WEEK 29 – GESTATIONAL DIABETES SCREEN… IS IT ACTUALLY NECESSARY?

Weekly Baby News

Baby Size: 38cm – 1153grams (1.1kg) – the size of a butternut pumpkin

3rd Trimester involves continued development and size of foetus in preparation for birth. In weeks 29-33 fat stores increase considerably, while the bones are still soft however are fully developed.  Baby’s nutritional needs are at their highest during the third trimester, so mindful eating is vital.

The baby will more than DOUBLE in size in weeks 29-33 by increasing in weight by approx. 1kg and in length by 15cm.

For Mum, 3rd trimester consists of less exciting changes: Body heat increases due to the little thermos you have inside you getting larger. Urination can increase seeing as there is a greater size baby taking up more room and putting pressure on your bladder. May experience more hair growth and potentially coarser because of the increased hormone stimulation. Colostrum may begin to leak from nipples in preparation for breastfeeding – interestingly you may notice it happens when you hear a crying baby. If they are producing an abundance of colostrum some mums express and freeze for when bub comes. The good old fatigue may return, just when you thought you were feeling great and this whole pregnancy gig wasn’t too bad after all.

There are more changes for mum however lets spread these out over a few weeks, in hope not to overwhelm.

Glucose Tolerance Test / Gestational Diabetes

Gestational Diabetes is when mum has elevated blood glucose that is first diagnosed in pregnancy. Your Doctor or Obstetrician more than likely recommends that you do the Glucose Tolerance Test mid-late pregnancy. While this is a ‘standard’ test in Australia it is NOT compulsory, other than in some birthing suites that have as criteria, in order to birth with them, to be classified as low risk you must have this done. This test acknowledges if insulin is not working sufficiently in the body to clear glucose from the bloodstream and utilised in the cells as an energy source. If insulin is not working correctly glucose can build up in your blood levels. In pregnancy it is a mild condition that glucose levels are insignificant to cause any major short-term effects, in fact usually causes no symptoms. It is quite normal to have mild hyperglycaemia during pregnancy due to the increase in hormonal changes and to ensure that adequate levels of glucose cross the placenta to provide energy for the growth of bub.

The diagnosing and treatment of Gestational Diabetes still comes down to the practitioner’s opinion rather than research, as there is no reasonable medical evidence and lack of high-quality studies to support the testing and treatment of this condition.

Screening for the test entails drinking 50-100mls of glucose, equivalent to 10-20 teaspoons of sugar, which then you have a blood sample taken before, and each hour afterwards to screen for how your body deals with the glucose. If results are high another test is required (full oral glucose tolerance test) to diagnose gestational diabetes. It is common for woman to test positive to the screen test but fewer in the actual test. Keeping in mind that diets high in simple sugars in the lead up days compared to a diet high in fibre and low GI foods can greatly affect the efficacy of the test.

The claimed benefit of diagnosing gestational diabetes is to identify the chance of having a larger baby (larger than 4kg or 8 pound 13 ounces) and to acknowledge increased risk of developing diabetes in the next 5-10 years. Other risks include the mum may be more likely to develop preeclampsia, high blood pressure and low calcium (all of which can be monitored separately and the GTT is only a ‘risk’ factor not a cause). Medical evidence cannot confirm if gestational diabetes or even mild hyperglycaemia is significantly harmful to mother or baby, nor whether the diagnosis and treatment actually benefits mum or baby or whether this outweighs the risk involved. Studies have found there are greater rates of caesarean section and induction when diagnosed with GD, due to the increased amount of medical intervention combined with maternal worry and stress. Please note that the drugs used to treat this condition have not been subjected to rigorous testing and may have unknown side effects for mum and baby that must be weighted up against the potential benefits verse risks.

