GTT test late in pregnancy and possible GD?

[barelyutterly]

Sorry, a bit long.

Just got back from a consultant appt which has left my head spinning a bit. Backstory is that at the 20 week scan, the placenta was anterior and low-lying (next to but not touching/covering cervix) so I was booked in for another scan at 32 weeks to check on its movement. Turns out it hasn't moved, so she had me book a consultant appt right away (2 hours later). This is the first time I've seen a consultant, to this point my pregnancy has been co-managed by midwives and my GP surgery. Everything else has been normal up til now, including all blood and urine tests. Better than normal, my pregnancy has been completely fine and actually quite boring!

So I turn up at the consultant appt expecting to discuss the placenta, options, future scans, etc. Instead all she wants to discuss is the so-called large size of the baby. AC measures just above 97th percentile, head is just below 97th percentile, but the ratio is is the same as it was at the 20 week scan. That scan also showed a slightly larger than normal baby but nothing as high as 97th percentile. To me it just looks like I'm growing a large-ish baby, which isn't that surprising as I'm quite a sturdy build and my husband is over 6 feet tall. I'm very fit and active, have been exercising regularly eat well, etc. so no risk factors for GD other than being over age 35. The fundal height is 30, so not big considering I'm 32 weeks.

The consultant who takes an immediate dislike to me as I'm fairly assertive and questioning convinces me to sign up for a GTT test. And has me book another scan at 34 weeks to measure growth. Nothing mentioned of the low-lying placenta. The receptionist hands me a sheet with details on how the test will go and when I get home I see it says "you should not be asked to have a GTT any later than 30 weeks gestation as GTTs performed after this time do not accurately reflect a diagnosis of diabetes."

So now I'm really adverse to doing this test as all I can see are worst-case scenarios: it's positive but inaccurate, but now I have to have all my care through a consultant, multiple appointments with various people, a diabetic midwife, no hope of a homebirth, increased pressure to be induced, etc. etc. And all this because of a low-lying placenta picked up at the 20 week scan -- if it had moved or had never been low-lying in the first place, there would have been no need for a consultant to look at the growth of the baby (which the scan technician did NOT flag in any way, I should note).

I would actually like to call them back and say "no thanks, I'm declining the GTT test" and just show up instead for the 34 week scan and see where that puts me. Or not even that! I actually have a glucose monitor at home (bought as part of my previous life as a serious amateur athlete) so I could technically do my own GTT and daily monitorings at home with it and if my blood sugar is on the high side, manage it myself with a more focussed diet.

I'm already quite bummed about the low-lying placenta and steeling myself for the possibility of an ELCS, but being thrown into what I see as extra added issues that may or may not exist is not where I want to be these last few weeks. I definitely do not want to deal with that consultant again and reading some of the horror stories of women diagnosed with GD only to be strong-armed into being induced and ending up with the typical EMCS and all the problems associated with that makes me very very wary. My main concern is the placenta moving, if it doesn't then GD is pretty irrelevant isn't it?

Any advice or experience to offer? (I've found and read the recent GD thread but sadly it seems to have petered out.)

I have GTT and my consultant said she wasn't sending me for the actual test as it's not always a real Reading of what's going on. Personally, cancel the test and monitor your sugars yourself and let the consultant see the readings from that.

Hmm - definitely sounds like you are being strong-armed down the "route" of whatever the hospital policy is for babies above a certain size. Can you request to see a different consultant and explain what your concerns / confusions are (without coming across as hostile)? I had very borderline GD with DS1 and now with DC2 and the first time did everything I was told and did end up with the sort of experience you describe above (though ultimately the CS and subsequent recovery was absolutely fine). This time I have refused to attend the clinics regularly as they are at an impossible time and I am capable for seeing for myself if my readings are within limits or not, I have been quite adamant about certain things to do with the birth and have had to push through a certain amount of resistance - they usually do eventually acknowledge that you have choices and they can't force you to do anything. I have no experience of the placenta issue so don't know about that but the real concern is to try and get them to draw up a care plan for YOU as an individual, not just put you on the "track" for people with GD or whatever - especially if you want a home birth. One thing I would say though - if it DOES turn out you have to be induced or have quite a medicalised birth, don't worry too much about it - ultimately it really doesn't matter how your baby gets here. Its a tiny fraction of the time you will spend with your child. Best of luck.

I'd have the GTT. Your home kit (I assume it's the standard type) is less likely to be useful during preg. The GTT works by measuring your blood pre then post consuming a set amount of sugar. A positive or negative in your home kit can't diagnose or rule out GD. Wiki etc have some good info on the GTT. I've never heard that it's less useful after 30w of preg - GD is most common in the third tri and my understanding is that's when it's most often done.

If you do have GD it can affect the baby more seriously than just being big, so that's why I'd go for the test. If not, I'd definitely assume I did have GD and do the usual diet and lifestyle changes. Good luck.

ps I can understand you being annoyed with the consultant's attitude. If seeing your MW or GP soon could you discuss this with them?

