Gestational Diabetes - Large abdominal circumference

[PamRavenscroft]

Hi, I'm 31 weeks and was diagnosed with gestational diabetes a few weeks ago. I'm trying to control with diet & exercise but my fasting levels are often very slightly over (5.1, 5.2, 5.3). My hospital has a very low cut off point of 5.0 for fasting. I was prescribed metformin but asked to wait till the results of my growth scan, which I had today, before I started taking it. All baby's measurements were nice & normal except the abdominal circumference which was on the 95th percentile. I am trying to work out the significance of this - obviously it means the sugar is going to the baby, but other than its tummy it isn't 'big'. I hate taking medication when pregnant but am I being an idiot for not? As my levels are so borderline I have been reluctant to start on meds but after today's scan I just don't know what to think. Any advice, previous experience etc. would be hugely appreciated! I lurk on the Jan 2014 thread but haven't posted yet - I'm hoping Tarka will see this!!

Hi, Sorry no advice on the GTT side of things but regarding the scan - I would be very wary about taking measurements from 1 scan alone as gospel.
My babies have all measured fairly large on scans but have been born between 7lb and 8:13lb

With this pregnancy I had a scan at 22 weeks and was put on 95th for AC, had to go back a week later as baby too curled to confirm heart chambers, and at this scan, baby AC was just under 75th. In fact the measurements ooking through my scans, have been all over the place.

The consultant said it is nothing to worry about on one scan alone. I would suggest you see about further scans so that you can build a better picture of what is going on in there.

Hahaha - yes I can't avoid a gd thread!

Normally I'm very much "take the medication" but... Those fasting levels are ridiculously low. I'm supposed to eat before driving if my levels are below 5. By my hospitals rules you'd be managing well with diet control. What are your post meal readings like though?

Having looked at the nice guidelines though it does say that medication should be offered if babies AC is above 70th centile. Have a look at page 18/19. Page 19 also tells you what levels you need to be achieving.
I've used metformin in both pregnancies and it has helped massively in keeping my blood sugars low. I do understand why people aren't keen though as hospitals often use it as the criteria for early (38 weeks) induction.
What centile is the babies head circumference? The worry is that the head is supposed to be the biggest part of the baby and the rest slide out easily but if the stomach is to big the torso can get stuck (shoulder dystocia).

Thanks for replying cooking and tarka. Normally I would take the scan with a pinch of salt but I know the hospital will be relying on it & they already want me on medication. Tarka, my post meal readings are great - never been over 8. Head circumference is normal - 50th percentile so only the tummy that's a worry. I'm going to have a look at the nice guidelines now....
Tarka, did you have any side effects from the metformin? And how was your birth & the baby's size & weight when it actually arrived?

In the short run (about a week) the metformin gave me an upset stomach but there is a (more expensive) modified release version which is supposed to be better for that.
I had the opposite to you in that my reading were often high but dd was always growing on the 50th centile. I was induced at 38 weeks and dd was 7lbs.

I had wanted a natural birth but the induction was fine. I was given a pessary which dilated me by about 1cm. Then, after a wait for a bed in delivery suite, they broke my waters and started the drip. 4hrs of discomfort, then when it got too painful I had an epidural and gave birth quite shortly afterwards with very little pushing. It was actually really positive even though on paper (stuck in back/drip/epidural) it was everything I thought I didn't want.

I'm not worried about being induced really, my first birth was at 35+4 weeks, waters went & they induced me, dd was 5lb 6 & like you it was a positive experience despite the intervention. I am fairly terrified of having a 'big' baby though as she was quite small, & I suppose I am worried that my aversion to taking medication could end up having an adverse affect on the baby & the birth. I think maybe I have been in denial about the GD because my readings have been so low & everyone keeps telling me I was only just past the cut off on the gtt. I hate all the testing, haven't eaten anything sweet in weeks & am quite stressed about it all. I suppose now is the time to start taking the doctors advice & just go with the flow. I feel guilty for having it which is very silly as I know it's not something I've done (I have no risk factors - just really unlucky!)

My results at 28 weeks were very borderline like yours, my fasting was spot on 5 and 2 hour after gtt 7.4 which is within range, after my growth scan we get results straight away and like yours mine were head circumference 25th centile and stomach 75th so doctor told me to go straight on metformin, I couldn't get past taking the 1 tablet as it was very harsh on the stomach and my glucose levels were high after low carb meals so ended up on insulin which so far my results are ok I have my second growth scan tomorrow so that will show if the medication has done anything!
I was a bit dubious weather to take the medication but as I knew naff all about gd my thoughts were do as I'm told till first scan and research in that time.
I think from what iv looked up it is better to take the meds if you can't keep your numbers down purely by diet and exercise as the excess sugars can be quite bad for baby, dietician said to me that if your numbers go over more than 3 times in a week it's better to take them.
I'll post bk tomorrow when iv had my second scan to let you know if meds have made a difference.

