QuestionHI Brenda
I am almost 37 weeks and this is my first pregnancy. I have GBS and gestational diabetes(no medication, just to control my diet only).
The first question that I would ask is, once in a week, my glucose level after food is 190. Is that a big problem? For the past 8 weeks, I ate carefully, but unexpectedly, once in a week, I lost my control. This will be harmful to my baby?
Secondly, as I have the diabetes, I just want to know after the baby is born in the hospital, will they test his blood sugar level?
Thirdly, I want to breastfeed my baby, so do I need to control my diet after delivery? Just wonder when the glucose level will be back to normal? I heard that it takes 4 to 6 weeks. My concern is after dilevery, my breast milk will contains high level of glucose and thus harm my baby if I do not control my diet?
And, during the birth class, the nurse said when the water bag breaks or bloody shows, before we go to the hospital we can take a shower and wash our hair. However, I read through some of the articles, they mentioned that when there is blood and break of water bag, taking a shower will spread the infection of GBS to the uterus, thus will harm the baby. What is your opinion? should I take a shower or wash my hair if it happens?
And, I am now having shooting pain around the vaginal area, severl times a day, and about several seconds per time. it that normal?
I am 39 years of age, any suggestion to this old-aged mother? usually delivery before or after the expected due date?
Thanks
AnswerDear Jenny,
Whew... OK, I'll try to get these all answered and not leave anything out for you...
We don't know exactly what causes gestational diabetes, but we have some clues. The placenta supports the baby as it grows. Hormones from the placenta help the baby develop. But those same hormones also block the action of the mother's insulin in her body. This problem is called insulin resistance. Insulin resistance makes it hard for the mother's body to use insulin. Gestational diabetes starts when your body is not able to make/use all the insulin it needs for the pregnancy. Without enough insulin, glucose cannot leave the blood and be converted into energy. Therefore, glucose builds up in the blood to high levels.
Gestational diabetes affects the mother in late pregnancy, after the baby's body has been formed, but while the baby is busy growing. Because of this, gestational diabetes does not cause the kinds of birth defects sometimes seen in babies whose mothers had diabetes before pregnancy. However, untreated or poorly controlled gestational diabetes can lead to macrosomia, or a "fat" baby. Babies with macrosomia face health problems of their own, including damage to their shoulders during birth. Because of the extra insulin made by the baby's pancreas, newborns may have very low blood glucose levels at birth and are also at higher risk for breathing problems. Babies with excess insulin become children who are at risk for obesity and adults who are at risk for type 2 diabetes.
Gestational diabetes usually goes away after pregnancy. But once you've had gestational diabetes, your chances are 2 in 3 that it will return in future pregnancies. In a few women, however, pregnancy uncovers type 1 or type 2 diabetes. It is hard to tell whether these women have gestational diabetes or have just started showing their diabetes during pregnancy. These women will need to continue diabetes treatment after pregnancy.
Many women who have gestational diabetes go on to develop type 2 diabetes years later. There seems to be a link between the tendency to have gestational diabetes and type 2 diabetes. Gestational diabetes and type 2 diabetes both involve insulin resistance. Certain basic lifestyle changes such as maintaining a healthy weight, making healthy food choices, and exercising regularly may help prevent diabetes after gestational diabetes.
Although you have said that approximately once per week your level will sneak up to 190, with your blood glucose in the target range the rest of the time and good medical care, your chances of a healthy baby are almost as good as they are for a woman without diabetes. Do your best to keep that level in your target range all the time(typically less than 140mg per dL 1 hour after a meal OR 120mg per dL 2 hours after a meal). Even a small amount of exercise can be very helpful in obtaining that target range.
Some new mothers have better blood glucose control in the first few weeks after delivery. However, for many it's a period of odd blood glucose swings. Not being able to predict how your body will act may cause some frustration. Breastfeeding is good for women with diabetes, but it may make your blood glucose a little harder to predict. During the first weeks at home with baby, you are likely to be tired, stressed from lack of sleep, and off schedule. Odd sleep patterns increase the danger of napping through a snack or mealtime. Low blood glucose is a real danger. It's important for your baby's safety to avoid blood glucose reactions that could confuse you. For all of the above reasons, it is important to check your blood glucose often during this time. And your records of your blood glucose levels will help you and your doctor adjust your insulin dose.
To help prevent low blood glucose levels due to breastfeeding:
-Plan to have a small, healthy snack before or during nursing
-Drink enough fluids (plan to sip a glass of water or a caffeine-free drink while nursing)
-Keep something to treat low blood glucose nearby when you nurse, so you don't have to stop a feeding to treat low blood glucose levels
Women who breastfeed use more calories. What you drink and eat can affect your milk supply, as well as your blood glucose. You will need to work with your doctor and dietitian to adjust your meal plan while you are nursing. If your doctor determines that the diabetes has gone when he checks your glucose levels at your 6 weeks check-up, then you won't have to be so concerned about these precautions. And yes, they will check your baby's glucose level.
As for the GBS precautions, since this is your first pregnancy/delivery, take a shower. Medical research indicates that giving antibiotics through the vein to the mother during labor can greatly reduce the frequency of GBS infection in the baby immediately after birth or during the first week of life. Treating the mother with oral antibiotics during the pregnancy may decrease the amount of GBS for a short time, but it will NOT eliminate the bacteria completely and will leave the baby unprotected at birth. Also, waiting to treat the baby with antibiotics after birth is often too late to prevent illness. That is why IV antibiotics are nearly ALWAYS given during labor/delivery.
Ideally, you'll want to get started on the IV antibiotics at least four hours before you give birth, but if your labor is very rapid you may not have that much time. But don't worry - getting started even a couple of hours before delivery significantly lowers the risk to your baby. If you don't get your first dose four hours before the birth, you'll probably need to stay in the hospital for at least 48 hours after delivery so your baby can be observed for any signs of a problem.
As for the pressure/pain you are feeling - it sounds like a common discomfort in the 2nd trimester of pregnancy called round ligament pain. Round ligament pain generally refers to a brief, sharp, stabbing pain or a longer-lasting dull ache that pregnant women commonly feel in the lower abdomen or groin, starting in the 2nd trimester.
You may feel round ligament pain as a short jabbing sensation if you suddenly change position, such as when you're getting out of bed or out of a chair or when you cough, roll over in bed, or get out of the bathtub. You may feel it as a dull ache after a particularly active day - when you've been walking a lot or doing some other physical activity.
The round ligaments surround your uterus in your pelvis. As your uterus grows during pregnancy, the ligaments stretch out to accommodate and support it. These changes can occasionally cause pain on one or both sides of your abdomen. You may also feel the pain starting from deep inside your groin, and can move upward and outward on either side to the top of your hips. The pain is internal, but if you were to trace it on your skin, it would follow the bikini line on a very high-cut bathing suit.
Many pregnancies to "advanced maternal age" women (women who will have made her 35th birthday by the time she delivers) actually end up being delivered early. Usually due to one high-risk factor or another which are related to advanced maternal age, such as gestational diabetes or Pregnancy-induced Hypertension (PIH).
Yikes, that was a LOT of information. I hope it all helps you and answers your questions. I wish you well.
Brenda
