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Friday
Aug062010

Barb’s Advice to Quell GDM and/or Humongous Babies

I am not a nutritionist or dietician. I have not taken any nutrition classes ever in my life. I did study prenatal nutrition in my midwifery education, but that was the most basic of the basic. I’m a Licensed and Certified Professional Midwife with personal and professional experience working with women who have had very large babies (over 9 to 9.5 pounds) and/or Gestational Diabetes Mellitus. I have attended and assisted at far too many shoulder dystocias, including having had one myself, so know first-hand the most dreaded complication macrosomic babies might endure. 

Over the years, I’ve helped women tweak their diets, using information from a variety of sources, but mostly from clients’ personal experiences – anecdotal evidence, which, in no way, is scientific or even universally accepted by other midwives. It does seem each midwife has her own beliefs regarding Large for Gestational Age (LGA) babies. 

Here’s the finale to the above disclaimer: Talk with your care provider before changing your food plan, especially if s/he has given you a plan already. These food ideas do not replace medications if you have been prescribed them. Use your common sense. Research things yourself. But, most of all, take responsibility for growing a healthy child by eating the best and most colorful foods you can find… colorful, locally and organic/pesticide-free if possible. 

And walk your butt off. 

Let’s begin. 

  1. Eat tree-bark carbs. While carbohydrates can wreak havoc on blood glucoses, the more complex they are, the easier they are on the pancreas. If a carb tastes like tree-bark, it’s a good one to have in your diet. Eat whole grain breads and pastas; not whole wheat, but whole grain. The crunchier the better. The faster it spoils out of the refrigerator, the better. What’s great about tree-bark carbs is you will eat much less of it than spongy carbs… and your pancreas will, once again, thank you.
  2. No soft fruits. Eat hard fruits and berries; these are much easier on the pancreas. Soft fruits (peaches, nectarines, bananas, etc.) elevate glucoses more than the harder ones. Extremely simplistically speaking, when your glucose skyrockets, your pancreas squirts out huge doses of insulin to try and metabolize the food. What can happen over time is the pancreas gets tired, thereby not giving out as much insulin is as needed, so the extra sugars go to your belly and hips. When the pancreas still works, but gets tired, this is Insulin Resistance (IR), a precursor to Diabetes. It isn’t uncommon to have IR for 10-15 years before Diabetes kicks in.
  3. No sugar! This might seem obvious, but many people overlook it. No soda, no candy, no cake, no ice cream.
  4. No juice. Juices are nearly pure sugar and have none of the good things your body needs. It takes about 6 apples to make one 8 oz. glass of apple juice. Can you imagine eating 6 apples in one sitting? When eating the fruit itself, you get the very important fiber. Fiber has a role in slowing down the zipping sugars so they can be metabolized more efficiently.
  5. (This seems to be a Net Rumor, so take it with a grain of salt.) No Aspartame/Nutrasweet. Mind you, this was lost on me for a couple of decades, but when I saw several very trusted doctors explain that Aspartame, several hundred times sweeter than sugar, tricks the pancreas into thinking a huge amount of sugar has been dumped into the body. The pancreas then goes into overdrive to metabolize it, but cannot keep up, making the cycle of sweet causing sugar crash (hypoglycemia) causing hunger all over again. Since I’ve stopped drinking Diet Coke, my glucoses are, for the first time in a very long time, back to normal. This might be one of the best parts of the entire recipe. Please adhere to this one! (My own experience mirrors what I say here, but I'll be darned if I can find one study that proves this!)
  6. Very limited dairy, especially for the last 6-8 weeks. Yes, that means yogurt, too. Standard dairies use hormones to grow their cows giant and to make them grow giant very quickly. Ingesting that, hypothetically, can help your baby grow bigger than s/he should, too. If you choose hormone-free dairy, that is better, but know that lower-fat types of dairy are actually higher on the Glycemic Index (GI) than full-fatted ones. So, there’s a trade-off… higher GI? Or more fat. If your diet, overall, is meticulous, some dairy wouldn’t be the worst thing. Ice cream should be ignored except in the absolute most celebratory event.
  7. Walk after every meal. The pancreas loves help and walking is the other part of the equation, besides food choices, that helps your pancreas be more efficient and not get overly-tired. I encourage women to walk at least 10-15 minutes after every meal. A regular exercise regimen is fantastic, too, but the walking after meals can make an enormous difference in how your body processes glucose.
  8. Just because you “pass” your Glucose Tolerance Test (GTT) doesn’t mean you aren’t having glucose issues. The common refrain after someone announces their big baby’s weight is, “And I didn’t have Gestational Diabetes (GD)! I passed my GTT!” The GTT is an archaic method of determining how the pancreas is doing during pregnancy. Insulin Resistance is a fairly new piece of the pancreatic puzzle and the tests for that are not a part of testing in pregnancy. While testing glucoses 4 times a day can give you some good information, the BGs fluctuate throughout the day and night and can affect you (and the baby) even though all screens/tests say the contrary. Someday, we’ll have a continuous “glucometer” that can be implanted in at-risk folks (and I bet pregnant women will all be considered “at risk”) and that mechanism will be able to determine the minute details of a woman’s daily glucose ups and downs, helping her to create a much more accurate plan to stay healthy.
  9. Ask for a Hemoglobin A1c at the beginning of pregnancy. The HbA1c can “see” what glucoses have been for the previous 8-12 weeks. The HbA1c is not used to diagnose Gestational Diabetes Mellitus (GDM), but that first A1c can offer a glimpse into the pre-pregnancy pancreas’ ability to process glucose. Some midwives will do three HbA1c’s, when mom first enters care, around 28 weeks and then again at the end of pregnancy. However, the pancreas can go from IR to GDM very quickly and by the time the HbA1c sees the change, the pregnancy might be over and the effects already completed. However! If you are able to continue eating great foods that come from as close to the earth as possible and walking after every meal, you will be far ahead of the game if you do choose to do the GTT at your 28-week visit, the first HbA1c offering a sort of baseline to your mid-pregnancy levels.
  10. Take your Vitamin D. What does Vitamin D have to do with GDM? Growing bodies of research are demonstrating that many diseases and complications are arising because of Vitamin D deficiency. You can ask for a Vit D test at your first prenatal to see where you are, but know that the lab’s recommended levels are far below what the newer research shows, yet even with the old levels, as many as 70% of pregnant women are terribly deficient in Vitamin D. The standard dose for adults is 400 IU a day, but plenty of experts say that is at least 10 times too little, and probably more. I have my clients taking 6000 IU a day and they are doing very well… shorter and less painful labors (Vit D helps the uterus to work more efficiently) and if they have GDM, it has been fairly easily controlled. Many ask about going out in the sun for Vit D instead of a supplement. The rule for getting enough Vit D in the sun is: you have to live below the middle of the country, be outside for at least 20 minutes every single day of the year and bare your entire chest, back, arms and face. If you are able to do that, great! If not, you need supplementation. 

