Induction for GD? - Mothering Forums
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#1 of 15 Old 03-22-2007, 03:21 PM - Thread Starter
 
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Has anyone heard of getting induced due to gestational diabetes? My levels are still sky high even though I've started the special diet and am being very careful. My dr. mentioned the possibility of induction the other day. Just wondering why they'd do that -- baby too big? GD out of control?
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#2 of 15 Old 03-22-2007, 04:25 PM
 
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The reason I've heard (over, and over, and over : ) is that they're afraid the baby will be "too big." I'm GD, controlled with diet. I'm also obese, AMA, and my first baby was 10 lbs. 9 oz (and 23" long). Sorry folks, but this baby's gonna be big, too, GD or not. Most hcp's are TERRIFIED of big babies. Thankfully we have a mw who isn't, and while she would be open to induction if we wanted it, she won't push. The ob, however, would have induced me today if she could have.

My 2 cents.

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#3 of 15 Old 03-22-2007, 04:45 PM
 
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Yes, it's my perinatalogisits policy to induce GDers sometime between 39-40 weeks. Not only the big baby thing (shoulder dystocia), but also because of a decline in placenta function can lead to stillbirth. I actually have an induction date set already, and I hope the baby comes before then, but if not, I am okay with being induced.
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#4 of 15 Old 03-22-2007, 06:45 PM - Thread Starter
 
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Thanks guys. I have such mixed feelings about this. I mean, I obviously want to have a healthy baby and I don't want her to break bones on the way out. But I also can't shake this feeling that many dr's are induction-happy. My own mother is petite and I was a 9 lb, 10 oz baby and she had no trouble pushing me out. Plus, I see so many large babies born naturally here on the board. But I didn't know about the placental-failure thing. I guess I'll see what dr. has to say at my app't on Tuesday.
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#5 of 15 Old 03-22-2007, 06:46 PM
 
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They haven't mentioned anything to me about a deteriorating placenta, but the ob did mention a higher risk of stillbirth at my 1st appointment with her. She didn't say how much higher ...

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#6 of 15 Old 03-22-2007, 06:48 PM - Thread Starter
 
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Originally Posted by heathenmom View Post
They haven't mentioned anything to me about a deteriorating placenta, but the ob did mention a higher risk of stillbirth at my 1st appointment with her. She didn't say how much higher ...

Yeah, the stillbirth thing I keep seeing in my GD materials. Everything I read says it is a "very rare" complication of GD. Still, though, it makes my blood run cold.
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#7 of 15 Old 03-22-2007, 07:09 PM
 
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I have GD and was told I would not be "allowed" to go beyond 40 weeks, and I know if my sugars were high or I was measuring big I would be hearing "inductions" already, but I have been lucky and my sugars are mostly normal and at 38.4 w the baby measured 37 cm, so nothing has been said yet.
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#8 of 15 Old 03-22-2007, 07:19 PM
 
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GD alone is not a reason for early induction. Uncontrolled GD, however, is -- the placental failure that you'll hear doctors talk about as one of the complications of GD is primarily a problem when the mother's blood sugar is running too high on a regular basis. If you can get your blood sugar into the normal range, you'll vastly reduce your risk of complications from GD. I know a lot of people are very resistant to medications, but seriously, if you need meds or insulin to get your blood sugar down, then I'd personally do it.

The standard protocol for gestational diabetics used to be to induce around 38-39 weeks, based partially on some older studies done on women whose blood glucose control was not as good as it is possible to maintain today. If your blood sugar is in good control and baby is looking healthy, there is no reason to induce, particularly not before term. But keeping your blood sugar in control is the name of the game.

Good luck. I know this is no fun. I was seriously depressed during my first pregnancy when I was diagnosed, especially after reading about all the potential complications. But the risk of those complications drops significantly -- in some cases, vanishes entirely -- if you have blood sugar in the normal range.
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#9 of 15 Old 03-22-2007, 07:30 PM - Thread Starter
 
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Thanks. I am committed to following the diet religiously and, if that doesn't work, I'll take insulin. I really want my little girl to come when she (and my body) are ready if possible.

As for the normal range, my dietician said that my number should be below 95 before breakfast and below 140 throughout the day. I got 108 this morning and 158 after lunch. Does anyone know if those numbers are grossly out of the norm, or if there is hope if I stay on this diet (have only been following it for 2 days so far)?
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#10 of 15 Old 03-22-2007, 08:49 PM
 
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My fasting is normally beween 74 and 92 before breakfast, although my dr woudl prefer it over 80.

I test my blood 2 hours after meals, and I am suposed to keep my levels between 80 and 120. Occasionally I will have higher levels, but then I look at what I ate and try to determine what might have made my levels high.

