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    Questions? Ask Henci!


    Find out what other moms-to-be are asking. Join in the discussion with Henci Goer, whose expertise is determining what the research tells us best promotes safe, healthy birth. If you would like to contact Henci outside of the Ask Henci forum, send an email to Goersitemail@aol.com.

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    Archived User
    I am at 27 weeks and diagnosed with borderline GD. I fit all the criteria for a GD diagnoses: overweight, over 40 and two previous births over 9lb babies. So far I have been able to maintain good glucose levels via diet modifications. My concern is in relation to fasting glucose levels. It seems to be getting a little more difficult to keep these numbers within range, while my daily ones are not an issue.

    My midwife has agreed to 105 being the cut-off, but there does not seem to be a consensus on the timeframe for those levels. Some say 8 hours must pass; others say once your past 4 hours. I understand that there is more concern placed on the fasting numbers being high, than there is for the daily numbers. Why is this and what are treatment options if they exceed 105 on a consistent basis? Are there any other alternative methods for dealing with this issue?



    By: lil'bit
    Archived User
    Let me start with why the concern when sugar is high after an overnight fast. First, a little background: During pregnancy, certain hormones make insulin less effective at transporting glucose out of the bloodstream into the cells. This is a good thing because the excess glucose is then available to the baby for growth and development. “Insulin resistance” increases as pregnancy advances. By the third trimester, women tend to have higher blood glucose levels after eating than nonpregnant women (hyperglycemia), despite secreting normal and above normal amounts of insulin.

    Blood sugar values after ingesting glucose vary substantially because, even with an exact amount of glucose drink, any number of factors can affect how fast the glucose enters the bloodstream and how quickly the pancreas responds. If you looked at a graph of blood glucose values, say, 2 hrs after the glucose drink, you would see the classic "bell-shaped curve," but it would look like a fairly gentle hill with the average value at the crown of the hill. The fancy way of putting it is that there is a wide variation around the mean (average). However, during overnight sleep, the pancreas should have a chance to catch up. In almost all women, including women whose sugar is on the high side after eating, it does. If you looked at a graph of fasting blood sugar values, you would see something that looked much more like Pike's Peak, in other words, a much smaller variation around the mean. All of this is to say that high fasting blood-sugar values are a symptom that your pancreas is having more of a problem than the common run even among women labeled "gestational diabetics."

    I have a couple of articles on gestational diabetes up on the web you can link to from my own website. One gives you background, the other is intended to help you make informed choices. Go to www.HenciGoer.com/articles and scroll down to them. You'll get basic info on diet and the value of exercise among other things. However, in cases where sugar levels cannot be controlled by diet, insulin is the usual next step.

    What are the consequences? I am not a doctor or midwife, so this is based on my reading of the research: Provided your blood sugar was normal in early pregnancy, the only consequence for the baby is that he or she is likely to be bigger than average, but you already know you have big babies. You would have known this regardless of blood sugar values because high maternal weight before pregnancy is the strongest predictor of the baby's birth weight not blood sugar level. It only looks like blood sugar levels are the key factor because high-weight women are also much more likely to have high blood sugar levels in pregnancy.

    There is one concern with big babies: you are more likely to have a problem at the birth where the head is born but the shoulders hang up behind the pubic bone (shoulder dystocia). The best way to prevent or relieve this problem is to plan to give birth on hands and knees or to turn to hands and knees should the problem occur (the Gaskin maneuver, the only obstetric maneuver named after a midwife).

    As for you, Mother Nature is giving you a warning. She is telling you that you are at very high risk of developing Type II diabetes and that you would be well advised to lose weight on a sensible diet after you have the baby and to make moderate, regular exercise a habit.

    -- Henci By: Henci Goer
    Archived User
    Henci,

    Thanks for the additional information! I have already read the articles at your site as well as your books, " The Thinking Woman's Guide to a Better Birth" & "Obstetric Myths Versus Research Realities". All of which prompted me to post my question.

    By: lil'bit
    Archived User
    I'm always glad to be of service. By: Henci Goer

    All Times America/New_York

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