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gestational diabetes ramble, twin size - Page 2

post #21 of 29
Exactly. Its just like a mama having 2 babies of the same gestation being different sizes...like, my 2nd was 8lbs 12oz and my 4th was only 7lbs 11oz at the same gestation (give or take a day). My overdue babe was only 8lbs 6oz. They vary a lot in weight-I'm mean, itd be odd for one woman to have a 5 pounder and then a 10 pounder at the same gestation, unless something was going on with one or the other, but all babies vary in size. And as I said, it isnt uncommon for them to slow down for a bit, then go through a growth spurt, or even just start back up again at the previous rate.
post #22 of 29
Thread Starter 
Updating to say that I did meet with my OB and she said nothing about the GD concern being because of the growth disparity. (The nurse or receptionist who called me with the info represented it incorrectly or had it mixed up, I think. "Everything looks great but there IS a difference in twin size, in that one twin is much bigger than the other, and the perinatologist wants you to be tested for gestational diabetes.") According to my OB, the issue was not the 25% difference. It is the fact that twin B has tracked consistently in the 97th percentile. She said big healthy twins are good, and that my babies show every sign of being healthy & happy (she had me in for a NST and took me off after ten minutes, I think, because their strip was "perfect") but that it IS unusual to see 97th percentile.

She also remarked that I'd passed the one hour test with no problems, but that it can be "false" for a twin pregnancy. She said if we ruled out GD as an issue, it might make invasive testing further down the road less likely to be recommended (i.e., amnio to test lung maturity at 37 weeks, since GD babies can have respiratory issues--but that all was predicated on the possibility of the recommendation to induce at 37 weeks, which I wouldn't be comfortable with, anyway....particularly because of the likelihood of respiratory distress!!! I think she thinks 37 week MZ twins withOUT GD are likely to have mature lungs because of the whole "twins are term earlier" rap.)

I neglected to ask her how the one-hour results would be false for a twin pregnancy....didn't ponder it until later. But, I already know that the 3-hour test is more accurate than the one-hour screen, and that the one-hour screen is supposedly just a simpler thing to rule out the majority of people who don't need further testing. Isn't the inaccuracy of the one-hour more in the realm of producing false positives? (i.e., people who fail it, but go on to pass the more accurate 3 hour test?) What is the likelihood that passing results would be FALSE for a twin pregnancy?

I should have asked.

Anyway, my whole approach in questioning her was sort of from the angle of "why suspect GD because one twin appeared to grow less?" And she put that one to rest right away.

The issue with the undiagnosed GD possibility was not the disparity, but the consistent size trend. (The fact remains that both twins have tracked above average, so we're supposedly dealing with two "big babies" even though one is consistently bigger than the other.)

I also started thinking what if the one-hour results were false and these babies ARE growing big because of GD, what would the impact be? (I do compare my "instinctive" diet with its natural aversions/tastes to the probable management diet for GDM, but I don't really know much specifically about that. And it's true that I eat a dish of ice cream with a banana almost every night before bed.... And in the last week before that ultrasound, I had eaten cookies in the middle of the day and a bunch of fruit leathers, when I was out and about and lunch plus an extra apple wasn't holding me.)

re: ice cream. It keeps me through the night and lets me get up feeling "normal" instead of shaky or nauseated, so I've stuck to the ice cream at night diet. I think it helped some with my weight gain (though it's only one dish a day, not like everything hinged on that ) since through the 2nd trimester I was eating mostly broccoli, bok choy, graprefruit, miso, brown rice, carrots/onions/peppers, eggs, apples, avocado and chicken. Closer to the 3rd trimester I added in pork. Not that all of those foods were "lean", but I'd say there weren't tons of calories in most of the things I was able to eat. So I think the ice cream helped.

Only once I was into the 3rd trimester could I seem to tolerate beef, and I started eating fish 2 or 3 times a week (haddock, cod, or salmon) then, too. That ice cream pretty much is the only time I have any dairy at this point, save a dollop of sour cream if I have a quesadilla (which also has cheese in it), or the very occasional grilled cheese (bread doesn't appeal to me very much.)

So, those have been my dietary instincts. No pancakes or French toast (wholegrain or not), I don't tolerate things like oatmeal or other cereal grains, bread, pasta (again, not even wholegrain), and I've been off milk/yogurt/most cheese since the 1st trimester. (For awhile, I ate lots of cheddar slices with apples, but now I just eat apples alone and cheese gives me an "off" feeling. No more nausea, just a bad aftertaste and an icky feeling overall.)


So the upshot is I consented to the three hour test. Which I took yesterday. And found out today that I passed.

