Log onto Squarespace
Archives
« Random Thoughts on (VBAC) Informed Consent | Main | Birth: 1987 »
Friday
Mar052010

What do we do with the GDM study?

A recent article disclosing the results of a large study relating to Gestational Diabetes has caused quite the furor. Gestational Diabetes: Blood Sugar Levels Once Considered Normal Are Not Safe for Baby, Mother is one of the overviews written about the studies that came out in the March issue of Diabetes Care. (I went to read the article, but it costs $45, so I’m going on the several overviews I’ve read. I tried to pick the most comprehensive article with which to begin this discussion.) (Subsequently, several people sent me the study. You all are the best!) The study looked at 23,000 women in nine countries over an almost ten-year period and was sponsored by the National Institute of Health. 

Looking from far away or merely taking the majority of the headlines into consideration, it sounds like the study only says, “New gestational diabetes guidelines could find more women at risk.” This sends Natural Birth Advocates (NBAs) into a frenzy because they see obstetric care pulling in droves of women with a wider net, stamping them with the screaming diagnosis, “GESTATIONAL DIABETIC” with the sub-text, the true meaning of the diagnosis, “I get to call more of you Gestational Diabetics, will order more testing, will schedule more inductions and will cut more of your bellies.”

There is another way to look at this.

The information given to us via this study is vitally important. It can be used to save more mothers and babies if care providers are able to impart proper instructions regarding how to confront and manage Gestational Diabetes Mellitus (GDM). Granted, the track record isn’t so great, but someone has to start somewhere. There are so many NBAs involved in the different organizations; ICAN, Birthing From Within, Bradley classes, state midwifery organizations as well as all the midwifery schools, childbirth educators and even doulas can all play a part in curbing the GDM crisis.

I can understand the concerns about increasing the intervention rates, but what I have a problem with is the number of women who discount the information at all. It doesn’t take but one look on a city street to see the enormous amount of obese people coming and going. Add to the obviously fat folks the sort of chunky women and you have an idea of what the study is reporting. Not acknowledging how fat we are, how poorly we eat or how little we exercise is sticking our heads in the sand.

We in the NBA group totally get the quality food thing; eat close to the earth, eliminate artificial foods and drinks, more veggies than carbs and meat and dairy as condiments rather than main dishes. Yet, how many of us adhere to this all the time? How many of us really eat the way the soldiers did on the Lewis and Clark Trail… foraging, hunting and carrying any food eaten. I use the L&C expedition because that is, in our country, one of the last examples of a number of Anglos eating the way these bodies were meant to eat. They also are somewhat representative of the amount of exercise our bodies are equipped to accomplish every single day. The expedition averaged 8 miles a day. That is if they walked every single day of the 2.5 year journey, which they did not. They camped several times, they were stopped by the elements, sometimes for several weeks and many days, they stopped simply to hunt for and prepare food. (I’m kind of a L&C weirdo, having read books and books about their travels and, of course, watching the PBS Ken Burns special several times.) When the Corp was moving on foot, they averaged 15-20 miles a day. Carrying everything they owned and ate. With a woman who was carrying a newborn, then toddler (who certainly nursed)… and Sacagawea never held the Corp back, to the surprise of the men.

Around the world, we can find similar examples… or we could have before Western influence changed many cultures. Migrating used to be the norm all over the earth, farming being a relatively recent discovery. And, before technology, farming was back-breaking, continuous work. Do any of us do remotely this sort of movement in our lives? Do any of us only eat food we can grow or forage or hunt? Do any of us only drink water we travel to and carry back to our houses? Imagine the calories expended looking for or gathering food. Imagine how eating occurred… some days extremely small amounts while others, after a hunt, great amounts (L&C ate an average of 9 pounds of meat per person after a hunt.)

Was there Type 2 Diabetes Mellitus (DM) in these days? Unlikely. The pancreas doesn’t struggle to keep up with the food intake until there has been too much for, sometimes, several years. But, before DM come more subtle insulin issues, what we know as Insulin Resistance, Metabolic Syndrome, Syndrome X or Pre-Diabetes. DM doesn’t just appear out of nowhere; it isn’t there one day and wasn’t there the day before. Diabetes slowly and gradually builds, the pancreas, at first, able to tackle the extra loads, but getting tired always pumping out insulin until there is just no keeping up with what’s needed.