I hope this helps those of you looking for more information besides the "Gestational Diabetes Diet" they hand out in nearly useless classes. I welcome other ideas as well.

Reader Comments (39)

Barb-

I am completely guilty of saying "and I didnt have GD/I passed my GTT" after having my 10lb7oz baby. He will be three in a week, was born vaginally with a shoulder dystocia, and was 1.75 pounds heavier than the biggest of my three other babies before him. I still remember my GTT results-122. He never had a problem with his blood sugar after delivery. I don't doubt that I had some insulin resistance of some sort.

Would you say that every woman should follow the diet recommendations, or just those with a history of a macrosomic baby?

August 6, 2010 | Unregistered CommenterRose

If a carb tastes like tree-bark, it’s a good one to have in your diet.
I LOL'd at this one!

Aspartame, several hundred times sweeter than sugar, tricks the pancreas into thinking a huge amount of sugar has been dumped into the body.
I'd heard this before. Your mention of Diet Coke reminded me of a former coworker. She used to drink a 3-liter bottle of Diet Coke just about every day, but around the time I started, she was down to "just" a 2-liter bottle per day. I think she drank Diet Coke because it was "calorie free" (or at least, low cal), so she thought it would help her lose weight, or at least not gain more. All of her family including herself were/are big (and tall), so I don't know how much was genetics and how much diet and lack of exercise [I am in MS, after all -- we're not exactly known for our healthy cooking and active lifestyles]; and now I'm wondering how much may have been due to insulin resistance or something else like that, perhaps *caused* by (or exacerbated by) her Diet Coke consumption. And she was a pharmacist -- you'd think she'd have known. :-/

August 6, 2010 | Unregistered CommenterKathy

Can you provide any links to the research showing aspartame causes insulin release? I've been searching pubmed, etc. and the only research I can find doesn't show an insulin release with aspartame. This idea seems to be pretty rampant on a lot of natural health websites but I don't see any citations to primary research.

August 6, 2010 | Unregistered CommenterChristie B

As a pharmacist who cousels diabetics, diabetic mothers & normo-glycemic mothers, you need to be careful of your recommendations.

Fruits, no matter their origin, have fructose as their sugar which goes into the Krebs cycle - just as sucrose and glucose. The rate at which it enters is dependent on how rapidly it is absorbed into the blood stream via the gut. All fruits will enter at the same rate (not statistically different) unless it is a slice of orange under the tongue (which is absorbed faster and bypasses the liver).

In addition, the extra sugars are stored as glycogen in the liver (thus the problem of "fatty liver"). When sugars can no longer be stored as glycogen, they again enter the Krebs cycle and get metabolized as fat to be stored in many places throughout the body - most commonly in the abdomen.

Finally, be very, very careful of advising about extra Vitamin D. We are seeing an upswing of Vitamin D overdose, which has a tremendously varied symptomatology. It is a fat soluble vitamin and can have deleterious effects on the mother and the fetus in excess.

Vitamin D's primary function is as a precursor to steroid hormones and calcium homeostasis. Its tremendously complex and oral non prescription Vitamin D suppliments will not have a significant effect on either of these and might have a deleterious effect on other organ systems - the kidneys. If a mother takes her prenatal vitamin and has 15 minutes of sun exposure per day, she has enough Vitamin D to have her body function. The uterus does not demand extra Vitamin D and the fetus might have adrenal dysfunction if excess is consumed since it is fat soluble.

