37 weeks- potential missed GD & big baby. What next?

[LunaDreams]

Hi,

37 weeks tomorrow with my first. Bump measurements have been measuring 2 weeks ahead throughout and most measurements on 75th centile at 30 week growth scan (due to reduced movements) but never had a GTT as was told this was all within normal limits.

Had further reduced movements last week so had routine growth scan today. Baby measuring over 95th centile in all measurements with abdominal circumference literally off the charts.
Current estimated weight 7lb 14oz.

Sonographer very breezy about it all and said I would need to meet with a consultant next week who may want to induce at 38 weeks but apparently won't consider a c-section until at least 39 weeks.
I've been under perinatal MH team for various reasons (partly tokophobia) and had agreed c-section at 39/40 weeks anyway.

Sonographer said baby's size could likely be due to undiagnosed GD but said too late for GTT and not much could be done now anyway!?

Feel quite stressed about not knowing if I have GD as surely I need to change my diet even in last week or so if I do?! Also upset at thought of being induced after so many appointments and plans to avoid this specifically.

I have tried to contact my MW and know I have a consultant meetign next week who will hopefully shed some light on it all but was wondering if anyone had similar experiences who could shed some light...

Current thoughts: should I change my diet as though I have GD?

Why can't they do a c-section at 38 weeks but happy to induce?

It would do no harm to change your diet if that would make you feel happier, but do bare in mind that some women just have bigger babies. I've never had GD but my babies have been 9lb 6oz and 10lb 8oz.

They generally don't do a c section until 39 weeks as with a c section, the fluid in babies lungs is not pushed out the way it is with a vaginal birth. Coming down the birth canal forces the fluid out of their lungs but that's not possible with a c section and so baby may be born with some breathing issues. My 2nd DS was a c section at 38 weeks due to an error made by my consultant, he had to stay in NICU for a week with breathing problems. He is a perfectly healthy 3 year old now but I wouldn't like to go through it again!

You do not need to be induced if you don't want to, they cannot force you to do that. If you are happy to wait until 39 weeks for a c section then you should push ahead with that.

Thanks for your response @BelieveInRainbows. I'll obviously do whatever I need to do to make sure baby is safe.

Just feel frustrated by not knowing about not knowing whether I have GD or not. Just want to keep him safe in there and my MW team are notoriously unhelpful so not sure how to progress!

I think this happened to me - my baby was huge (which he shouldn’t have been - he’s since settled on something tiny like the 7th percentile for both height and weight). I had a c-section booked in for 38+5 anyway (standard practice over here - I’m not in the U.K.) and he was indeed a whopper when he came out.

His blood sugars were quite unstable and I was under a lot of pressure to get him to latch after he was born, but thankfully i had expressed quite a lot of colostrum before the birth which helped him without needing formula. Other than that he was absolutely fine and eventually shrank down to his correct genetic size! (I jest now but the weight loss was quite stressful at the time!).

It’s worrying isn’t it.

I’m 37 weeks and all of a sudden baby is measuring 2 weeks ahead so have GDT booked for Friday … feel abit deflated /miffed / confused. Does GD develop that late or has it just been missed?

@feesh did you ever get tested for GD out of interest? Glad to hear he was able to feed well after birth and weight has since settled down!
@Rubyrecka did that most recent measurement come up via scan or fundal height measurement? Is GDT the diabetes test?

I've since spoken to my MW who said there is no way they'll do the fasting test at this stage. I asked if I could at least have my blood sugar levels taken to give me some indication whether GD or not and she said even that was unlikely...apparently it all has to go through diabetes team who she seemed to think will want me to wait and see consultant next week first. I asked if I said change my diet just in case and she said no as its not a confirmed diagnosis...

She also said it can just develop really late but did admit I've never been properly tested as felt there was no clinical indication to so think it can be either. It is worrying though.

One thing is definite from what everyone has said...he will definitely be out before 40 weeks!

@LunaDreams it was fundal height measurement ( i know these are renowned at being inaccurate but still a worry) and yes GDT is the Gestational Diabetes Test.

I’m confused why your MW hasn’t sent u for a test? My appt was today and after my reading I have a GDT on Friday even tho she thinks it’s likely to be the baby position. Surely they need to know either way as it can affect birth and baby?

I had a similar experience with first baby.

Reduced movements at 29 weeks checked by a scan saw baby was very big. Had diabetes test come back clear. Carried on with growth scans baby was measuring off the charts he was plotting about an inch above my top line in my notes!

It was suspected i couldve developed 'late onset' diabetes this was around 36 weeks but was told they wouldnt re test as nothing they could do that far along anway even if i had it and just to carry on.