DM used to be a disease of old people, but the age of diagnosis has gotten earlier and earlier, now, sometimes as early as six years old. Six years old. As diagnosing the disease has gotten younger and younger, have people had fits that the pharmaceutical companies are making up the disease so they can make more money? Is there anyone thinking doctors are full of crap that someone under ten could possibly have an old person’s disease? If they are, they are rare –and delusional. Look at our kids. Look at their pot bellies, their fat arms and legs, watch how they walk slower and slower, sitting more and more –and eating less and less fresh and home-prepared meals.

If we see these people, know these people, become these people, how can the NBA discount the new information that the numbers needed to create unhealthy pregnancies, unhealthy babies and babies that are far larger than our bodies are meant to make?

For years, NBAs bragged about having babies over ten pounds; I was one of those women. We stuck our noses up to those stupid doctors who told us our babies were too big and wouldn’t fit through our pelvises. We said, “See… nothing was wrong with us. You tried to scare us with your doomsday predictions, yet we showed you, didn’t we.” Today, we have information that really, really, women do not naturally make babies that big without having some insulin issues. I’ve heard for years, “Big babies run in my family.” Well, so does diabetes. That you had a big baby and your mother had big babies is a wild red flag that, unless you keep your weight in the normal range, the range that doesn’t tax the pancreas, you are courting diabetes and, most assuredly, dancing with insulin issues already.

How long do we want to taunt the odds that “We’re just fine and dandy, thank you,”? If we can see and know the serious number of diabetics in our lives, look around and see how fat we’ve all become, why is it so far-fetched to think that there could be damage far earlier than previously thought? Information isn’t finite. We continue learning from experiences and this study that was just released offers that new information.

Midwives wholeheartedly embrace (cling to) any new study that says great things about midwifery, home births, that says less technology or interventions are called for, yet when something new comes out that asks for more technology or new standards, it isn’t just railed about, but outright ignored. How do NBAs justify these contradictions?

Instead of freaking out that doctors are, once again, trying to wrangle women into the operating room, perhaps we can hear the message of this study as, “Let’s do our best to keep women from having cesareans.” In fact, this information is stated specifically in the articles. Instead of blah blah blah-ing that doctors are meanies and they try and find anything they can to institute more rules on us, maybe we can see this as an opportunity to try and get a handle on the diabetes issue.

Just like we talk about speaking to young girls about their choices in childbirth, we need to add to that discussion how vital good/proper/healthy eating is for our growing babies’ health and, in many circumstances, even life.

It’s time we stop seeing fat talk as something rude or that hurts someone’s feelings. It’s time we stand toe to toe with the fat issue and do something about it. Obviously, being polite and ignoring it hasn’t gotten us anywhere. As women get fatter and fatter, we will all begin to see the devastation insulin issues can have on our pregnancies and babies. When will we begin paying attention? Let it be now.

(My dad, 1939, born weighing almost 13 pounds. My entire paternal side has died from complications of diabetes. You can see my grandmother's poochy belly 20 years before her diabetes diagnosis.)

References (7)

References allow you to track sources for this article, as well as articles that were written in response to this article.
  • Response
    Response: Check This Out
    Nice page, Preserve the fantastic job. Many thanks.
  • Response
    Response: check my blog
    Lovely Web-site, Continue the good work. Regards.
  • Response
    Response: us gold bureau
    - Navelgazing Midwife Blog - What do we do with the GDM study?
  • Response
    - Navelgazing Midwife Blog - What do we do with the GDM study?
  • Response
    Response: Calgary SEO
    - Navelgazing Midwife Blog - What do we do with the GDM study?
  • Response
    - Navelgazing Midwife Blog - What do we do with the GDM study?
  • Response
    - Navelgazing Midwife Blog - What do we do with the GDM study?

Reader Comments (20)

I'm confused. It says that 180 used to be considered normal for a 1 hour test. But my doctor (perinatologist) sends you for the 3 hour OGTT if you get higher than 140. And I thought that was pretty much usual standard of practice. And I looked at a table previously that showed that more than 50% of women who got 180 on the one hour would be diagnosed diabetic after the 3 hour. So I don't know how they are saying 180 was ever normal.