I appreciate your initial statement you have no nutritional background. Given that is the case, I'd advise the mother to follow her OB's instructions on nutrition and follow up with those who might have more extensive knowledge in nutrition and the many factors which might influence glucose tolerance or perinatal exposure to excess vitamins or any other nutrition supplements.

After all, we know that estrogen is vital for implantation and maintenance of the fertilized ovum. However, we found in the 50's that excess estrogen in the early weeks had deleterious consequences. Given that Vitamin D is a steroid precursor and a precursor to estrogen, we might find in 30 years, excess exposure might have consequences we did forsee. We have found that with excess Vitamin E and Fish Oil in the cardiac patients.

Caution and "less is more" is a good plan for soon-to-be mothers. Take your prenatals and get plenty of calcium supplements - milk, yougurt, cheese, brocolli, etc.

August 6, 2010 | Unregistered CommenterLinda

With regards to D, I've been reading study after study, speaking to the pregnant body's need for much more than is in prenatals and that appropriate levels of D most certainly *do* affect the uterus as a muscle, the rate of cesareans being lower for women with adequate D because they do not have failure to progress or uterine atony like women can with inadequate amounts. I appreciate, very much, your knowledge... surely most of it is way more than I possess... but on this, I will disagree.

Re: the aspartame... damned if I can find ONE THING about it affecting insulin levels! How crazy is that? I'll modify what I said in the piece. Thanks for the challenge. And besides studies, I scoured Diabetes org's websites also trying to find any info that would back up my own empirical experience. Nada.

And one note about following OB's nutrition advice. They typically have ONE CLASS in med school; about as much as I've had.

August 6, 2010 | Registered CommenterNavelgazing Midwife

Isn't it true that some women just grow big babies?
My son was 10.5 lbs and was born rather easily with nuchal arm. This one seems to be just as big despite diet changes and a 2 vessel cord.
Not trying to come off wrong, just wondering. :)

August 7, 2010 | Unregistered CommenterMicah

As a biochemist you misrepresented insulin resistance....The pancreas still secretes insulin, but the body's cells do not respond to it. Therefore, the cells do not uptake the sugar as the insulin is signaling them to do; instead the sugar remains in the bloodstream. Eventually, the pancreas can fail, because it has been releasing ever increasing quantities of insulin to get the cells to respond, but that is not the first step in insulin resistance.

August 7, 2010 | Unregistered CommenterMeghan

Thank you for your kind thoughts. Its good to have a nice discussion about something I deal with daily. I'm a CDE in addition to a pharmacist, so that may give me more interest & insight into articles about diabetics & diabetic pregancies.

As for studies looking at Vit D in pregancy - there are very few of them. Why? It is difficult to do a double blind, well controlled study on pregnant women - just as it is in children. The risks are very high if we do find something damaging, so very few IRBs will approve studies looking at that.

However, from animal studies, we do know that large amounts of Vitamin D in the first trimester can affect fetal development. In the second and third trimester, this is not an issue and since bones are growing in length and weight, more D supplementation may be justified. However, one must weigh the risks of its affects on the heart if the levels get too high.

One caveat of most all vitamins - you can almost never get too much of any one vitamin via foods (however, there are case reports of excess Vit A from eating too many carrots). A diet rich in foods with Vit D, in addition to that found in the prenatal in addition to 15 min of sun exposure will assure a woman of enough D for a health pregancy for the most part. Those with metabolic issues or dietary issues are more complicated.

There are 4 forms of Vitamin D and you can find supplements in 3 forms. However, only one form is biologically active and the other 2 require liver & kidney metabolism for activity & 1 is not biologically active at all. There are also many ways to measure Vit D levels and we don't have a standard yet. Some measure cholecalciferol, some measure 25-hydroxy Vit. D, and there are others depending upon what endocrinologists want to look for. So, looking at studies requires a skeptical eye by first looking at who is doing it, what the parameters the researcher is looking at, how the study is designed, etc. Studies in healthy adults is going on right now to look at exactly which form of Vit D will tell us most about the physiology in the body & which form of supplementation is the best. These studies have not been done for 40 years and in the last 40 years we have learned a lot more about the vitamin, what it does and why - although it still has lots some of us find a mystery.

Although you have a skeptical eye toward nutritional knowledge of physicians, I do not. As a pharmacist, I only took one class too, but my knowledge of nutrition and how vitamins and minerals act as drugs (& they ARE drugs) and how drugs act on vitamins and minerals was gleaned in my years of clinical training - all of which took 8 years and many, many rotations.

My daughter, who is a physician (although EM), can talk circles around me because she too was given that one talk, but the information comes up over and over again as she went through her clinical rotations - endocrinology, PICU, NICU, Peds, OB, oncology - all of these patients have issues with vitamins in one way or another.

That information has served her well as she sees pts in the EM & must discern if she is seeing illness from an endogenous or exogenous source.

My advice still stands - until we know further on what high doses of Vit D might do - avoid doses beyond that in prenatals in the first trimester when the infant is developing organs. After that, an increase might be warranted after evaluating diet.

Best Regards! You bring up timely topics!

August 7, 2010 | Unregistered CommenterLinda

Interesting stuff. I have some hypoglycemic issues and in my research it seemed that glycemic load was more useful than glycemic index, thus soft fruits really aren't that bad because they have a low glycemic load. Just something else to think about.

