Barb's Daily Dose

Gestational Diabetes Part 2

3 hour Glucose Tolerance Test (3 hr GTT) 

When a pregnant woman's 1 hour glucose test result is greater than 140, it means that she needs further testing.  It does NOT mean that she definitely has gestational diabetes, it just means that she may be at increased risk and further testing is necessary. So try not to panic yet. 

The next test that should be done, to be safe is known as a 3hr Glucose Tolerance Test. 

• First, she'll be asked not to eat or drink anything for 8 hours before the test.
• Next she'll have a fasting blood sugar test. 
• Then she’ll be given a bottle of sweet liquid to drink, with 100 grams of glucose in it. 
• Then her blood will be tested every hour for the next 3 hours. 

Tips

Many women schedule this test for the morning, because it’s easier to fast overnight. 

Gestational Diabetes

Many women ask me what is Gestational Diabetes? 

Briefly, when diabetes occurs during a woman’s pregnancy, it’s known as Gestational Diabetes. 

We think that it caused by the change in hormone levels, but also by the additional weight gain that occurs. This combination of factors affects the woman's blood sugar and her body's ability to use insulin. The blood glucose levels increase and the amount of insulin available is not sufficient.

Insulin Resistance

We think that for some pregnant women, insulin resistance occurs also plays a role. In that scenario, the food that a woman eats is metabolized into blood sugar. Insulin's job is to help transport blood sugar from the circulation into the cells. When there is an insulin resistance, it's much harder for the insulin to move the glucose into the cells. 

Higher levels of blood sugar, also known as blood glucose, can have harmful effects on both mom and baby. 

Pregnant women & the Flu vaccine

Pregnant women need the flu vaccine 

Now is the time that the flu starts wreaking havoc in our lives. It begins in October and can last until mid-May. About 20% or 1 in 5 people in the US will come down with the flu. If you have little ones at home, you’re almost guaranteed to be exposed. 

Information on the Flu Vaccine guidelines for everyone.

Pregnant women at higher risk

Pregnant women have a slightly less effective immune response to the flu and are at risk for developing a serious pneumonia from the flu. Most Ob doctors recommend that their pregnant patients get the flu shot as soon as possible. 

Types of flu vaccines

Injections  – There are vaccines that contain thimerosal and ones that are thimerosal free, which are available at a slightly higher cost. Experts from the ACOG, the American College of Ob/Gyn physicians say that either are safe for mother and baby. 

Nasal-spray – Are not recommended for pregnant women, but are safe for women who are breastfeeding.

Since I work around pregnant women, I’m getting mine this week.

Baby Names

How many times have you asked a pregnant couple what they plan to name their baby, then after they proudly let you in on thier decision, without realizing it, you find your foot squarely in your mouth. Yikes. 

 

This is a minefield

Be careful wading into this particular pool of conversation. If you don't have a credible "poker face" then might want to practice a big smile and a quick and enthusiastic response, such as, "I love it."

 

What ever you do, please don't cringe or give unsolicited advice on names as it can have long lasting and devastating consequences to new parents, which I hear about during the prenatal visits.  I've known moms who were so traumatized by comments from family members that they are reluctant to share any possible names for fear of being dissuaded. 

 

What not to say

 

I had a dog with that name.

You're kidding,right?

That's my cousin's name, and he's a real jerk.

You should name your baby…..and then fill in the blank with your own preference.

 

For new parents

This is the advice I give my patients, have a list of names that you'd never in a million years consider for your precious new baby.  Names like Bathsheba,  Osgood, Thurston, etc. When someone asks, you can throw that name out and watch their reactions. 

 

During my pregnancy, my patients and friends couldn't help themselves , there was so much unsolicited advice, comments and suggestions, that finally I announced that we were naming the baby, Sparky.  It was plausible enough to stop their comments, and since that wasn't my real pick, I had no emotional reaction to the range of shocked and un-diplomatic responses.  

 

It worked for me.

 

 

 

 

Blood Test instead of Amnio?

New blood test may detect Down Syndrome early

Yesterday, it was reported that Stanford researchers have found a new way to detect genetic abnormalities in babies using a blood sample from their moms. This is based on a study of 18 women where every one who carried a baby with a genetic defect was correctly identified. This new test needs to be studied further on many more women before it will become available to pregnant women, which the researchers estimate at 2 to 3 years.

No Risk

This new test would have no risk to the baby, as it's looking for the baby's DNA fragments in the mothers blood. It's not invasive and there is no risk to the baby.  This is a brilliant concept and doesn't require much blood from the mom. This will be simple blood test that, according to the researchers, will cost about $300.  

Here's the press release.

How it's different

Currently we have a variety of tests that look for genetic abnormalities in babies. The test range from being invasive and risk miscarriage with Amnio and CVS, to being time consuming when ultrasounds and multiple lab tests are used. The other experience that's difficult for parents is the worry as they wait for multiple different lab tests to return.

This new test, if it delivers on it's promise would be have a much faster turn around time and carry no risk of miscarriage. 