(FTR I am not GD myself--I'm seeing the high risk guys for other stuff--but since I am fat and have a diabetic father I try to keep track of this stuff. My own 1 hour was 130 and so I freaked when I saw the headline!)

March 5, 2010 | Unregistered CommenterLily

Very nice article - thanks for your thoughts. I had been wondering what to make of this news release, and you had really good points. Thanks!

March 5, 2010 | Unregistered CommenterDiana J.

Well, there are areas in the country where people walk 6+ miles a day, do carry their own water to home and eat a butt load (that's tech talk for a lot) of water. Namely I did that in my first year of college, I was the slimmest and healthiest I have ever been even at 210lbs (and that's my ideal weight according to my fat content and lean mass). So, we could all move to Fairbanks, live in a 20' by 20' cabin with an outhouse and no running water, dump the car, and we'd do fine - except that's not practicle of course. Just saying, some of us have done it or lived that life, some still do it.

You're right though, this pregnancy I am losing weight, not hungry for whatever reason (I think it has to do with the 1,000 IUI X 2/day vitamin D I have to take), and this fetus is right on size wise for gestational age. This is new for me, my sons were 2-3 weeks ahead size for gestational age, I don't have a pouchy tummy when not pregnant and do not nor ever had any whiff of diabetes in my life, just the obesity (and the super healthy extra thick thighs and fat upper arms that spells health for the obese, tired of the wing flaps though). So I am going to have a 7-8lb runt instead of my 9lb 6oz, 22" and 10lb 5oz, 23" baby. Weird.

I am trying to re-adjust how I feel about being obese, for a long time I just thought I was perfectly healthy despite it, and actually I was if you only look at that time and not look at lifetime health, but maybe in the long run I need to do some work. I don't want to weigh less then 210, not at all, I'd like to get there though. I wish eating was divorced from emotions most of the time, right now it is (I think the vitamin D has done that, but I was really really really deficient too).

But our whole country needs to take a good look at ourselves too, Kevin Smith was kicked off a plane for his weight when really he's become average, Scott Simon had an thinly veiled fat attack essay about it and the vitriol seeped through (I guess he's never been fat, and thinks it's okay to demean folks based on weight). We're a country of people who have gotten to the brink of metabolic disaster and many of us have fallen off the side. There is shame and disgust at ourselves mixed in with tasty food that is plentiful and cheap which we use to comfort ourselves, kind of like the oil prices in the late 80s. It's not just diabetes, not just babies, it affects every single one of us before birth to the end of life.

Maybe we women need to be the ones stand up and fight this fight, we are the keepers of culture and we kind of define what familial culture is, including food technology in the home. Ge da hun (rise up!)!

March 5, 2010 | Unregistered CommenterEthel

I hate how macrosomia gets blown off, but I also wish there was more attention paid to people who have macrosomic infants but DON'T get gestational diabetes. With my over 10 lb daughter, my midwife quickly assumed that my diet had been responsible and that I had probably had undiagnosed GDM. So, my next pregnancy, I avoided sugars like the plague and ate mostly nuts, other good proteins, vegetables and some fruits. I got an 11 lber, a gestational week younger than his older sister. GDM can absolutely lead to macrosomia, but it doesn't always mean that and not having GDM doesn't guarantee you a regular sized baby either.

Macrosomia is a serious issue, and I hate when it turns into "your baby won't grow a baby too big for you to give birth to." Well, tell me that when your baby had a 3 minute shoulder dystocia with cord compression leading to 1 minute apgar of 0. 17 1/2 inch shoulders were absolutely too big for me to safely give birth to, and I deeply resent when experiences like mine get glossed over.

In good news, I think I figured out how *I* need to eat to avoid a macrosomic infant. I tried eating normal/low amounts of protein in the 1st trimester instead of protein loading, and I'm now 32 weeks pregnant with a 31cm fundal height. I had 2 normal sized babies before going to a high protein, Brewer type diet and 2 very large infants with placentas the size of large pizzas being on the Brewer diet. I ditched Brewer this pregnancy, and I'm back to a normal trend instead of 3-6cm ahead fundal measurements.

BTW, I've never failed the glucose challenge test. Even with my 11 lber, my 1 hour level was 96.