August 7, 2010 | Unregistered CommenterLaura

Meghan: You are right, I forgot about the cell's resistance to "absorption." I'll definitely add that. Thanks for the reminder.

ALL of you science-women, you are helping, not only me, but others, so much. And I really do appreciate it. Sharing on FB is pretty incestuous; sharing it on the blog is a whole 'nother story and I really do appreciate -and welcome- the input.

As far as some bodies "just making big babies," I don't agree at all. I used to, but not anymore. I've seen too many women who had big babies develop diabetes in their 40's. And if you had a big baby *and* were "overweight," then I *really* don't believe you just had a big baby because that's the way it grew.

August 7, 2010 | Registered CommenterNavelgazing Midwife

Avoiding artificial sweetener just makes sense. As far as Vitamin D is concerned, I almost with they could do randomized controlled trials...but I wouldn't want anyone to have an adverse reaction because of it. Has anyone wanted to do trials on themselves? Unfortunately I only want 2 children, but I think if I was planning on having lots more I would start doing one thing differently ever pregnancy just to see if there were differences in the outcome, especially related to the pain level and length of labor.

You mention that Vitamin D seems to help shorten labor, and maybe this is something that helped me in my first-less than 5 hours from start to finish, with only 2 hours of really painful contractions. I drink a LOT of milk. Seriously, I think I'm a milk addict, so Vitamin D intake was not a problem for me in my pregnancy. I did not take prenatals, though. However, during my pregnancy I did pretty much everything I could to make labor go as smoothly as possible (exercise, RRL tea, spinning babies, healthy diet...etc) so it's possible that the Vitamin D had nothing to do with it. I just wish I knew what factors helped so that I could tell my friends what to do to have easier labors.

August 7, 2010 | Unregistered Commentersara

Barb, In reference to no Aspartame/Nutrasweet and the side effects you pointed out, is this also true for say an artificial sweetener like splenda, as well as something more "natural" such as Stevia?
Does this run on make sense? ;)

August 7, 2010 | Unregistered CommenterShannon

I think we can worry about vitamin D excess intake when the massive vitamin D deficiency epidemic in American women goes away.

There are tons of recent vitamin D studies completely debunking the scaremongering about vitamin D excess intake, all up and down pubmed. This is not a circumstance where barely any data exists. The corpus of data is growing steadily and it's not finding that vitamin D is an evil.

I agree that it is optimal to get vitamin D from food, but considering the nutritional lack in the modern American food supply, this is simply not feasible for American women. Soil depletion, overreliance on corn/soy/wheat, overfishing, pollution, and overreliance on processed foods make it quite hard to get enough D from fresh, healthful sources. In light of that, a fish oil supplement looks a lot better than yet another round of women with no detectable D in the bloodstream.

The 'fat soluble is risky' meme is derived from the anti-fat policies of the last few decades, which have occurred concurrent with an overall decrease in health and increase in the very diseases fat consumption is claimed to be responsible for. Well, and it's also derived from highly flawed studies as well.

The risks of taking the prenatal are greater (issues with the minerals and binders in the pills) if one is worried about supplements being risky than the fish oil capsules full of vitamin D. Sciencedaily mentioned some recent studies to that very effect.

I'm a little leery when something that keeps cropping up as lacking in so many women and something that is clearly showing up as crucial to infant health and development is labelled dangerous and unsafe to take in any but the wee-bittiest quantities by establishment professionals. Again, many current, recent studies show that several thousand IU of vitamin D per day improve fetal and maternal outcomes. And as for sunshine, dark-skinned women do not get enough vitamin D from 15 minutes of exposure daily, even assuming they live in the proper latitudes to get the necessary exposure via sun year-round (being further north means even light-skinned women are not getting enough D from sun year-round). So that advice would be unhelpful for dark-skinned women, who are already ill-served by the medical establishment.

Anyway, I am clearly pro-science and evidence, and it doesn't point away but rather to better and higher intake of vitamin D for women, whether pregnant, nursing, or just living.

August 8, 2010 | Unregistered Commentermari

Last December (on the winter solstice), I wrote this post on vitamin D and getting it from the sun. In addition to links to help you calculate how much sun you need, based on your location as well as your skin tone (rather than assuming we are all lily-white, living in California), I included links to various studies/abstracts on "Vitamin D" and "pregnancy" and turned up some quite interesting things.

August 8, 2010 | Unregistered CommenterKathy

I don't know...he has stayed that big. He was in the 95th percentile for weight and 87th for height. To this day (he's almost 2) he's never dipped below the 85th in either. I'm inclined to think he's just a big kid. I don't think being 10 lbs overweight means I'm going to be diabetic or that that's why he was so big.
Also, what about Amish women? They are extremely healthy and hard working their whole pregnancies yet it's not uncommon for them to have big babies either.
Or athletes?

August 8, 2010 | Unregistered CommenterMicah

Micah, as a midwife myself I'd have to say Amish women have the worst diets! As a birthing woman 5 of my 7 children have been over 9lbs. Three of my boys were over 10lbs. In my last pregnancy my 4 yo daughter was diagnosed with type 1 diabetes, very different from IR or what has been discussed here but none the less, life changing for us. Her pancreas no longer works. When she was diaganosed I was 30 weeks. My diet radically changed. I lost 10 of the 30lbs I had gained So far during the three days of her hospital stay. I never gained it back or gained another pound. I ate very low glycemic and no sugar. I just knew I would have my smallest baby. He was my biggest at 10 3. What the rip?! See as a midwife I have these theories too. Vegans have had some of the biggest babies I've seen, skinny moms but too many carbs.