For myself I chose not to do the test, as drinking 10-20 teaspoons of sugar is absurd, I wouldn’t have that much in a week and the effects it would cause me to be quite ill (which is very common in this test) and seems crazy to put myself and bub through this unnecessarily. Holistically we can assess the pregnant woman by looking at risk factors such as: family history, body composition, diet, age and ethnic group etc, to acknowledge with an integrated choice to screen or not. I did have a different test that was simply added on to my normal pathology to acknowledge greater risk and for me to then decide whether I felt the need to proceed to do the GTT. It is called HbA1C that counts the number of red blood cells that are glycosylated (attached to sugar) and reports as a percentage (this results should be less than 7%). This is a more accurate indicator of risk due to the simple blood glucose can be easily influenced by prior food intake and even stress levels, with only measuring the free glucose in the blood. Therefore acknowledging blood glucose levels from the GTT test, can only give a picture at that time rather than give accurate information to reflect the mum’s risk levels.

This can be a confusing subject however it is best to find out all the appropriate information and how it effects you personally, I suggest you talk to your integrated practitioner before making this choice as there are many options available and from a holistic pregnancy perspective why would you put yourself and bub through all the physical and emotional stress unnecessarily.

What you can do to prevent Gestational Diabetes:

• Reducing excessive weight before pregnancy

• Reduce intake of simple sugars and carbohydrates and increase low GI carbohydrates, fibre and essential fatty acids

• Exercise: 15-30mins of light exercise 3 times weekly has been shown to dramatically reduce the risk

• Have your food intake assessed by your naturopath or nutritionist as there are many foods that turn to sugar once in the body

• Ensure adequate levels of nutrients in the body, focussing on magnesium, chromium, vitamin E, selenium, B6, antioxidants and zinc which all assist glucose metabolism.

• Foods to assist this metabolism: onions, garlic, fenugreek, ginseng, liver (can have dried form in capsules)

• Keeping worry/stress levels to a minimum – another great reason for regular pregnancy massages and prenatal yoga

My Journey

We travel home this week and I actually still don’t miss home, other than Miss Meeka of course. I’m enjoying the traveling around and quality time with my husband. It feels like a second honeymoon. The time away has gave us a lot of time to chat about the birth and parenting which has been amazing to connect with each other and discuss our wishes and parents we hope to be. I highly recommend this time for all parents-to-be as we have found it very helpful to be away from normal life and have the space to put our heads together without daily life distractions. Not to mention how great it was to have a last little holiday just the two of us to take a step back from the craziness of life while we can. Plus how fun are road trips!! Getting to stop in wherever you like and be spontaneous and discover awesome little beaches. Thankfully we had more luck on the way home and Sheeds got some amazing waves, which he was super happy about. So beautiful Australia truly is, we definitely have to do these trips more often as there is so much to see of this country. It is funny that this was our first holiday in Australia together, we have travelled overseas 4 times for a holiday but never in Australia. We are definitely doing another road trip next year with baby in tow, we would like to do south of Sydney though, maybe down to Bells Beach for the Pro around Easter.

This week I definitely started noticing that I am getting rather pregnant-like with the following observations:

• Blocked Ears: now this is driving me a little bonkers as there is nothing I can do to fix it rather than just be patient for it to pass. I do wonder if I sound weird when speaking with the blocked ears as I sound pretty strange to myself

• When laying in the sun at the beach Button would start moving quite a bit, I’m not sure if that is because he/she likes the sun or was trying to get away from the sun

• Feeling a FOOT: this week we have been able to feel body parts. So instead of just a flutter we have actually thought ‘wow that is a foot’ or a elbow or a cute little butt sticking out.

• Belly Size: my belly is now actually big, I accidently knock it on the kitchen bench as I’m walking past or hit it on my steering wheel when I’m getting in the car. WIDE LOAD coming through haha

• Bending has become difficult: from setting up a tent through the week I became present to how difficult it is bending forward with a big belly in the way. Even doing up my shoelaces can make me a little out of breath. Lets just say there are a lot more sound effects that accompany me through the day.

• Lifting: from not having abdominal muscles in working order anymore lifting has become quite a mission. Thankfully Sheeds is accommodating and will happily carry things for me and take out the washing basket. This has pointed out that I need to work on strengthening my arms and legs though.

Next week back into work for a few more weeks before I start slowing down. I have actually missed being in my clinic in the last two weeks and am looking forward to seeing my clients. Plus back to routine that will be a little strange seeing as I was away for 3 weeks out of the last 4, hopefully I can manage.

Yours in Health

Talita