March 5, 2010 | Unregistered CommenterJHolmes

@JHolmes: What you say is dead on about the Brewer Diet. I've also ranted about that, too, but get blown off.

So, somewhere there's a connection here. My own (former apprentice) friend Donna had a hx of LGA babies with shoulder dystocias, so when she seemed to be getting bigger, she changed her diet to meat and salad, almonds and little else. She still had a 10+ lb baby with a gnarly shoulder dystocia; Donna's hip was dislocated trying to get the baby out. Now, I ate almost every meal with Donna, so she and I were absolutely baffled by what happened. She isn't fat, was on her exercise bike for several miles a night... and she still had a macrosomic baby.

I agree there will be macrosomic babies that defy explanation (today), but we really need to be clear that macrosomia, in and of itself, is not a manifestation of a normal pregnancy. And that the overwhelming majority of macrosomic babies are from moms with insulin issues.

You all know I'm fat. Have been since I was 6 and had my tonsils taken out. For many years, I bragged about how healthy I was, how my labs were fabulous, how I passed my GTTs... sounding very much like you few who've commented. I'm 49 at the end of this month. I'm assuming you all are much younger. I'm begging you to hear me. Humor the old lady.

March 5, 2010 | Registered CommenterNavelgazing Midwife

Dude, I'm not arguing, so please do me the honor of not condescending to me about my weight or my blood sugars (which I SAID I am paying attention to, ffs.) I just wanted to know under what rubric 180 is considered a normal score on ANY glucose tolerance test! Because as far as I knew, it was always considered abnormal.

I think the Brewer diet is stupid. It has never been scientifically validated, for one thing. I followed it religiously with my first, under the guidance of hb midwives. I gained 60 lbs and was miserable. I threw that to the side with the second and gained a net of 20.

March 5, 2010 | Unregistered CommenterLily

Not trying to be condescending *at all*. Sorry if it came across that way.

March 5, 2010 | Registered CommenterNavelgazing Midwife

I'm right there with you, NGM. I have a sister with PCOS and a mother who is pre-diabetic, so I know how important it is to watch my weight and my dietary intakes. I don't want to strain my body any more than necessary, and I cook pretty much entirely from scratch.

My normal un-pregnant weight is about 133 lbs at 5 ft 5 inches, and that's higher because ... well, let's say I could feed an army of hungry newborns. ;-) I haven't been over a 34 band or under a F cup in years.

I have a theory on how this stuff works: I think it's an underlying progesterone/estrogen issue in terms of excess protein helping an already overenthusiastic endometrium grow too large a placenta, which in turn grows too large a baby. I also have extremely high fertility, with 9 pregnancies (2 twin) including 4 live births thus far in about 8 1/2 years. My old OB told me that I wasn't necessarily getting pregnant more often than anyone else but that I'm implanting pretty much everyone.

I think I've got a very very hospitable uterus to start out with, and if you try to add protein to "help the placenta grow" on top of that you're going to get a very large placenta. I found a mammal study that showed placental overgrowth preceded fetal overgrowth, and that lines up with my experience of above average fundal heights but with babies measuring 50th percentile at the 20 week scan. Something's got to be inflating that fundal height, and my placentas are absolutely gigantic. If you can get an oversized placenta in I think it was cows causing oversized calves, it isn't a stretch to think that a similar mechanism could happen with some women. And my 11 lber in particular did not remotely look like a sugar baby. He looked like a normal 4 month old.

There are also studies showing high carb/low protein intake (I think specifically in the 1st trimester) being linked with lower birth weight. So, I think there's something going on there, and that there really might be too much of a good thing for some people. I haven't gone sugar bingeing (gee, let's grow a huge baby for a TOTALLY DIFFERENT REASON!) but very controlled protein 1st trimester and then just normal eating after that has resulted in a small to average sized baby for me this time.

For me, the proof is in the fundal heights. There is nothing normal about a 18 week uterus measuring 22cm when gestational dates have been confirmed by early ultrasound. 2 babies normal diet = normal size. 2 babies "Super Awesome Brewer Diet" = an 11 lber and a 10 lber with nuchal cord x2 stuck for 3 minutes and a 0 Apgar score. Decide to screw the Brewer Diet and eat the foods I gravitate to naturally including whole grain breads? My smallest measuring baby yet, and it's not like there's been a change in father of baby or even that my caloric intake is different. And as we plan on having another 4-6 kids, I should have ample opportunity to replicate results.

