Gestational diabetes and large baby

[Giantbabymama]

Hi everyone, apologies if this post turns out too long. I am an expat so some of what I need advice on will be too specific. Basically, I am 33 weeks + 3 and although my GTT was fine when I had it, my doc is now saying I might have GD and wants to send me to endocrinologist and dietician and all sorts. This is on basis of 3 finger prick tests done two days apart each - 1 of which was too high, another was fine, the third was a bit high but not disastrous. The way the measure here seems v different to UK so I won't confuse things by posting readings. The doc initially said as baby is "big" according to scans (they do scans once a month minimum here) that it may be safer to have c section, particularly if is predicted to go above 4kg.

I took husband to today's appt and when I said, look, not keen on c section, doc said "actually was thinking induction" then I said not keen on that either, she started on about how having a baby over 4kg meant risk of shoulder distocha etc and best to get it out before then but may not be necessary if can control blood sugar with diet. The reason I am questioning it is she tells me that the scans can be wrong by 20% so I don't see as good reason to get baby out early, particularly when I was 4kg myself, born by forceps, my younger bro was 4.5kg and born without intervention, and me and the husband are both taller than average. Another reason I am a bit cynical is that it's private health here, so the more intervention you have, the more they can charge your insurance co, and docs here seem to prefer the convenience of planned births as opposed to being called to attend in the middle of the night. As you can probably tell, it is doc led here - you choose obstetrician when u find out you're pg and the only see midwives when in labour.

My question is, do u think this sounds right if you've had GD yourself? I have read about Shoulder distocha and it sounds nasty but I understand it is rare. At the moment I feel that the doc is just frightened of delivering big baby which I suppose is understandable as the majority of population here is smaller than us great big Europeans. She is also quite vague, ie doesn't remember what she's told me. I totally get that in NHS where they are rushed off their feet but they see relatively few patients here and moreover, when was in UK, I noticed medical types recorded things scrupulously on their computers but that definitely is not happening with this doc. Am I being unreasonable? I can see this doc has induction/c section in mind for me! which I will go with if I can be convinced it's safer, but at the moment I feel like I am being railroaded and am considering just seeing another doctor instead.

Also, I have no symptoms of GD apart from raised BS, was this your experience too? The doc didn't really sure herself that I had it, which is fair I suppose as is not her specialism,but I do feel a bit like she wants more of my insurance money to go on tests rather than thinking I have it.

Again, sorry this is so long, but any advice on big babies and GD appreciated!

[TipseyTorvey]

I have recently given birth to a perfectly average sized baby of 7lb9 after having had GD and all through they kept telling me the baby would be huge and in the end it was mainly fluid BUT I did have an early c section due to another medical condition that made things risky.

Not sure about the shoulder thing tho, no one mentioned that to me here (NHS uk) , however my blood sugar was so high I was on insulin to control it and had a very strict diet, prior to diagnosis I felt exhausted beyond normal pregnancy tiredness and had to wee loads more than usual.

Different situation to yours though I think....

[MagpieCursedTea]

I had GD. I was very strict with my diet but still had high readings (mostly the fasting one in the morning rather than the after meal ones) so ended up on insulin.
I had an induction at 38 weeks and my DS only weighed 2.8kg (I had a scan at 36 weeks that estimated him at a higher weight).

[Giantbabymama]

Thanks ladies. Magpie - do you mind if I ask why you were induced? Was it planned because of GD or did it happen for another reason? I am trying to work out whether I basically have to agree to induction/c section if I get officially diagnosed with GD or I can stick with what I want - waiting to go into labour naturally as long as I can control blood sugar, and therefore possibly baby's growth, with diet/insulin. I had scan last week which said was already nearly 5lbs 12, and yes, I am a bit sleepy sometimes but still going about daily business, so I am putting tiredness down to being nearly 8 months preg. Maybe I am just in denial!!!!!

[MagpieCursedTea]

The consultant told me that in women with GD the placenta aged faster so risks increased after a certain point which is why they wanted to induce me (she was more blunt than that but I found it quite upsetting so won't repeat it!).
From what I've read since, different NHS trusts have different guidelines and some are happy for women to go to 40 weeks or more even if they have GD.
I was also told it was 38 weeks because of the insulin and it would've been 39-40 weeks otherwise.