I have been doing this for ~1 month, and I have learned a lot - for instance, cottage cheese is the best breakfast for me - it keeps my levels lower all day than other breakfast meals. I have found out that I need to eat a lot of protein with any cars that I eat. Also, I now know enough that I was able to eat an ice cream sandwhich right after lunch and my level 2 hours later was 92! It may take a few days or more, but you will figure out what makes your levels higher and then avoid those foods. Oh yeah, they stuck me on a 2000 calorie diet, but I could tell after a day or so that I would lose way to much weight on it, so I am instead watching carbs - no more than 30 for breakfast, 15-30 for snacks, and no more than 60 for lunch and dinner. I usually eat less than that except snacks - I have a hard time finding low carb snacks that I like.
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#11 of 15 Old 03-22-2007, 08:59 PM
 
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108 is not crazy high, and neither is the 158. But you don't want to be running numbers that high on a regular basis, of course. There is definitely hope that if you follow the diet and get good exercise you can bring the numbers down on your own, but if it doesn't happen, please don't beat yourself up. Fasting numbers especially are very difficult to bring down with just diet and exercise -- it can be done, but they aren't directly affected by the meal you just ate, unlike your post-meal numbers. Fasting numbers are more a reflection of your background insulin resistance, which during pregnancy unfortunately tends to just keep rising. It's because your placenta is producing hormones that help increase insulin resistance, and not because you are eating poorly or have "really bad diabetes" or whatever. That having been said, some people are able to just follow the diet + exercise and keep their numbers in range.

I agree that testing religiously after meals will help you identify your "trigger foods" and help you know what to eat and what to avoid. Everybody's body is a little different, although in general you can't go wrong sticking with low-glycemic foods and making sure to eat a lot of protein along with your carbohydrates. Exercise after meals also tends to help me quite a bit. A good brisk walk, or 20 minutes on the exercise bike, can drop my level by 20-50 points (sometimes more).

A lot of care providers are revising their GD protocols these days, and I am hearing from more and more women whose providers didn't start talking about induction until 40 weeks, or even later, which is obviously a huge improvement from the days of automatic induction at 38 weeks. Unfortunately, there are still some providers out there doing the automatic induction at 38 weeks thing, even though there is really no good reason for it. If it comes down to the wire for you -- which hopefully it will not -- my advice is just to use stalling tactics and perhaps go in for a few more monitoring tests (non-stress tests, etc.) than you would otherwise. If they say, "Well, we want to induce," ask why. If the baby is looking healthy, your blood sugar is in good control, and there are no other contraindications such as high blood pressure, etc., there's no reason you shouldn't progress normally with your labor.
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#12 of 15 Old 03-22-2007, 09:02 PM
 
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Take a good look at the diet that the dietician has given you and use your common sense. The one recommended around here is so high in carbs that I would never survive on it and I would have HUGE issues with my sugars. Give it a few days and keep a food diary, it's best to figure out on your own what puts your sugars up because we are all different.

Mom to Kayleigh (05/07) Jacob (05/09) and Ned decluttering 615/2010
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#13 of 15 Old 03-22-2007, 09:24 PM - Thread Starter
 
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JanB (and others) -- you are a wealth of information! Thank you so much. I am determined to get this under control and to avoid early induction.
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#14 of 15 Old 03-22-2007, 11:34 PM
 
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Hi, my doc says my baby will probably be around 8 pounds by 40 weeks (with GD) so I haven't heard a word about induction. I did hear about the fear of the baby being stillborn or not surviving after birth from hypoglycemia due to the baby's body not being used to life without my sugar supply.... If this is a concern with your doctor, insist on breastfeeding immediately and exclusively. I've read that supplementing the baby's sugar intake with a sugar IV can cause the same problems it's meant to cure for babies of GD moms who are suffering from hypoglycemia. Breast is best for a reason.

Request delayed cord cutting so the baby doesn't immediately get cut off from your sugar supply after birth. Also be sure to snack during labor if you can, to keep your blood sugar from getting off too far. And don't even worry about large babies. CPD is truely diagnosed in only something like 1 in 2500 cases and if your pelvis isn't big enough, try changing positions for pushing. All fours or squatting can help open you up as much as 30% more!

This is all what I've discovered with the massive amounts of reading I've been doing. In the end, I'd say induction is a small price to pay for a healthy baby, but I'd do everything I could to avoid it anyway as it is in no way natural. Best of luck!
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#15 of 15 Old 03-23-2007, 01:43 AM
 
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My MWs aren't concerned about my glucose levels but I am (I declined the GTT and am just testing myself.) I test 1 HR and 2 HRs after meals and try to keep things in check but I am still finding trigger foods. I ate potatoes baked and fried and they didn't bother me much so when DH made potato soup, I ate it. BIG mistake - 1 HR level was 190. Of course, my 2 HR (more like 2 HR 15 mins) level was only 76! So in this case I think it was more of a hypoglycemic episode. If I only went by 2HR numbers I don't think I'd ever notice it was high. I spike 30-60 mins after a meal almost exclusively. I had it go to 190 on one other occasion and to 170 once. Usually though, it is around the 125 range 1 HR after a meal. It worries me a bit but my MW is not worried at all - so I dunno! I've been trying to snack throughout the day and eat a mixture of proteins and carbs. I hope everything works out ok, especially since I just have a feeling baby is going to be late, rather than early.

I'm kinda worried about keeping it even during labor. I definitely don't want it to spike then - since it could cause hypoglycemia in the baby.

I've done a lot of reading about it and overall, no one is truly really sure how it affects the baby. Some studies show it can cause significant problems while others find no significant adverse effects.

Me (37) ~ DH (39) ~ DS (3) ~ TTC #2 since 4/10
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