Sorry for the novel! I'm just so sick of the "no such thing as a too big baby!" thing. Yes. Yes there is. I've had two, and it was scary as hell, and they're not big kids now! Now they're both about 25th percentile in height and weight, so not a case of "gee... just a kid who is a giant."

March 5, 2010 | Unregistered CommenterJHolmes

As a midwife, I'm not worried about 10 pound babies that were meant to be 10 pounders, I'm quite concerned about 10 pounders who were meant to be 8 pounders. And also those women who are meant to have 8 pound babies but grow a 10# baby.
I wonder if A1C will have a place in maternity care along side the 1 hour screening test? I do think there are women who are running higher than necessary blood sugars on a regular basis, but never reach "high" levels.
There is not one person in my Dad's family that hasn't gotten diabetes if fat + forty. Two have escaped by being quite thin. I'm working hard to stop being fat. because forty comes one day and there's nothing I can do about that. I do not want to lose my vision, the feeling in my feet, go on dialysis, or die from complications of diabetes.
I'm not a good diet counselor, although I try to advocate for changes in the third trimester. Dessert 2 times a week or less, one glass of milk or less per day, restricted white foods. Telling people what to eat hits my buttons, so try to do it as little as possible.

March 5, 2010 | Unregistered CommenterJane

The biggest issue I have with GD is it becomes a label that implies a lot of treatments that I can't find any evidence to support. I'm willing to buy that monitoring and controlling blood sugar is a good idea.

However, I start hearing about induction because of the GD even when my last baby was of normal size. My doctor doesn't want me to go beyond 41 weeks with this one or so in part because of the GD, even though he's 55%tile.

My biggest question is, aside from monitoring and controlling blood sugar, how should GD pregnancy be treated differently than a normal pregnancy?

(As a side note about your comment with diabetes developing gradually, perhaps, but the signs of it appeared suddenly for me. I had GD with my first pregnancy, tested normal, and started my second pregnancy with pre-diabetes one point away from diabetes. That's less than a two year gap. The reason I got tested was because I was monitoring my sugars, so I know that the actual time it took from normal to almost diabetic was a matter of months. My post-meal sugars remained basically normal (under 140) over that period. I am overweight, and my lifestyle in no way resembles that of L&C, but I'm not obese, I do exercise regularly and eat relatively well.)

March 8, 2010 | Unregistered CommenterKrisWithGD

Curious what's considered a high-protein diet, versus a normal amount of protein in a balanced diet. I've been told I need 60-75 grams a day while pregnant. That's probably a little higher than I would normally get, but I haven't made drastic changes to get there. (Like for a snack, I'll have a handful of nuts along with a piece of fruit, or I'll have peanut butter on toast instead of honey - that sort of thing.)

(And I don't have a history of macrosomic babies, so I'm not necessarily that worried about it, but with my first pregnancy, I wasn't given a lot of nutritional guidance - just eat a balanced diet, avoid simple sugars - and with this one I was given more specific instructions. Mostly I'm just curious.)

March 8, 2010 | Unregistered Commenterchingona

@Kristi - Around here, it's not that uncommon to want pregnancies, ALL pregnancies, to end at 41 weeks.

How should GD pregnancies be treated differently? An interesting/odd question given that GDM is a not a normal variation in a pregnancy; it's a serious complication. It isn't *so* complicated that I don't feel uncomfortable having GDM clients (if they need insulin, they are risked out), but it does call for additional testing and monitoring, even if that includes an extra ultrasound or two or an NST/BPP near the end of the pregnancy... IF indicated.

@Chingona - The Brewer Diet calls for 80-120 grams of protein. That is, to me, far above what is needed.

March 9, 2010 | Registered CommenterNavelgazing Midwife

Great post!

Add me to the list of women with big babies (big on my side and husband's side) even though both of us are normal weight people who exercise regularly and have pretty healthful diets. I did gain about 40lbs with each pregnancy though. I was never anywhere near failing the 1 hour GTT.