Sorry I know nothing about the low-lying placenta thing, but I'd have the GTT if I were you, if it comes back ok at least it will shut the consultant up!

FWIW I had one after a 32wk scan showed baby was 3wks ahead, & they wanted to double check I didn't have GD before giving me some steroid injections (for something else).

Did that make sense? What I'm trying to say is that it might be useful for them to be able to rule out GD as part of whatever they have to do for the low-lying placenta thing?

And could you ask to be seen by a different consultant?

Thanks everyone for the advice.

The home kit I have is just a standard monitor, one of the AccuChek ones. I have glucose in bulk in my house (along with a ton of other sports/carb/protein powders) so will do my own GTT this morning having fasted since 10pm last night. At least that should set me up for what to expect tomorrow.

I am also going to call the MW unit this morning and query this information sheet I've been given and ask why exactly I'm having this GTT when their own sheet says not to have it.

Diet and exercise... well I already cycle at a fairly moderate level about 8-10 hours a week so not sure how I'll fit more in but I can certainly improve my diet which I've let slip these past 7 months going off my athlete's diet and eaten more junk food than I should be! Back to watching what I eat more closely.

Sadly I don't have a MW of my own as my care is "team-managed" so I've seen about 4 different ones. Even my GP I hardly know as I've never had to go see her apart from this pregnancy! I only met this consultant yesterday, she wasn't even the named consultant on my notes but her nametag said "junior doctor" or some such.

trixie I read your posts on the other thread and that's exactly what I was thinking -- I have a real feeling they are sending me down the route of "this is what we do with big babies" and not seeing my personal circumstances. That does worry me as both my husband and I weighed 8.5lbs at birth and this baby is only tracking to be about the same. Not sure how that is considered big?

I'm really trying to avoid unnecessary contact with consultants and the general feeling that I need to be "managed" as if I'm "ill". From what I've seen with GD, they ask you to change diet/lifestyle and check after a few weeks, and the last thing I want is to be put on a round of drugs -- which is what this consultant threatened me with yesterday. She was a real doom-sayer.

Anyway, the great thing about Mumsnet is being able to read and search through other threads and posts to read about experiences and use that to arm myself for my own, even though this is my first time going through it. Thanks to all the posters for that!

I think you're over reacting tbh. I had lots of serious complications before I was even diagnosed with GD. I have always been under consultant care, but the general aim has been a natural, vaginal birth with the view this was best all round. Even now I am diagnosed with GD and have needed a lot of insulin (most women with GD control it with diet alone) the plan is still very much to see how it goes and deal with potential problems as they arise as opposed to too much intervention.

Re consultant / junior doctor. It does sound like a second opinion / appt would be useful, particularly as the reason for appt (low lying placenta) wasn't addressed. I'm in the same situation, having a team of MW. In my case, any of them can refer to see a consultant. In which case, you may find when you turn up for the (as yet theoretical) appt you have a longer wait to see the OB themself but it could be useful, rather than seeing one of their team.

For info, a low-lying placenta most often self-resolves in late preg. It's not until the last months that the lower part of the uterus stretches. Unless the placenta is touching / over the cervix, the natural stretching of the uterus between the cervix and placenta should be enough to allow a VB. Individual consultants' opinions vary but I believe a gap of about 2cm is considered safe for VB. You'll find more info on the web - go armed if you make a follow up appt for the OB. They'll likely suggest a further scan in late preg to confirm the situation.

So my home GTT test was well negative -- 4.2 fasting and 6.3 post 2 hours. I guess I should probably go in there tomorrow and do their test and when it comes back negative I will back to where I was before. Not convinced at the usefulness of another growth scan at 34 weeks though, especially as the consultant insisted the placenta could not move by then. I suppose they want to know if the baby is growing "too much" but if I don't have GD what are they going do about it anyway?

Re. the placenta, I'm still holding out hope of it moving, but apparently that can take as long as 38 weeks so while I'm happy to go back in for scans related to that, I really don't want to be bothered with the red herring of GD/baby size when that's not the issue here. From what I've read, baby size estimates aren't guaranteed accurate by a long shot!

Anyway, thanks again everyone for the advice. I'm absolutely sure I'm overreacting but having read so many horror stories of women pressured into various interventions and treatments, I guess I'm a bit paranoid. Been so happy and stress-free with this pregnancy that I would hate to see it descend into one appt after another in an attempt to fix things that aren't broken iyswim. Would just like to be left alone to manage the next few weeks as I have all along, and be trusted that I can do that and will not put the baby's or my health unnecessarily at risk! I sort of got the impression yesterday that I was not to be trusted and everything I think/feel is second-rate to the consultant's opinion formed by the 5 min she knew me and talked to me.

Will definitely get more info and a second opinion in any case. So far nobody's explained to me the benefits of extra growth scans, much less the placenta issue. So in my heightened state all I can see are risks.

Ok no more ranting!