[Giantbabymama]

Ah OK. I think I can imagine what she said.... Poor you.. I guess all I can do is be v careful with diet and hope for the best, and try not to get too worked up if I end up being induced or with c section.

It's odd. This is my first and always assumed I would be the "give me all the drugs, yes please elective c section, wake me up when it's over" type but I've surprised myself by being very reluctant to have any intervention at all. I feel like I want to lock myself in a cupboard and tell everyone to sod off until it's all over.

[MagpieCursedTea]

I was the same, I desperately wanted a natural birth and was gutted when they wanted to induce me. It wasn't that bad though, it was long and the environment was more medicalised than I would've liked but I got the things that were important to me (vaginal birth, with a midwife even though a doc was there, immediate skin to skin etc).
I think I just had to make the best of my situation and I look back on my DS's birth very fondly now.

[Giantbabymama]

Thanks for sharing your experience, you too Tipsey. I think I'm gonna see another doc for a second opinion and if they also say yes you have GD and yes the risk of complications is high because of its large size, then I will have to agree to induction or whatever.

I am feeling a bit more logical today. I have been feeling a bit emotional about having interventions that I had hoped to avoid but I suspect when it comes to the day, I will just be grateful to have it out safely. Maybe by the time I'm at 38 weeks, I'll be at the for the love go god get it out stage as this pregnancy has not been fun, horrific sickness til about 23 weeks and then sleepless nights due to worry and hip pain etc etc.

[lotsofcheese]

I work in a diabetes obstetric team.

Firstly, GDM is only diagnosed through a GTT. In your shoes, I'd be asking for another. Finger pricker tests are used for monitoring existing GDM, so can't be read into at this stage. In our centre we ask patients to check a fasting glucose level 1st thing, then 1 hour after meals during day.

In terms of growth scans, a few are needed to establish patterns rather than relying heavily on just 1.

There are NICE guidelines on the diagnosis & management of GDM - have a look at the website - sorry can't link as on phone.

Hope that helps.

[Giantbabymama]

Thanks lotsofcheese, very helpful, it's really good to have input from someone who works with GD. I have been thinking that it's a bit odd that the doc seems to have decided I definitely have it from finger prick tests when my previous GTT was fine but I suppose the baby measuring very big has set the alarms off for them.

I will bring up repeat GTT with my doc and check out NICE guidelines and I will mention about more than one growth scans too. I think part of the problem I'm having is the doc is a bit vague and I am not sure that she keeps very good records of these things.

Thanks again.

[Giantbabymama]

As a follow up to this, I reached a stalemate with my obstetrician so agreed to see an endocrinologist who got me testing my blood sugar four times per day (first thing before eating and two hours after each meal) and the levels were fine. If I am GD, then it would seem I am borderline. I tried to get another GTT but they wouldn't so it and tbh, it made me feel quite awful first time around.

Assuming I can keep levels ok by avoiding sugar and too many carbs, does anyone know if there is a predicted baby weight limit beyond which docs want to induce? I know my doc will want to induce or do c section if the baby is expected to be above 8lbs 3oz and while I am not keen on either, I would go along with it if that is what would be happening back home.

[Giantbabymama]

They wouldn't do not so another GTT

[Giantbabymama]

Sorry, that should be will want to get baby out early if expected to be above 8lbs 13oz.

[Thehedgehogsong]

I was suspected GD and had a clear GTT, so I was left alone. I went on to deliver a 5.06kg baby naturally at home at term plus 12, three weeks ago. It wasn't even tricky, and I had no stitches. Natural birth can happen with big babies!

[Giantbabymama]

I think that may be the problem. Apparently my GTT was 'borderline' for GD. I think that combined with predicted big baby will make them quote all kinds of scary stuff at me til I agree to do what my doc suggests.

[mrsnec]

Hi,

I'm an expat too and throughout my pregnancy my consultants kept an eye on me for gd. I had high blood sugar but it wasn't enough to get a diagnosis but I was tested regularly.

I was constantly told dd was going to be big. I had weekly scans towards the end and I saw 5 different consultants who all had different opinions!

The consultant that thought I was going to get gd tried to put me on a diet. It was impossible because of my sickness but I tried to cut down on sugar as much as I could.

