Gestational Diabetes and other complications with this second pregnancy

People say every pregnancy is different. In my case, it has been drastically so.

When I was pregnant with Zoey, it was an uncomplicated and pretty easy-going pregnancy. I didn’t have much morning sickness. While I did lose some weight in the first trimester as I learnt to manage the nausea, my appetite returned soon after I entered the second trimester. In fact, my¬†appetite improved to the point that I enjoyed my food possibly a little too much and eventually put on a significant amount of weight, somewhere in the range of 15 kgs. From my memory I puked maybe a total of 3 times throughout the pregnancy.

So I optimistically thought that the second pregnancy would be a breeze.

How wrong I was.

This pregnancy has been a challenge, right from the beginning. I know some people would say that due to my age (I’m 36) this is normal as I’m now considered a “high risk” pregnancy. However, it sometimes feels as if I cannot get a break!

It started with me having some bleeding during the first few weeks. I had returned from Seattle in early June while I was about 6 weeks pregnant, feeling fairly confident that things would be easy. Unfortunately, this baby had other plans. Within a week of my return, I found myself having some bleeding. A trip to the gynae found no obvious reason for the bleeding, but I was put on progesterone pills plus jab to try and stem it. The bleeding would continue on and off for a few weeks, with each episode prompting a trip to the gynae for another jab.

Then the morning sickness started and it was brutal. I could not keep the food down and spent a lot of time eating and puking. I struggled to eat anything at all and there were days when I survived on cream crackers and water. The smell of food was a huge trigger and I started carrying little puke bags wherever I went. I lost about 5 kgs in the first trimester because of this. The nausea only started dissipating around the middle of the second trimester.

The next complication came when I had ultrasounds done. They found¬†multiple fibroids in my uterus, the biggest measuring over 5 cm. Given that I have a history of fibroids, I was not surprised to find this out, but it has become a cause for concern during this pregnancy as the fibroids have grown as the pregnancy progresses. For some women, the fibroids shrink during pregnancy. For others, as in my case, the fibroids grow bigger and can sometimes compete with the baby for space and blood supply. Due to this, I have been closely monitored during this pregnancy, having more ultrasounds scheduled then normal. Right now the biggest one measures around 9 cm with multiple smaller ones between 2 and 5 cm. There are too many to count and they cannot be removed during the c section as there is a concern there may be too much blood loss. There is a chance they might shrink after the pregnancy so here’s hoping.

At the same time, the doctor finds out that I have iron deficiency anemia, something that has¬†been a recurring issue for me, with or without being pregnant. So I’ve had to go on iron pills on top of my prenatal vitamins which of course make me constipated and needing to up my fiber intake.

Then the back pain started. I had the same pain while pregnant with Zoey, but it came quite late in the pregnancy, towards the end when carrying the extra weight in the front caused me to have back pain. This time it started around the middle of the second trimester. It got so bad that I would have shooting pain down my leg when I walked or stood for too long. Fortunately my gynae referred me to a physical therapist who helped provide me some exercises to keep it under control. I’ve also learnt to make myself more comfortable, whether while sitting, standing, walking or lying down. Having prenatal massage done once a week¬†has helped make things more comfortable.

Then I found I had a particular tooth that could no longer be flossed. Every time I brought a floss to it and tried to force the floss between the gaps, I would break the floss instead of bring able to get into the gap. So I ended up going to the dentist where I discovered that this particular tooth has a fracture and is now lodged tightly against the neighbouring tooth. This of course has to do with the fact that I’m a grinder. I normally wear a mouth guard to sleep, but because of the pregnancy, I’ve stopped wearing the guard as my gums bleed when I do. This in turn has caused more grinding pressure on the tooth, causing it to split. Fortunately the fracture has not progressed far enough for it to hit the nerve, however I had to have a crown put in to prevent the fracture from splitting the tooth in half. Being 8 months pregnant and having to sit in a dentist chair for a couple of hours while getting this done is not pleasant, but at least it’s done now and I’m kind of glad it’s fixed. At least I didn’t need a root canal.

Which brings me to the latest complication in this pregnancy and the reason why I am writing this blog post.