Do you think following a GDM diet could be helpful for people to have a smaller size baby even if they don't have any demonstrated insulin issues? First baby was 9lbs posterior and I coulldn't push out. Next baby was just shy of 10lbs was also posterior and I just barely pushed her out (face up) after 3 hours of pushing. I would really love not to go through that again. I asked my OB and he didn't think I could do anything about it.

March 10, 2010 | Unregistered CommenterMargaret

Boy... now I'm just twice as conflicted.

My mom had big babies. I was her smallest at 8 pounds 13oz. My brother was over 10 pounds. But my mom wasn't overweight at all, she started at 125 pounds and would gain 50-70 pounds each pregnancy. Currently she's less than 120 pounds at 5'6".

Here I am, 7 months pregnant. Pre-pregnancy weight was 255. I lost 18 pounds in the first trimester (no puking), and now I'm 253. I've been following the high protein diet, and my fundal height has been measuring spot on, if not a little small.

I had a gestational diabetes scare - a 2 hour reading of 189. I rigorously kept track of my blood sugar for several days, but no matter what I ate, I couldn't get a spike remotely close to that. Turns out that my midwife's glucose meter need to be recalibrated, and I don't have gestational diabetes at all. I can't complain, the scare helped me eat better and ramp up my exercise.

Another factor is that out of my entire family and extended family (over a dozen aunts and uncles by blood), there's only person that has diabetes. My cousin was diagnosed with Type 1 at 10 years old. And it most certainly wasn't a case of being overweight (he's always been on the lean side), but probably because he had cow's milk at 1 years old.

So... why the big babies with no diabetes or history of one? Can't big babies run in the family?

April 1, 2010 | Unregistered CommenterLeah S

Hey Barb!

I wanted to give you an update on how ditching the Brewer Diet wound up working for me after macrosomic infants. I gave birth just shy of 42 weeks to a 9 lb 12 oz, 21 inch baby girl whose size was very reasonable for my body. There were birth complications, but none of them had anything to do with her size. Girlfriend did decide to go ROT and have both arms flayed out after her head was out, but her positioning issue really wasn't a shoulder dystocia in the true sense and was resolved inside of 30 seconds. And her placenta was about half the size of her big brother's and sister's, leading to estimated blood loss around 250cc instead of the 1250 and 1300 I lost the last two births.

Following the Brewer Diet with lesser or greater degrees of fidelity, I had a 10 lbs 2 oz at 41 weeks and 11 lbs at 4 days past due. Adjust the scale to make them all 42 weeks and I had a 9 lbs 12 oz instead of probably 10 lbs 8 oz or 12 lbs. I'll take it!

So, as a mom with no GDM who eats healthily, gets plenty of exercise and always starts pregnancy at a healthy BMI, I will be restricting protein and focusing on good carbs in the 1st trimester and controlling sugars throughout pregnancy but especially 3rd trimester. And we thought my daughter was a lot smaller, too! How she managed to hide 9 lbs 12 oz of herself into a 37 cm fundal height is beyond me, but that's what she did.

I don't know if this is helpful to you, but thought you'd be interested to see what the end of the story looked like over here. Have a great weekend!

May 22, 2010 | Unregistered CommenterJHolmes

I often look to see what is going on in the realm of fat women and pregnancy. I couldn't walk away from your blog posts about it.

Here is what the latest research shows; Income is directly related to lifespan, and we aren't just talking about people not being able to afford care b/c those on the mid-scale can, we are speaking of complications. It is also DIRECTLY related to BODY SIZE.

Research done on baboons shows lower-ranking baboons tended to gain fat stores rapidly-(They often did not receive as much food as their higher counter-parts) and when their blood was measured for stress hormone, it was higher. This led to complications, and they died early. Now humans aren't baboons. But, surprise, the blood stress levels in human beings also reflected this. The rate of bloodstress level and complications, regardless of body mass, went down with the possession of affluence and power.

Body size is also related to race. Races who've been oppressed have higher BMIs than those not so. This is related to why native american, african american and hispanic american women who RESIDE in AMERICA (doesn't happen in indigenous or supportive environments) tend toward higher BMIs and therefore more complications.

Aquiring fat deposits is a way to deal with hardship. It's not what kills you. The hardship itself is the sword you fall on.