I have the unique capability of watching what carbs do to blood sugar as I am my daughters pancreas. And she wears a continuous glucose monitor which gives me a bg every 5 minutes. Pizza and Chinese food are hell, we avoid them like the plague. I can say when she eats like the guidelines you have laid out, my job is easier and her bg is steadier and our calculated insulin amounts work well. It would be interesting to give her a diet coke, 0 carbs so no insulin needed and see if her bg went up?

Good post, love all the stimulating thoughts. The subject matter is close to my heart as a midwife and a mother.

August 8, 2010 | Unregistered CommenterCheri

I had to start moderating my sugar intake when I went off my antidepressants early in my pregnancy; I had to moderate it even more after a reeeeally borderline GTT result. (135.) This is the plan the midwives gave me -- bear in mind, I began this pregnancy at 275 lbs and 5'2":

No more than 4 servings of carbs (where "carbs" means "starchy carbs," as opposed to vegetables) per day, of which no more than two may be refined white carbs. Bear in mind that a hot dog bun is 2 servings, and a serving of rice is a half a cup.

PLUS no more than 2 servings of non-berry fruit per day. Berries are apparently so low-GI and so chock full of good things that they didn't consider them worth restricting. Jam and jelly count as a fruit serving. . . just remember that a "serving" is a whole apple, a half a banana, a tablespoon of jam, or a teaspoon of jelly. Choose wisely.

PLUS, one small sweet thing per day. A small chocolate chip cookie. A single two-bite cupcake. A European-size scoop of gelato. Again, choose wisely. The peanut butter cookie made with whole wheat flour is going to be a hell of a lot better for you than a lollipop.

Vegetables with every meal, even breakfast. Fat is unrestricted. I'm supposed to eat 80 grams of protein a day, which I rarely achieve.

Now, there's a reason why I describe this as a carb-moderated diet rather than carb-restricted. That is just not terribly restricted, when you get right down to it. However, it is SUCH a change from how I was previously eating. The mood swings that caused me to go on antidepressants in the first place? Gone. The wretched inability to get up in the morning? Gone. And, at 27 weeks pregnant, I've LOST 31 pounds. (Fundal height is perfect, baby's growth is totally on track.)

Perhaps most awesomely, I'm realizing that there's not a lot I miss about eating the previous way. Sure, I miss eating Laffy Taffy by the handful, but I do not miss falling asleep on the couch and snarling at my loved ones, and I can't have the one without the other, so. So my new plan is to keep eating this way for the rest of my life. I'm meeting with a nutritionist to discuss high-calorie but low-glycemic index foods to have around during the first month postpartum, when the Breastfeeding Hunger is upon me, so I don't fall back into a carby cycle of ups and downs. I'm actually really excited; I've been doing this plan for the better part of five months, and I feel great.

August 8, 2010 | Unregistered CommenterKathryn T.

Barb,
Just wanted to say thank you for posting your diet info. I used it when I was pregnant with my 2-year-old daughter and she came out at 8lbs 3 oz. My husband is 6'5" and I am 6'0", and I was very afraid at the time of having a gigantic baby. I had a 135 on the GTT, which I believe is borderline for further testing, but the midwife never recommended it. Obviously, I can't say what would have happened had I not followed your guidelines and eaten whatever I wanted, but I like to think it made a difference :). And even though I'm not pregnant now, I still limit the juice and NutraSweet, and eat only hormone-free dairy and meat.

August 8, 2010 | Unregistered Commentericedancer

So you don't believe in genetics?
The notion that every human born will not vary from a certain weight scale unless something is horribly wrong is not accurate. No, really. I am sorry you've seen so many people have complications, but that is anecdotal evidence. Which you can't use in science. And I hope you do use science, because you are caring for women who deserve it.
Do you check the Academic Ob/GYN blog with Dr. Nicholas F.? He mentions a few times about different populations being able to have much larger babies than others. That is...sort of how it plays out. Sometimes.

For full disclosure on my part... I am in an at-risk minority for gd, we are of larger than average stature as a whole, I had a daughter who was 8lbs, 2 oz. past term and a son, who was 7lbs. 7 oz.. With my son, I had mild Gd (failed the test, showed no anomalies with frequent blood tests as well as a portable monitor). He was not large. But, my husband is a small person. Even now, my son is smaller than average. While my daughter is far taller than average (still very slim).

The size of a human being is VERY MUCH INFLUENCED BY GENETICS. Consider identical twins. Have you ever seen them of drastically different sizes regardless of diet or lifestyle?

Also, you do alot of "speaking" to fat women here on your blog. Since it is a topic of interest, consider taking a look at some of Paul Campos' works.

August 9, 2010 | Unregistered Commentererica

Kathryn: I am inspired by your story! Please keep in touch and let me know the rest of the story! I really am inspired to eat better today. Thank you!

icedancer: COOL! Thanks :)

erica: C'mon. I would have to be a complete idiot to not "believe" in genetics. And while some think I am an idiot, it is certainly not completely. Do I understand that Nordic Swedes have different sized babies than Japanese women? Than Indian women? Than African women? Than Samoan women? Of course I do.