Where I am they favour as little intervention as possible so I had one consultant talking me into a natural birth even with a low placenta and considering dd's size and that I also had cpd. I didn't want an induction either so in the end I booked an elcs for the closest date to my due date I could get and told them I'd try naturally if anything happened before then. I ended up having an emcs when I went in for my pre-op assessment because dd was breech. This was a compromise because one consultant wanted to do a section at 37 weeks.

She was born at 39+2 and weighed 3kg not the 5 they predicted. That's been the same for everyone I know who was told they were going to have big babies. Including those with gd concerns.

I also know someone who hadn't even had gd mentioned and her dd had shoulder distocia. It was her 5th baby! And whilst it was a traumatic birth both were fine in the end.

I know you probably have your own reasons for not wanting a section. I was terrified considering I'm in a country where I don't speak the language and I'm hospital phobic but it was all over by the time dh had got back from picking up my bags from home.

[Giantbabymama]

Yeah I don't really know why I'm not keen to get a c section, I think it's mainly the extra time in hospital when the husband won't get much pat leave and the fact that I would like to at least try to give birth naturally. Unfortunately my mum died 7 months ago and although I wouldn't say I'm hospital phobic, all the time spent with medical professionals and discussion of drugs and interventions etc does not take me to a happy place, if you know what I mean.

Of course this is all v different from the blood cancer docs and treatment my Mum received at home from palliative carers etc, but I think because of having been through that so recently, anything that even smells a bit hospital like to me makes me want to run away. My ideal birth would be labouring at home for as long as is possible when contractions get going then going into hospital for a birth that's as intervention free as possible then getting home ASAP! Home birth is illegal here so that option is not open to me. I know if it really isn't possible, I will have to be a big girl about it and do what's best for baby etc. it's hard to balance what the docs are saying with what's best for me and baby as they do seem to be v pro intervention as many people are used to private healthcare and fully expect docs to intervene. Mat leave is v short here too so I think docs are used to women wanting to schedule delivery for that reason and are a bit bemused by my resistance to it!

[mrsnec]

So sorry to hear that op. Your circumstances are perfectly understandable in that case.

I was in for 5 days and it drove me round the bend! It's the same with home births here too but they convinced me hospital was the best place anyway because they tested me for so many things. If I was in the UK I may have looked into homebirth or waterbirth in an mlu at the least!

You don't need to be a big girl about it. It's about what's best for you too.

What are the options when you give birth? I was more relaxed about a section here because they don't use gas and air,epidurals or use forceps for vbs.

Also, I found this interesting, one of my consultants had come over here from the uk because he felt the hospital he worked at used to much intervention and he preferred the approach here. It turned out I had a better experience overall than anyone I know who gave birth in the UK at the time despite how long I was in for and that makes me feel better but they were over cautious for sure.

[Allycat]

I had no GD but was told that baby would be a big size at my scan. At a follow up appointment, Obs then said that baby was normal size when he felt my bump.

Come the big day, baby was 4.6kg and got stuck at his shoulders. Shoulder distotia was awful, we nearly lost him and I was cut from front to back. I had to be stitched in theatre, after being told that I may become incontinent. Thankfully, after all that baby and me are fine.

After the birth, I was told that there was a higher risk of Mums of baby's over 4.5kg developing diabetes in later life. 7 years on I did develop type 1 diabetes out of the blue. Symptoms were losing a stone in 3 weeks and a never-ending thirst.

If I had my time again I would opt for a CS. Nothing worse than risking losing your baby. However, this does not take away the diabetes risk.

Good luck!!!

[TarkaTheOtter]

Afaik (gd in two pregnancies), guidelines are to induce at 38 weeks if the GD is severe enough that you can't control it with diet.
I never had any symptoms and had to use insulin to control my bs as I was already eating healthily so couldn't just adjust my diet.
Have you seen the endocrinologist yet? I expect your ob doesn't know much about gd and you'll get clearer info from the diabetes team.

[Giantbabymama]

Yikes that's scary Allycat. That's the problem isn't it? For all I read about scans not necessarily being right, if baby gets stuck because it is too big and something goes badly wrong, will never forgive myself, particularly as doc keeps warning me about it.

Mrsnec, the options here for vb are pretty much the same as UK, epidural, gas and air. Some hospitals will do either ventouse or forceps as they don't always have someone trained in both. I think unfortunately they r v keen on the feet in stirrups flat on back approach for delivery as it can be a bit old fashioned in that respect.