I find your posts about fat people's bodies awful. Being an indigenous woman, it leaves a terrible taste in my mouth. It reeks of being written by one who hasn't tasted hardships. Have you ever seen a "food desert?" How difficult is it to buy "organic" when the only place to purchase food is a govt. vendor or a gas station? How difficult to walk when it is dangerous to go outside?

I'm so sorry our bodies offend you. I'm so sorry we have harder pregnancies (but LOWER rates of pre-term labor, that seems related to body mass as well) but we have a right to exist. And procreate. And hope our children know easier lives and caring people.

June 7, 2010 | Unregistered Commentererica

Do you *not* know that I am over 250 lbs? Of *course* I understand that minorities (in this culture) have higher rates of obesity. I absolutely understand that the poorest often have to eat the crapiest food because it's cheapest and that's primarily what public assistance pays for and hands out in food closets. I WAS THERE. I know first-hand everything you are saying.

Just because you are in the middle of the war doesn't mean no one else is.

You can justify being fat all day long, but the research shows that fat = unhealthy for MOST people; and the fatter the person, the unhealthier the person.

You're going to *really* like (not) the next piece I am working on. Get your angry pen ready!

June 7, 2010 | Registered CommenterNavelgazing Midwife

FWIW, I had my A1C tested three times (once each trimester) while pregnant here in NZ, in lieu of other GD testing. Results were absolutely normal, and absolutely identical the first two times (5.1) and slightly higher the third time (5.3). Also tested myself randomly with my husband's meter with no abnormal readings.

My BMI is about 30, and I craved a lot of animal products while pregnant, so while I didn't try to load up on the protein, I probably did anyway, My daughter was 9lbs 4oz at birth at 40+6 gestation, though in all fairness she tried to come out a week earlier and my messed-up body didn't let her, and experienced a moderate-severe shoulder dystocia that resulted in a collapsed lung and a 1-minute-APGAR of 3.

Interestingly enough, a year later, she continues on the same percentiles as she was at birth, so I'm not sure if that's a way to tell if the size at birth was the one she was 'meant' to be. I guess 9lbs4oz isn't truly macrosomic...

June 21, 2010 | Unregistered CommenterVW

@VW - *Technically*, 9# 4oz *is* macrosomic. Anything above 4000g or 8# 13oz is considered macrosomic or LGA (large-for-gestational-age).

My first was also 9# 4oz. I ate like *crap* and gained about 70 pounds with that pregnancy. My next baby, 10# 6oz (with a sd), grew on a veggie diet that was probably 50% cheese. It was all organic/local cheese we got from the co-op, but it was still an enormous amount of fat and calories. I only gained 30 pounds with her, but had never lost the "baby weight" from Tristan.

It's so hard to talk theoretically without really examining things. It sounds like you have and it *might* have been the meat... hard to tell now, though. Was the meat organic? If not, there were growth hormones in the meat that some feel (anecdotally) can contribute to a larger-than-should-be baby.

Did you walk a ton? Walking after *every* meal gives the pancreas a boost.

This table is interesting: http://www.rajeun.net/HbA1c_glucose.html It shows that 5.1 and 5.3 are on the higher side of what a normal should be.

5.1 and 5.3 *are* within the normal range, however, according to the ADA.

Will we ever know all we need to know about macromia, diabetes, etc? Doubtful anytime in my lifetime.

I'm glad your baby is doing great. My Meghann turned into a brilliant child.

June 21, 2010 | Registered CommenterNavelgazing Midwife

That's an interesting table -it does seem very strict from what I know from my husband's diabetes management. I did walk a lot with my two dogs, but probably not right after eating, But I will keep these things in mind, along with the non-Brewer diet, when/if the next time rolls along.

Speaking of SD, what's your recommendation about previous/primary SD for subsequent births? Do you recommend against home birth b/c of the risk of recurrence? I'm trying to see how different people/regions handle this to figure out my options.

Thanks!

June 21, 2010 | Unregistered CommenterVW

PostPost a New Comment

Enter your information below to add a new comment.

My response is on my own website »
Author Email (optional):
Author URL (optional):
Post:
 
Some HTML allowed: <a href="" title=""> <abbr title=""> <acronym title=""> <b> <blockquote cite=""> <code> <em> <i> <strike> <strong>