But, if we were to weigh genetics alone, then I believe we'd have to go back to hunter and gather diets... the Inuit eating whale blubber, the Native American eating very little protein (except for a couple of gorge times a year), the Amazon inhabitants eating what they could find and grow (oh, as they do now perhaps?).

If we ate and moved our bodies as they were intended, the genetic differences would mean very little as far as this discussion goes.

But, we aren't. We're looking at bodies that are sedentary and who, for the most part, eat crap food, artificially created food from artificially manufactured food.

The high risk groups... Asians, Hispanics, Native Americans and African Americans... the principle diets consist of refined carbs -rice, bread and fake food.

I'm not saying one thing in this comment we don't already know.

I will definitely look at Paul Campos' work. Thanks for the referral.

August 9, 2010 | Registered CommenterNavelgazing Midwife

A few observations.

As far as artificial sweeteners go, a HUGE (60,000 women) study found that a single diet soda per day increased the risk of pre-term birth by 38%. Four a day, and it was a 78% increase in the risk of pre-term birth. This held whether the mother in question was at OR above her 'ideal' weight:

Am J Clin Nutr (June 30, 2010). doi:10.3945/ajcn.2009.28968

So even if they DON'T cause blood sugar problems, this is more than enough info for any woman to avoid these chemicals during pregnancy.

I find it interesting that doctors and pharmacists seem to think THEIR "years of training" is plenty enough to overcome the fact that they have maybe one class in nutrition but a midwife's years of training are irrelevant a bit of self serving drivel. Last I checked, pharmacies sell artificial baby milk, and most OBs, Peds, and L&D units give the stuff out like candy. I've yet to meet an independently practicing midwife that does so. That alone makes the clinical observations of a midwife more credible to me than those of an OB or pharmacist.

Note that getting vitamin D from milk is NOT 'getting it from food.' The highly processed, liquid food like substance in those cartons has a vitamin D supplement added to it. As well as a bunch of other things. Seriously, READ the carton. Even organic milk has an ingredient list! If I am going to take a supplement, I want it to be one that I have more control over how much I take and what else is in the package. For the record, I do take a D supplement, despite being an outdoorsy girl of Eastern European ancestry living in Florida. I have read numerous research articles on D supplements, and came to the conclusion that since I do avoid mid-day sun for vanity reasons ( :) ) that a supplement was my best choice based on the preponderance of the available evidence.

The studies on the risk of weight gain or metabolic syndrome increasing with increased diet soda intake in humans are all, unfortunately, epidemiology. They measure correlation and not causation, and really don't have enough other information to help one to tease out the mitigating factors. Avoiding soda in general is a good idea for EVERYONE. Virtually all US sodas have manufactured sweeteners in them (I consider HFCS a caloric artificial sweetener) so don't hold your breath waiting for a well funded, well done study on this. This may be why the main diabetic advocacy and research groups don't trumpet any of the research that is out there, much of their funding to exist comes from the 'diet food' industry.

For Cheri - I was wondering if you had read any of the new research coming out connecting some of the same genetics of Type I diabetes with those found connected to Celiac's disease? There is some fascinating stuff in there, and you might find something applicable for you and your daughter.

-A

August 9, 2010 | Unregistered CommenterAmy

On my dad's side of the family, large babies are the norm. No glucose problems, we all have normal sugar levels during pregnancy, we just have 9-13 pound babies. I had the smallest baby at 8#3oz(she was my first, and was induced for being 2 weeks overdue, but now that I know my cycle better and educated myself she wasn't actually late at all), but my other two were 9#+. We also weigh far more than we look like we should and have sturdy looking children. I don't mean overweight, I mean healthy-as-a-horse type look. I coached my cousin's girlfriend during her labor, her baby was almost 14# and looked like a 6 month old, it was amazing!! I do feel there are times when it's genetic. I am 5'8" and was 160 with baby1, about 170 with baby2 and about 180 with baby3(you can see I don't lose weight easily).
I did read recently that having large babies is a sign that you can develop diabetes 2 later, and sure enough I have prediabetic levels. I'm working on all that, though, I've lost 30 pounds in the past year and am trying to eat mostly proteins and veggies.

August 9, 2010 | Unregistered CommenterMarie

Amy, I appreciate the validation. Lots. Your thinking is right where I am (obviously)... and my experience (which, of course, is NOT scientific).

So, within 2 weeks of being off Diet Coke (I am 2 months off now), not only did my glucoses straighten up, but the pain in my joints is virtually gone. It was just like when I had hypothyroidism before meds... that wrenching pain that made walking and picking anything up hurt like the dickens. Now, gone! My MIL found the same thing. Haven't read a darn thing about why, but whatever. I feel SOOOOO much better!

And I don't go to 7-11 to get a refill every day and that keeps me away from the donuts and orange slices. A side benefit, for sure.

August 9, 2010 | Registered CommenterNavelgazing Midwife

See, Marie... that's what I'm saying... women with big babies ARE having glucose issues even if it isn't measurable. And yes, the research does say that women with big babies, 15 years or so later, tend to develop diabetes... unless their lifestyle dramatically changes to loads of exercise and a lowering of the refined carbs.