Tarka yes, saw endo this morning, and he is happy with my levels from last couple of days and says keep eating healthy, do more tests in five days and come back if it goes above a certain level. He seems to think I will be fine, so hopefully he will pass that on to the obstetrician.

In some ways I feel a bit of an idiot, moaning about not wanting interventions when I read loads of MN posts from women who want elcs for example, for perfectly good reasons, but don't qualify under NHS guidelines.

The grass is always greener etc. and I suppose once it's all over I will just be happy to have the baby and none of this will matter. I am 34 weeks today and I wonder if once I've had 4-5 weeks of low sugar and carbs and am increasingly massive and uncomfortable, I will have complete change of heart and go to my doc saying: "alright! Just get it out already!"

[mrsnec]

Allycat's experience is definitely what I was trying to avoid. The consultant pushing me for a natural birth also told me some damage was inevitable!

I would have been more inclined to try though if gas and air and epidurals were available here where a natural birth is an episiotomy and a couple of paracetamol! Although thankfully no stirrups.

If it helps, my recovery from my cs was so much better than I thought it was going to be and my issue with my hospital stay was only that they were strict on visiting hours and I was lonely.I would also say maternity had a different feel from the surgical wards in my local hospital too.

It's great your levels are good though.

[Giantbabymama]

Yes I wonder how long I will keep if up. Christmas with no booze was bad enough, and without mince pies and choc etc was very tedious!

If the baby could just do me a favour and come of its own accord at 38 weeks, that would keep everyone happy, but it doesn't seem very obedient so far. I had horrific sickness until about 25 weeks which has come back in the last couple of days. It seems to like to make its presence felt, ie sickness calms down, tiredness starts, followed by measuring enormous and convincing my doc that I must have GD.

Anyway thanks for all the info everyone. Happy New Year to you all. I will raise a glass of water or diluted juice to you in a few hours!

[RetroHippy]

I've just had a 7lb10 baby at 35 weeks

Nobody picked up that I may have had GD until I went into hospital at 34+3 with contractions and had glucose in my urine sample. I was given a scan when the consultant thought he felt big. He measured a pretty accurate 7lb8 on the scan.

I have no idea if the early labour was related to the fact that my baby was already pretty huge or something completely unrelated. I ended up having an EMCS when the fetal heart monitor showed that he wasn't happy. Turned out he had the cord round his neck and the cord blood oxygen level was low. If I hadn't been contracting enough to be concerned things might have turned out very differently.

Whatever birth you get, try to focus on the healthy baby at the end of it. I wanted a natural birth with yoga balls and breathing exercises. Delayed cord clamping and immediate skin to skin to initiate bf.

As it was, I didn't see my son for 14 hours as he was whisked to the neonatal unit and I was slow to recover from the op. He was formula fed via tube for the first four days (with the odd colostrum top-up from me) until his blood sugars stabilised and my milk came in. He is absolutely fine now, as am I, and we are finally settling into family life.

I will be making sure I read up on GD before I get pg again, and hoping I don't have a repeat. I still don't know for sure if it was GD, but I was thirsty, peeing loads, tired... All things I put down to being pg. I also developed a serious cake addiction...

[Giantbabymama]

Hi RetroHippy, I am glad you are both ok now. I think maybe they pick up on borderline GD cases more where I am due to the private health system (am expat) because they look for reasons to flog you drugs! I have found the blood sugar monitor I bought really helpful as although am officially not GD, can tell if I am moving in that direction and go and get checked out, although I would definitely check with a doc before using one as I am in no way qualified to recommend it to you for if you get pg again. The health system tends to be more DIY here anyway, ie people with any health issues at all will have a blood pressure cuff or a holos sugar monitor at home rather than pay to see the doc, as insurance only covers so much, particularly for antenatal.

I am getting more used to idea of maybe having baby early etc. I think there's the initial disappointment of not getting what I want but I guess I at least have time to get used to it whereas it sounds like it was a bit sudden for you.

[Allingoodfaith]

hi op I'm at the other end of the scake.

First baby was 7.6 - four hour labour. Gas and air.

Second baby was 10.lb. hideous labour. Its completely put me off natural labouring. Id be inclined Togo with your consultant advice.