscopy 07/2003, lesion removal). History of Chocolate cysts, PCOS unconfirmed.
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Re: Gestational Diabetes and Macrosomia.

Postby spirited7777 » Mon Mar 17, 2014 10:31 pm

sounds like you have a good doctor who you can trust - glad. to be fair to your other doc, he is doing scheduled Cs because thats what many women in the US want, or at least think they want.
me: 35 df: 30
ttc #1 - 2-13
bfp - 5-13
m/c - 6-13 - 10w0
6 month ttc break
bfp - 11-1-14 - new yrs oops/shocker - first time lucky after break
26-3-14 - first ultrasound (13w6), measuring 4 days behind, everything else looks great. 4d image strongly suggests it's a boy, he looks like dh already! go team blue! :)
2-4-14 - 2nd ultrasound - measuring perfect - 14w6 - short legs making me think it might be a girl after all!

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Re: Gestational Diabetes and Macrosomia.

Postby armywife1980 » Tue Mar 18, 2014 7:02 am

Well, try not to worry. Measuring 1.5wk ahead it's highly unlikely your baby will reach proportions that would make a section a consideration. I had GD last pregnancy as well so I am speaking from experience. I wasn't diagnosed until 33wks because the office failed to call and tell me I had failed the 1hr and I didn't find out until the 32wk check up that I needed to do the 3hr. I was 34wks before I seen disease management for a glucometer and met with the nutritionist. My sugars were well controlled by diet last time until the last 2wks and my fasting was high. Unfortunately, there isn't much you can do about that one but medication so I did have to take glyburide to help out. My daughter was born only weighing a few oz above the national average even though I went many weeks with GD being uncontrolled because I wasn't aware. She was 7lb11oz and only 6oz larger than my 1st daughter with whom I didn't have diabetes. I am so glad your doctor isn't scalpel happy. Induction at 39wks is standard for women with GD that require medication but otherwise it's not indicated. Induction will not reduce the risk for shoulder distocia unless you are induced well before baby reaches 8lb14oz when it becomes a concern. Best of luck and it can be very hard to find a doctor that will be cooperative. I'm currently battling mine because I want a trial of labor before a section. My baby is measuring a little over 4wks ahead though but is my 5th and I have a generous pelvic cavity and have delivered both breech and posterior babies. From what I've heard from the nurse in NST she has a bit of a reputation for pushing sections though. I don't have much say in who I see though because it's a military facility so I guess I'll just have to continue to deny her until she gets the point. My boy doesn't feel particularly heavy to me, just very long.
Brandie (33) DH (32) Twin Boys (15) DD#1 (11) DD#2 (1yr)
Alyssa Marie 7/20/12 @ 7lb 11oz & 21in long
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Re: Gestational Diabetes and Macrosomia.

Postby spirited7777 » Thu Mar 20, 2014 1:22 am

that's not cool being pushed to have a section. i'm pleased i am in UK where as i mentioned, they are loathe to section unless absolutely necessary. hope it works out well for you both xx
me: 35 df: 30
ttc #1 - 2-13
bfp - 5-13
m/c - 6-13 - 10w0
6 month ttc break
bfp - 11-1-14 - new yrs oops/shocker - first time lucky after break
26-3-14 - first ultrasound (13w6), measuring 4 days behind, everything else looks great. 4d image strongly suggests it's a boy, he looks like dh already! go team blue! :)
2-4-14 - 2nd ultrasound - measuring perfect - 14w6 - short legs making me think it might be a girl after all!

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Re: Gestational Diabetes and Macrosomia.

Postby armywife1980 » Thu Mar 20, 2014 6:34 am

Thank you spirited777. I seen a different doctor at my appointment this week who was much more reasonable and honest about the risks of delivering vaginally. Though it's recommended to section if baby is suspected to be 10lbs or more, he did admit that it's frequent that the weight estimates are off. Also, in 25 yrs of practice, he's seen a lot of cases of shoulder dystocia but no fatalities and only 1 case of nerve injury. He is understanding of my decision to not do an elective section based off of size and to allow me to labor. Here they treat the condition and not the patient. Meaning, they follow the "standard of care" which is basically a blanket protocol and practices of evidence based care according to each individual situation is rare unless the patient fights for it.
Brandie (33) DH (32) Twin Boys (15) DD#1 (11) DD#2 (1yr)
Alyssa Marie 7/20/12 @ 7lb 11oz & 21in long
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