I also had an NST, and twin A (the smaller one) wasn't as reactive on the strip as they'd like. Which nags at me a bit, but then, this was after the horrid GD test experience and I went to get some eggs when I finished (4+ hours after arriving at the lab) only to find out that they stopped serving breakfast at 10:15 and they only had things like bagels and breakfast pastries out. Ugh.

So instead of having my usual good protein meal and showing up for the NST, I was feeling icky from the test and from eating "off" for me. Hopefully that's all the NST results were about...

Well, another ramble.

Hopefully these test results put "Doctor Clouseau" and his comments to REST! Twins DO "grow big," and ultrasounds estimate size and can be wrong either way (my first child's late-term u/s measurements were off the other way, indicating a "nice small baby" even though my instincts told me she was 8 lbs + and I disbelieved the results but was relieved that they went "that way" because it was less likely I'd be pressured to induce, or pressured into a c-section for "failure to progress" even though my labor was long because of her positioning.... She was 8 lbs 12.5 oz when she was born, and I still remember my medwife's shock. She actually remarked quietly to the apprentice midwife, "Lucky I didn't know that baby was so big." Irked me so much, just the obvious implication.)
post #23 of 29
Thread Starter 
Also, I was prepared to defend against "suspicions" of TTTS if they came up to explain the growing disparity (mentioning the plus/minus factor of u/s measurements, plus the very normal doppler cord flow, the good fluid amounts, observable bladders with contents, and the usual signs of fetal well-being) but my doc was quick to acknowledge (before I started in) that all signs pointed to no distress or issues accompanying the widened gap in size. There was no playing on my fears with that angle, or trying to say that the larger twin was "growing bigger" or anything like that.

The only issue she voiced was if the overall size indicated that we'd missed a diagnosis of GD. Which, assuming the 3 hour test can be trusted , is not an issue.

I've been feeling like breech/transverse twin B has turned vertex. It's also possible that he jockeyed into twin A status (presenting closest to the cervix.) Wouldn't that be a convenient thing, if the "bigger" twin were suddenly in line to be born first? I don't know how accurate my hunches are, and I can't tell if twin A is still vertex (as he's been pretty consistently) or if he's turned breech....I do feel something hard high up on that side (that always has been twin B's head lying across the top, before now.) Maybe I'm completely baked on the whole positioning thing, but this is what it's been feeling like...a big shift on B's side.
post #24 of 29
Thats good news about the test. Yeah, I had always understood it that they got false POSITIVES with the 1 hour test, not negatives. I know I had a false positive with my first, then passed the 3 hour with flying colors. The tests made me so sick though, I never did them again, lol. I'd do it if I had a good reason to, but I have no history of diabetes in my family, also eat a fairly diabetic type diet to begin with, and I'm only a lil bit overweight. Basically my midwives said I have no risk factors-unless baby was measuring big or they started seeing glucose in my p, they arnt worried about it.

Anywho, its good to see your OB isnt freaking out You go girl! (and wow, an 8lber being *huge*? HAHA-I mean, that isnt exactly tiny, but seriously, I know women who have had 11.5 lbers :P)
post #25 of 29


The ultrasound I had the day before I went into labor estimated Claire at 7.3 and she was only 6.6. We couldn't even get a good read on Ben because at 38 weeks they were so squished together and Claire was laying her head on his stomach and throwing the measurement way off. He ended up being 7.6. AND he was my twin B. And posterior. And he had a nuchal cord. I still pushed him out. It was rather hard at that point because laboring a footling breech and not pushing for 2 hours had exhausted me but I still did it just fine.

Anyway, I obviously don't have mono twins but I wanted to comment to those two things since they related to my situation. Ultrasounds can be way off or a little bit off and you have to wonder if your tech is different each time are they measuring consistently off or bouncing all over the map? Claire was teeny but had a big head (13 3/4 inches) and really long legs so I'm sure that accounted for the size discrepancy.
post #26 of 29
Thread Starter 
Quote:
Originally Posted by DocsNemesis View Post

Anywho, its good to see your OB isnt freaking out You go girl! (and wow, an 8lber being *huge*? HAHA-I mean, that isnt exactly tiny, but seriously, I know women who have had 11.5 lbers :P)
That midwife kept pushing us to transfer upstairs (from the alternative birthing center) to have an epidural and "rest" (It's true we'd been laboring at home from 0% effaced & 0cm dilated for 32 hours, then came in to the birthing center and spent 12 hours there. I was pretty tired and I know my husband was wrecked--he is 6 feet tall and only 132 lbs, very slender frame, and he needs his sleep and his food! I am more of a tank in terms of being able to cut corners where sleep and regular nourishment are concerned, without suffering overmuch. Poor guy. )