So saying "we just have 9-13 pound babies" is inaccurate. Probably every one of you *did* have glucose issues, they were just Insulin Resistance ones, not diabetic ones.

August 9, 2010 | Registered CommenterNavelgazing Midwife

Thank you thank you thank you! I'm a Type 1 Diabetic and 21 weeks pregnant with baby #4. I have very good blood glucose control during pregnancy but I still have large babies (no birth complications though). I've been very conscious of what I eat, I'm trying to figure out what can help me grow a smaller baby and have made a few changes. I now take a Vitamin D and Calcium supplement, eat hormone-free dairy/meat and am on the way to cutting Diet Coke completely out of my diet. Let's see if it makes a difference!

Thanks again, I was here to reread your posts on Vitamin D and was happy to see this new post!

August 9, 2010 | Unregistered CommenterSilvia

Barb- so when you recommend 6000 IUs daily of Vit D...what form are women taking it in? Cod liver oil and through whole foods?

August 10, 2010 | Unregistered CommenterSarak

Usually a silent reader, but i want to speak to the "doctors only take one class in nutrition" point that keeps popping up. Doctors and pharmacists have a solid background in organic chemistry and biological processes. Most of them don't need numerous classes in nutrition because their basic scientific knowledge grants them the ability to understand how various chemicals act in the body.

I try to read and learn about health on a sort of superficial level, but because i never made it through organic chemistry, i will not be able to fully understand how those things fit together at a basic, molecular level. There is nothing wrong with that, by the way.

Certainly, midwives (like NGM) who have spent years observing women and their babies will have certain valid insights that should be taken seriously. That's the first one or two steps of the scientific process, no? I'm saying, it's terribly important. The next steps involve narrowing down that correlation and figuring out the how and the why on a biochemical level.

August 10, 2010 | Unregistered CommenterS

I read your blog often but haven't ever commented. I was just curious about whether your recommendations applied to all pregnant women? I started all my pregnancies at about 130 and ended at about 155. I've never been a super healthy eater, usually my pregnancy diet is the same as my non-pregnant diet. Except that my daily coke becomes a weekly coke :-)
But my children have been 7.1 and 8.11, with the next one TBD. Am I just a genetic accident? Do your recommendations apply across the board or were you targeting a specific group of pregnant women?

August 11, 2010 | Unregistered CommenterEmily

Emily: I think the information is helpful for everyone! Yes, it is geared towards larger women and or women who are at risk for GDM (browner cultures), but, much of it is common sense.

Not sure why you asked if you were a genetic accident, but if it means because your diet isn't fabulous and you are still small, my guess is you are expending just the right energy for the calories you take in. That's the math of it, anyway.

Sarak: Women can choose their type, but I think most are taking D3 supps from healthfood stores (D3 is the kind sold in stores unLESS it specifically says D2. D3 is what we need, the important source.).

Trying to get 6000IU a day from food would be an amazing challenge and one that I think might also take at least 6000 calories!

August 11, 2010 | Registered CommenterNavelgazing Midwife

If vitamin D overdose is a concern it is one easily watched for with periodic blood tests. As a person with MS with extremely low vitamin D levels, I can feel very comfortable taking 4,000 IU D3 without leading to overdose. I also live in a northern state, and do not get out in the sun as often as I should. There is only good sun 3 months out of the year here anyway. Since vitamin D deficiency is so common now (so much time spent indoors on computers? lol) it would only be wise to get an initial levels check done and then go forward from there.

August 12, 2010 | Unregistered CommenterHeather

Thank you Barb for this discussion. I appreciate all the info from you and the others and yet find it makes my mind spin with even more questions.

In my recent prenatal class (I'm a CBE) the Ob told one of the participants to eat a health balanced meal just shortly before her fast hour for the Glucose screen.. His recommendation, a glass of OJ, a slice of bread and peanut butter (?!) YIKES - I'd have to agree that defiinitely all OB's do not all have the same background in nutrition.

Erin

August 13, 2010 | Unregistered Commentererin

Erin: Actually, it isn't uncommon to encourage a pretty high carb pre-meal, sometimes for 3 days before the tests. Some believe (I do) it can totally help the pancreas get ready for the overload. It isn't cheating, but giving the pancreas the benefit of the doubt. With someone at risk, however, I don't think it'd be the best idea.

August 13, 2010 | Registered CommenterNavelgazing Midwife

Barb.. well, now I'm a bit confused. There is a (well respected ) doula in town who advocates no sugar or carbs before the screen for three days - the complete opposite. I need to go back and do some more research.
thanks for the reply
erin

August 15, 2010 | Unregistered Commentererin

Barb I've been going back over your vit d postsnwith interest too :) I'm around 29wks with #4 and suffering through a freezing Melbourne Winter. My vit d was very low last pregnancy and even lower this time. I'm wondering at what gestation you recommend the higher doses of vit d, or is it for throughout the pregnancy?

My lovely midwife has recommended we retest levels in a few weeks to see if the level of supplementation I've been on has helped at all. Presently I'm taking 2000iui a day which is a lot lower than the levels I've read about here.