Postpartum Depression resources

3 Simple Questions may predict who's at Risk

Recently an article in the Journal of Pediatrics found that 3 simple questions might help providers identify new moms at risk for postpartum depression. For this new screening tool, new mothers were asked to answer "Yes, most of the time," "Yes, some of the time," "Not very often" or "No, never" to the following statements:

1. I have blamed myself unnecessarily when things went wrong.
2. I have felt scared or panicky for not very good reason.
3. I have been anxious or worried for not very good reason.

These questions are modified from a much longer screening questionnaire, the Edinburgh Postnatal Depression Scale (EPDS). I have used this with my patients in the past and found it very helpful. 

Now, we are using a different questionnaire, the Beck Postpartum Depression Predictors Inventory (PDPI). 

In any case, it's my experience that not enough practices use any type of questionnaire. Hopefully, this new shorter version will make it easier and faster to identify moms who are more likely to be depressed and not just experiencing baby blues. 

Angelina Jolie & New Moms

Postpartum is no a Picnic

Angelina Jolie recently delivered twin babies and according to several tabloid magazines may be having some difficulty adjusting to her new life circumstances. If this is true, then it only proves that any woman, from any circumstance needs time to adjust.

Normal
Certainly, it would be completely for a mom with other children at home, to feel a little overwhelmed bringing home twins. Her situation may help other moms who might be feeling ashamed or inadequate because they’re struggling.

Study
In early August, Childbirth Connection, released the findings from "New Mothers Speak Out, National Survey Results Highlight Women's Postpartum Experiences." Read the study here.

One finding that leapt out from the report was that 44% of all mothers reported that “their physical and/or emotional health impairment had interfered with the care of their babies.”

The Best Birth Plan Ever: Part 5

If you’ve been following the previous posts, you know that we’ve been talking about birth plans and how to talk to our OB provider.

Trust

Here’s one of the most important aspects of OB care. Trusting your provider. I believe that providers earn their patients’ trust by doing the following:

• Listening to concerns, fears and priorities
• Remembering that each patient has a unique life story
• Tailoring care to the patient’s individual priorities, whatever they are
• Remaining non-judgmental
• Providing recommendations based on education, experience and the patient’s unique circumstances
• As much as possible, taking the patient’s desires into account when making decisions.

When you don’t trust your provider

Hopefully you have one of the many warm and caring midwives or OB doctors who love their jobs, are great communicators and excellent care providers. Hopefully you trust them and feel comfortable. But if your instincts and the little whispers we all hear at night are nudging you and telling you that this is not the right situation for you, then look for someone else who you are more comfortable with.

What Works for me

This is what I do in my practice.

About 6 weeks before the due date, we schedule a longer OB appointment for a woman and her partner to go over what typically happens in Labor and Delivery, how we handle the most common situations, when to come to the hospital and what happens when they arrive. Only, after we review our typical process, do we look over the birth plan and 9 times out of 10, find that, as it turns out, we’re all in agreement about how things should proceed.

Amniocentesis

Many people have asked me why would a woman have an amniocentesis even if they wouldn't consider any option but continuing the pregnancy. This question has come up a lot recently. My position on whether families should have an amniocentesis is that this is another highly personal choice. There's no 1 right way or wrong way, my job is to provide information that they might not be aware of so that they can make a more informed choice.

Risks

1. The risk of miscarriage from Amnio is between 1:200 and 1:300. The risk is related to the skill of the doctor performing the procedure. So a perinatologist in a University setting with over 2000 procedures under their belt would have a lower rates of miscarriage compared to a OB/GYN in a smaller setting with less experience. Now, let's put that in perspective. The generally accepted risk of miscarriage in the 2nd trimester is the same, about 1:200 to 1:300.

Preparing for Medical Conditions
2. Many families choose to have an amnio, knowing that they would not terminate, as a way to be better prepared in case their child needs specialized care soon after the birth. Over half of babies born with Down Syndrome have significant heart defects that may require surgery soon after birth. Most have difficulty feeding, as well as a whole range of other challenges.

Being Born Prematurely

In the July 17 issue of the New England Journal of Medicine, researchers reported that babies who were born prematurely were more likely to have cerebral palsy and mental retardation, which are long lasting medical complications which would affect the quality of the child's life and also their parents. Surviving prematurity affects all areas of life, from having an increased risk of asthma and needing glasses to needing special education and even multiple surgeries. Researchers have also found that when preemies grow up, they often are less likely to make a high income, they may be unemployed and receiving social security benefits. (Washington Post)

Even with all the advances in medical science, still 1 in 8 babies is born prematurely in the United States, which translates to about a half a million, or 480,000! That's too many babies. Many of these babies will have mild issues and many will be more severely affected. The personal and emotional cost to their parents is enormous. One extra week in mom's tummy may mean:

• the difference between having asthma and not needing a daily inhaler

• It might be that a baby just spits up occasionally or has chronic reflux and throws up every day

• It might be the difference between being able to play soccer and needing multiple surgeries to lengthen tendons in the legs.

• Reading at grade level or needing special education.

Being born prematurely is no picnic, and one of the best ways to find out if you're at risk is to ask your health care provider to be tested for fetal Fibronectin, which is a simple test that can be performed in your provider's office that can predict which moms we need to worry about, and which ones are less at risk.

See http://fullterm.net/ , and Am I at Risk? for more information.