Late in the day at the birth center, my labor finally was getting "good" after I left everybody and spent all this time alone in the shower. I got out and dried off and stayed alone (with my husband) walking in the back bedroom, leaning against the wall during contractions. And I was in the zone, relaxing more with the contractions instead of fighting them, vocalizing less, but feeling productive. My midwife said that my being "quieter" during contractions was a bad sign, that things don't get easier with labor, and that this was called failure to progress. She kept recommending the epidural "to rest," and pitocin to "help things along," and kept mentioning my small baby and my excellent chance for a vaginal delivery if I did those things....rather than sticking with our plan and getting more and more tired, and stalling completely. (And ending up with a c-section.) I kept thinking, "I don't have a small baby," but of course I didn't say anything like that!

I know that an 8lb 12oz girl is not huge or off the charts in any kind of unbelievable way. That is part of why hearing my midwife say that ("Lucky I didn't know") just felt so undermining and confirmed how adversarial and pre-conceived her notions and opinions were....hearing from her own mouth that if she'd even suspected that size--which obviously I was able to birth vaginally--she'd have been pushing c-section and calling for surgical backup just based on THAT! I don't know what that late-term u/s actually said in terms of size, but I know she had her nose in my file and she kept saying "you've got a baby between 6 and 7 lbs, most likely under 7 lbs, with excellent chances for a vaginal birth if you just rest and get some help...", so I'm assuming she was relying on the u/s and that the estimate was pretty far off. But also, I think that u/s was a couple of weeks before I actually had the baby.

Even so, I think 8/12 is in the upper percentiles for girls, and most of the perinatologists we've seen have seemed to relax about Twin B's measurements after they find out the size of my first child, (referring to her as a "big baby" or 90-something percentile in a kind of "that explains it" way.) In fact, the first peri we met of the team we're seeing walked into the room after reviewing the scan results with the tech and the first thing he said to me was, "How big was she when she was born?" as he pointed at my four-year-old. When I told him her stats, he gave the tech a pointed look and said, "There you go, there's the reason for the big babies right there."

I was fully expecting my first to be between 8 & 9 lbs. As far as "big" or not, I figure it's a nice "baby-sized" baby! And sort of has bought me insurance, a bit, with the twins. Except for with the one GD-happy perinatologist....
post #27 of 29
Honestly, I think the average baby is around 8-9 lbs-of course it depends on the woman and the baby-but so many OBs push for induction or cesarean before they are even due or get the dates off or freak out over a *big* baby on US, that it majorly skews the numbers to the 7lb range.

Ironically my biggest baby (at 8lbs 12oz) was by FAR the easiest to push out and the smallest (6lbs 14oz-she was 3 weeks early) was the hardest. That seems so backwards...but for whatever reason, the small one hurt so bad the entire time, and the big one is the only one I've had that urge to push really kick in and it really felt good to push.
post #28 of 29
Thread Starter 
Just updating about the size thing.....

I went in for a scan at my OB's office. It was supposed to be a biophysical profile with no measurements (since we did measurements at the perinatologist consult just over a week ago on June 3), but the tech started right in with head & abdominal measurements. I let it go without comment because I was tweaked by twin A's sudden drop on his curve, and wondering if it was a matter of the (different) tech mis-measuring something last week.

(The twins do share a placenta and the gap between them widening to 25% is not really comfy given the possibility of TTTS, but there were no signs indicating any kind of transfer problem so nobody jumped to that conclusion.)

Well, the result of the most recent u/s measurements is that either twin A gained 17 ounces in a little over one week (while twin B gained 6 oz), or last week's measurements indeed were off.

The estimates:

twin A: 5 lb, 13 oz
twin B: 6 lb, 12 oz

This puts them back to their usual size difference, minus the extra gap that suddenly was reported a week ago. And still pretty big boys for 33+ weeks. Though I guess I'm 34 weeks as of today (Friday.)
post #29 of 29
I have not been able to read the other responses so sorry if I reapeat anything that was said.
I had my original GD test and then had to have another because of ecess fluid (which can be caused by GD) And tested slightly pos. the second time. I adjusted my diet and the fluids eturned to normal. WIth that said I don't think size would be reasonable reason to test, but with all the stress with your dh and all it might be easiest/less stressful you to just do the test. Its a pain and all they would do is adjust your diet. Though if you refuse the testing maybe you could appease them by saying you will eat like you have GD?
Its not the most invasive but it is a PITA. Sorry you are dealing with this, try to take the road with the less stress for you, you are goin through alot right now.
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