Thanks terilou, good luck at your next scan. The more I have thought about it the more I think I should just take the medication - I would never forgive myself if I had a difficult birth that could have been prevented. It feels like such a numbers game though doesn't it?

Yes, I think your thoughts are about where I was when I started them.
iv been on them 4 weeks now and the numbers start to get harder to control as you get further on, I seem to be increasing the insulin every couple of days, but I read somewhere it slows down again around 36 weeks. I'm hoping that's right as I'm 33 now and really don't want it to get any worse.
I can't believe how hard/ inconvenient it is remembering to take insulin before every meal then test blood an hour after each meal then before bed. I really feel for those who have this all the time!

Right I have just taken my first metformin - sitting here keeping my fingers crossed it doesn't upset my tummy too much!

Good luck Pam make sure your close to a toilet got my scan at 1:40 so I'll update you after that.

Fingers crossed for you!

Fwiw I think that is the right decision.

I found the side effects disappeared after a few days. If they don't ask your dr if you can try the modified release ones.

Thanks tarka. So far no bad side effects, am off to bed now (I'm in australia) so hope nothing wakes me up in the night - I usually have a cast iron stomach so fingers crossed!
Hope you & the family are feeling better after your nasty bug - what horrible timing!

Scan went fine, baby is still measuring 25th centile for head and 75 for stomach so no change but main thing is it's not any worse, I was kind of hoping that the measurements would of equaled out a bit.

Glad scan went ok terilou. I know what you mean - you would hope the rest of the baby would grow in proportion to their tubby little tummies after all the effort you're making, but at least the main thing is it isn't any worse. Did they say if you will have any more scans?

Yes iv got my last scan in 4 weeks then I'll be given exact date for c section consultant said it will be around 38 week mark which will be 27th December. It's all starting to feel pretty soon rather than ages away. eeek!

Omg what's with the swollen ankles?? My stomach has been fine but my feet are huge! Is this a metformin thing?

How exciting terilou you're pretty much on the home stretch now!

Iv no idea about the swelling but id get it checked out to be on safe side.

Hello ladies
I'm in the GD boat too, 32 weeks and struggling to keep glucose under control with diet and exercise, I have been put straight on insulin that I enject once a day. My levels where only slightly over before and now seem to be within range but hosp felt I needed to start insulin so I did. I don't want to worry anyone but it's not just a risk of having a big baby, there are other possible complications as well if not treated. I think you are doing the right thing by starting the meds.
I have been booked for a Section on NYE all being well, it feels better to have an idea of when baby will come, light at the end of the tunnel !

P.s will be having chocolate as soon as I can once baby is here :-)

Hi summer, what I would give for some guilt free achocolate
1injection is good and it's good that your results are in range, iv got to have the novarapid insulin before meals 3 times a day and a levimir before bed but my numbers are now all stable and within range,
you must be due around same time as me, I'm 33 weeks tomorrow! And Nye is a good day for a c section! Iv got to wait till 36 weeks to get my exact date but I'm hoping to be home by then with a bigger than average glass of pernod and black to make up for a sober Christmas

Hi summer! Ahhh chocolate - I think this is the worst time of year to be banned from eating sweet treats don't you? I would give anything for a mince pie. In fact I'm planning to take a packet in my hospital bag to eat once baby is born! How exciting that you have your date already set. I am currently in limbo but I'm ok with that as I hope to avoid a cesarean. We've just been for our hospital tour - all looks very nice. Last baby was born in the uk & this one will be a little Aussie so I'm interested to see the differences when it all kicks off.

Hello ladies, i'm another fellow gestational diabetes pregnant lady. On insulin 3 x a day. I'm 32 weeks & got my induction date of 30th dec.....very exciting!! Babies size has been average so far so going for natural (well... ish) vag birth!

Oohhh i cant wait to have some guilt free chocolate....yummmmm

Sign me in too- 32+weeks and desperate for a good munch of chocolate, 85%cocoa solid stuff just isn't cutting it. First thing in my hospital bag will be a wee choc bar

Pam deffo go and get your swollen feet checked out