I recently read this article – Doctors Shocked At High Rate of Gestational Diabetes in Singapore, where they talk about how the rate of gestational diabetes is surprisingly high in Singapore. The article appeared at the right time as 3 weeks ago, I found out I have gestational diabetes. It has also made me wonder if it is possible I had gestational diabetes in my first pregnancy and simply did not know it because I was never tested.

In the United States, they test all pregnant women for gestational diabetes between the 24 and 28 week mark. Even though I am not in the traditionally high risk group, I had to take the 1 hour glucose test which consists of drinking a really sugary drink and having blood drawn an hour later. I failed it with a score of 146 mg/dl when the passing rate is below 140 mg/dl and so had to take the 3 hour glucose test.

The 3 hour glucose test requires fasting the night before and blood is then drawn 4 times during the test. First, the fasting glucose score which is supposed to be 94 mg/dl or below. I scored 96 mg/dl so I marginally failed. Then I had to drink the sugary drink again and my blood was drawn 3 times at hourly intervals. The 1 hour passing mark is 179 mg/dl and I scored 153 mg/dl which was a pass. However, the 2 hour passing mark is 154 g/dl and my score was 180 mg/dl. 3 hour passing mark is 139 mg/dl and mine was 151 mg/dl. All in all, I failed 3 out of the 4 scores.

Fortunately, my test results were not high enough to warrant going on insulin immediately. Instead I’ve been tasked to watch my diet and moderate the food I eat in order to keep my glucose levels steady throughout the day. This basically means taking smaller meals more frequently and having snacks between the 3 main meals per day. I also have to use a small machine to test my blood glucose 4 times a day. Once in the morning before breakfast and then 2 hours after¬†breakfast, lunch and dinner. The target is to have a fasting level of between 60 to 95 mg/dl and be below 120 mg/dl 2 hours after each meal. On top of this, I have to keep a food journal of everything I am eating so I can figure out what foods to avoid, how big portions should be and whether my blood glucose levels are stable.

I would be lying if I said this has not been a source of stress and worry. Given that there has been a lot going on in this pregnancy (International move followed by a local move, car accident, credit card fraud, Zoey getting head lice and spreading it to the family just to name a few), this is definitely another added stress that I don’t need. For the past 3 weeks, I’ve been diligently watching my diet and taking my blood glucose levels 4 times a day. I’ve tried to keep my levels even, generally below 100 and I was feeling quite pleased with the progress. Never mind that I’m sometimes a little bit hungry, nothing a handful or almonds or some crackers cannot solve. So I thought the situation was under control.

That is until we had our prenatal check up today.

So it turns out that because of my dieting, I’ve not put on any weight in the past 3 weeks. The bigger problem now is the fact that baby’s growth has slowed down. At 33 weeks and 2 days, baby is about 1.8 kgs. The doctor is concerned that baby has gone from the 8 percentile to 6 percentile in less than a month plus amniotic fluid has decreased, although not to a level where it is a cause for concern yet. Instead of being monitored every 2 weeks, I now need to go in every week for monitoring to see if baby is facing¬†Intrauterine growth restriction (IUGR). I want to say that I generally have small babies. After all, Zoey was only 2.44 kg at birth and she’s fine now. Also measuring our tiny Asian baby against the American sized babies is probably going to put us on the lower end of the scale. However, the fact is that baby is not putting on as much weight as it used to and it likely has to do with the fact that I’m not eating as much as I used to. This also means that there is a chance we will have to get the baby out earlier if baby is really not thriving inside of me.

Most people with gestational diabetes have the opposite problem. They tend to have babies who are bigger and thus diet watching is a way of making sure the babies are not too fat. In my case I have a serious dilemma now. Should I continue to eat less and risk baby not getting enough nutrition? Or should I just eat more and not worry so much about the blood glucose level given that it seems to be under control over the past 3 weeks?

Either way the last few weeks of this pregnancy promises to be interesting. Already my gynae is talking about pushing up the date of our schedule c section. We were originally planning for a 38 week c section on 20th January. Right now this is up in the air. It is very dependent on whether baby continues growing on target and if I can balance my nutrition while managing this gestational diabetes well. I’m just hoping baby stays put and doesn’t make an early appearance because an extended stay in the NICU is the last thing we need!

soloshot

A shot from maternity shoot we did a couple of weeks ago.