Baby was born at 39+3 at 8lb14 so no where near where he was plotting. I think they are so inaccurate with measurements i wouldnt worry yourself too much x

Also guidlines are c sections must be after 39th week as its been shown that babys lungs before this via c section are not prepared enough.
(It is different with a vaginal birth because when baby comes down the birth canal the lungs are essentially squeezed so it gets rid of all the mucus and stuff).
So only in certain cases will they consider a c section before 39 weeks, and if so you will have to have steroids for babys lungs.

Same here! Though like @Rubyrecka mine is just based on fundal measurement, I haven't had any scans. There was a bit of a jump at 36 weeks and an even bigger one yesterday at 38. No mention of going for a test though and I'm quite worried. This baby now plots on 97th centile line when my first was on the 27th. Also wondering whether to change my diet just in case...

@Rubyrecka yep they have outright refused to do the usual diabetes test. They are going to discuss whether they will even do blood sugar reading with diabetes team but said it was unlikely as wouldn't change anything like @bee38 experience.

Makes sense about them not doing section before 39 weeks if that's the reasoning. I guess will have to speak to docs next week about risks of him staying in for section at 39 weeks versus reasoning for inducing at 38.

@Struggling217 definitely worth mentioning to MW about having a GD test if you're concerned. I'm not sure how far along in pregancy you are but think they only tend to do it up to around 28 weeks (although @Rubyrecka is getting one later on!).

As you say it might be a completely over estimated measurement or just that I've grown a big baby! Suppose I will just have to hold tight and hope consultant can give some answers and a clear plan next week!

I had GD during my pregnancy but it was picked up at 28 weeks.

I had my baby by elective section at 37+4 and he was born weighing 7lb 5oz.

My consultant opted to deliver at 37+4 due to the fact I was on insulin for the GD as diet had not been able to control my levels nearer the end.

I’d definitely say it would hurt to alter your diet. There is some fab info and recipes in the Gestational diabetes uk website. It’s mainly cutting carbs and food pairing.

But there’s also the chance that the growth scan isn’t all that accurate as many aren’t.

The only growth scan I had was at 34 weeks where baby was estimated to be 5lb 5oz at that point. So mine actually was pretty accurate as it means in the 3 weeks and 4 days from the scan to delivery he put on 2lb, which is about right when they say roughly half a pound a week weight gain from then onwards.

@LunaDreams I had passed my GTT test earlier in the pregnancy, but my OB reckoned I had developed it later.

All 3 of my kids were born by c-section before 39 weeks by the way, all had good APGAR scores and none needed any help at all.

A similar story here re: big baby, but I was constantly tested for GD throughout my pregnancy as my first was also big. Even at the later stages (36+ weeks) they did various blood tests including random glucose, Hba1c and fructosamine. I think it depends on your Trust but from googling, fructosamine seems to be the most accurate in later pregnancy so you could ask for that. The consultant did say that none of them are particularly accurate and the most useful thing to do if you are really worried is buy yourself a home blood sugar monitor and test yourself on waking and then 1 hour after meals (she told me to do one meal every day and mix it up, so breakfast one day, lunch the next). I did this and mine were always fine, baby was just big. I ended up being induced at 40+4 and that was fine too.
I asked the same question about if I should change my diet even without a GD diagnosis, the sonographer said there wasn't really any need but if it made me feel better I could avoid sugar, particularly bananas (do not think this was my issue - was having daily cake by this stage).

Hope all goes well with you, I would definitely recommend picking up a blood sugar monitor if you can afford one as this was really reassuring. You can Google for the normal limits fasting and post-prandial. Most chemists sell them over the counter.

Thanks for your responses all.

A quick update for any future readers:

I spoke to my mental health MW this morning as still felt upset and very anxious about yesterday's scan. She managed to bring my consultant appointment forward to today. After really pushing for it, I was given a blood sugar monitor and the 2 readings I have already done are high suggesting GD.

Consultant earlier said regardless of readings they will consider doing c-section at 38 weeks with steroid injection before or at 39 weeks as planned anyway. It is down to me to decide over next few days once have got bit more of an understanding of my sugar levels.

Certainly a whirlwind 24 hours! Consultant said like PP that might not have even been that it was missed but that I just developed it late on. Just relived to have a plan and a better understanding now.

Good luck to those in similar situations.. my advice would be keep standing up and advocating for yourself and your baby!

Thanks for the update, so glad you got some answers and they could adjust your plan accordingly. I did actually email my midwife with my concern last night and she fitted me in for a glucose blood test today to be on the safe side, I should have the result tomorrow. Fingers crossed!

Ah that's good @Struggling217! Let us know how you get on x