Love your blog, thankyou :)

August 16, 2010 | Unregistered CommenterKate

I had a 10.7 Pound first baby.
It's the diet!
I started with a very wholesome homemade diet, tons of vegetables, and lean protein at each meal, and whole grains.

The 8 and 9th month I was so hot and tired (summertime in NYC) and only wanted to eat Hagen daz ice cream (a pint a day habit), and craved plain yogurt and a head of broccoli each day .

No surprise i had a big baby.

August 22, 2010 | Unregistered Commenterddewi

I have only just started following your blog. Curious to read back posts and gain some good insight.

I am also curious that no one has asked about the test itself. I have had clients who have chosen an "alternative test" for GDM. Much of the reason is that the test itself tends to set up some women for a positive report. These are women who have very good diets that don't include the kind of sugar levels that the test itself includes. When they take the standard test, their bodies are hit with an overload of sugars, and of course respond with increased levels. They are then told to go to a Dietician who may or may not believe in woman's ablity to birth (I have clients tell me that they hate going to appointments due dietitians filling them with fear of "big babies", and telling them the well NEVER be able to "birth that thing" and should just plan a c-section early). They labeled "high risk" and fast-tracked by some Obs toward a c-section claiming a "big baby" that turns out to be 2-4 pounds less. If not a c-section, they are told that they must induce before the actual EDD which leads to a higher level of intervention, which leads once again to a higher level of c-sections and possible NICU babies. This is NOT my personal experience, but that of my clients and the women that I have served as a Postpartum Doula.

I realize that we abosoultely need to be aware of sugar levels and diets both between and during pregnancies. I have learned a great deal from reading this post and the comments and plan to do more research so I can provide clear and evidence based information/research for future clients.

I also just wanted to throw this out there as part of the discussion and see what came from it.

Molly

August 24, 2010 | Unregistered CommenterDoula Molly

I keep wondering about the whole idea of having big babies. My first was 9#6oz. I'm 5'6 and prepregnancy weight is 135--so I'm slim. My second was premature but probably would have been 9+lbs had he been full term. My 3rd was almost 12# with a shoulder dystocia. With the 3 I ate healthy but didn't forsake sugar. I would say my lifestyle wasn't sedentary but I could have been more active. I just had my 4th 3 weeks ago and because of my 12pounder with shoulder dystocia I wanted to avoid having another experience like that. So, I ate SUPER healthy--avoiding any refined carbs etc. and worked out 2X a day for at least 30-40 minutes. I gained 22 lbs. in the pregnancy (whereas before I gained 40 with #1 and #3) and my baby was STILL10lbs. 4 oz. I kept an eye on my blood sugar just to make sure I wasn't having any hidden issues. I never measured LGA with this pregnancy and I was honestly surprised that I had another big baby--although he came out very quick with no other issues.

I guess I wonder how big my baby would have been had I not been so careful but I have wondered if my husband and I just make big babies. Perhaps I will develop type 2 diabetes at some point in my life but I'm not overweight and am even more active now than I was 7 years ago when I had my first.

I had to work so hard throughout the pregnancy and it was worth it. I'm already back in my regular clothes and my baby was healthy--just big.

I'd love to hear your thoughts on that.

Re: the diet coke thing....my mom has rheumatoid arthritis and fibromayalgia and was drinking about 3 12 packs a week of diet coke. We kept telling her that she should stop drinking all that fake stuff. I remember hearing a while ago that large amounts of aspertame caused memory loss and joint aches--both things she deals with from her diseases and medications. She has finally cut down on her addiction and her blood sugars are better than they were. She hasn't totally stopped drinking them though. I should ask her if she notices any less muscle/joint aches after she totally quits.

August 25, 2010 | Unregistered Commenteramelia

Yeah, Amelia, your baby might have been seriously large/macrosomic.

It's important to remember than Insulin Resistance comes long before diabetes and requires testing that has nothing to do with testing blood glucoses. Only half the women who have PCOS are fat, so that leaves it open that you might be in the other camp.

I am not a doctor (as you know) and the answers to the questions have not been universal, but I'm asking anyway... trying to piece things together. FEEL FREE TO NOT ANSWER! Not trying to invade your privacy at all.

1. How are your periods? Did you have issues getting pregnant?

2. Your big babies, how pregnant were you with each one when they were born?

3. How much vernix did they have on them? None/Little/Moderate/Lots/a WHOLE lot?

4. Did the babies feel squishy, like holding white flour rising dough?

5. How much lanugo ("body hair") did they have? If they had lanugo, where was it located?

I appreciate your help if you do choose to answer. I'll explain afterwards.

August 25, 2010 | Registered CommenterNavelgazing Midwife

I'm intrigued so I'll play along!

1. Periods are normal. 26-27 day cycle. Very regular. No problems getting pregnant.

2. Baby #1 born at 40 weeks
Baby#2 born at 34 weeks
Baby#3 and 4 born at 41+2

3. #1 not much vernix
#2 lots
#3 a little
#4 somewhere between little and moderate

4. Hmmm....I don't think so--maybe #3 but I can't really recall. #4 definitely not.

5. #1 I don't remember. #2 had lanugo on his back. #3 had it on his back. and #4 has on his back and even on his ears.


Hope that helps!

August 25, 2010 | Unregistered Commenteramelia

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