Monday, August 20, 2012

Elderly primigravida? Here!

Who knew that "elderly primigravida" is the official term for advanced maternal age? It was printed on one of my ultrasound reports, along with other inspiring labels like "poor obstetrical history" and "preg via assisted reproductive technology."

Ah I'm a granny-mom-to-be with a poor obstetrical history. Not exactly new news, and not how I planned things, but here we are. "Elderly" or not, I am so, so grateful - and still incredulous - to be here. Thrilled through to my core.

So this "elderly" first-time mom-to-be went in for her latest OB appointment today, 30 weeks, 2 days.

My OB is on vacation, so I chose to see the partner of hers I hadn't yet met. Her other partner was my OB for our first four pregnancies and miscarriages, so I feel plenty acquainted with him and know I would feel comfortable if he is on call when I am laboring.

But I wanted to check out the third guy. And phew! I really liked this other partner as well. He was very thorough and went over my entire chart with me, noted my history of Hodgkin's, noted the history of miscarriages, talked to me about what we'd done differently this pregnancy (lovenox, corticosteroids, IVIG, gluten-free for first trimester). We agreed together that much of it has probably been voodoo, but hey, voodoo or not, why mess with success?

My blood pressure looked good (108/65), and strangely I seem to have lost 3 lbs since my  last visit two and a half weeks ago. Which must be water weight or something because I'm definitely not calorie restricting - if anything, I'm on a much higher fat diet with this gestational diabetes.

The covering OB pointed out that Magpie's growth has been slowing (she's gone from the 41st %ile to the 25th %ile at the last growth scan). Although overall he said it's not that big of a change, and Will and I aren't big people, he wants to keep an eye on things to be sure her growth is not trending downward. He's scheduled another growth scan next week to check on her.

He also wants me to start non-stress tests this week, whereas my regular OB was planning to start them in my 32nd week. Fine by me. I want a safe and healthy baby - so more surveillance is just fine with me.

I was expecting to hear that my fasting blood glucose levels have been too high, since that has been my (and my new nutritionist's) opinion. Sometimes my fasting numbers have been in the 106ish range and they are never lower than the mid to high 90s). I've been doing everything I can to get them to go lower...but this OB said the numbers are still ok in his book. That was a surprise. We'll see what my regular OB thinks.

I have another appointment next week to see my regular OB, by my's been 3 weeks since I saw her (when she told me I had GD)...and now that I'm officially high risk with the GD, I just don't want anything to fall through the cracks.

But so far so good-ish. This is one well-monitored little girl!


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  1. I had lots of extra monitoring with my pregnancy because of my earlier miscarriages and I loved it. Take all of that extra reassurance you can get! I'm so thrilled that everything is on track!

  2. NSTs are the best way for them to make sure she is okay so that should help you stay sure about her well-being. I hope her growth stabilizes and that your doc is okay with the fasting glucose numbers.

  3. When I heard "elderly" I about had a conniption fit. I was just getting to be OK with AMA, but elderly is just plain mean. My mom happened to be at the appointment with me and she asked my OB if I'm elderly, what was OB promptly responded with "SUPER ELDERLY" We all had a good laugh.

    Glad to hear things are going ok...NST and growth scans ahead. I'll keep you in my thoughts as you start down that road... GOOD LUCK!

  4. I find it interesting that you lost weight on the GD diet - my weight has been steady since I started the diet changes a couple of weeks ago. And for me, that's like losing weight, because I've been gaining so fast throughout this pregnancy. I wonder if it's because of the lower carb thing - if you think about it, the GD diet is kind of like a modified Atkins diet. Even though we're eating fattier food most of the time, maybe less carbs = less weight gain?

    I'm glad you're getting such great care from your docs - it must make you feel so much more secure. And CONGRATULATIONS on 30 weeks!! I feel like that is the biggest milestone of all - just to have a "3" at the beginning makes me feel like it's so close! I can't believe we're here either, Mo - but for you it's even more special after what you've been through. So happy for you!

  5. If I'm remembering correctly, Tiny Boy was 25th percentile at around 20 weeks and then started dropping every growth ultrasound after 30 weeks. Glad they're keeping an eye on Magpie!!

    NSTs are boring, boring, boring. Bring something to read :)

  6. "Elderly"....gotta love it Mo!! Nothing has made me feel as old as infertility - I sometimes have to remind myself that 39 is NOT ancient in all aspects of life but in the land of makin' babies I guess I'm an old broad!

  7. 30 weeks, woo hoo! Great news. She's the size of a squash! Yay!

    I think maybe newbie is right about the low carbs thing...

  8. Hahaha... very funny! I can't believe they actually printed it on one of your reports! Sorry to laugh, I'm on the same boat so I can laugh... I like to believe 40 is the new 30's though :)

  9. I remember my LO ostensibly being 7#5oz at 37 weeks and then actually being 7#4oz when he was born nearly 4 weeks later -- or maybe I have those backward. Long story short, their ability to estimate Magpie's size before she's born is pretty limited, but as others say, it's good that they're keeping a close eye on everything. I wouldn't pay too much attention to things like the size estimates, but overall having a lot of data seems like a good thing.

    Also, great that you like the docs ... as far as I can tell, if labor starts naturally (as opposed to being scheduled), it will do so when whoever mom likes least in the practice she's seeing is on call. Murphy's law at work, I guess ... so I figure the best decision rule is to pick the practice where the doctor you like least, you still like ... sounds like you are well above that metric.

    Here's to weeks that start with the digit 3 in the tens place!

  10. I ALWAYS feel like when I read your post I am reading me and my husband's story! First let me say I am so excited for you and share what you are going through and have BEEN through..when we got close to the end of our pregnancy my DR wanted me to have non-stress test because "as they said" I was AMA- advanced maternal age, I was 35! I had NO idea what I had to do during the stress test til I got there, and let's just say I was- a little surprized :)

  11. I'm usually a lurker, but have been meaning to post something for ages, ever since your diagnosis with GDM, but life keeps getting in the way....

    I'm an endocrinologist (of the non-reproductive variety) and have a special interest in GDM. I think your primary OB is right, above 90 fasting is too high. The numbers were never really clear cut until the HAPO Study a few years ago clearly showed that once you hit 90 fasting, the risks of complications start to increase.

    A lot of my patients have a LOT of success with plain, full fat, full sugar vanilla ice cream (one cup) as their bedtime snack for getting morning sugars to goal. If you've tried that, and other 30g of carb snacks with fat and/or protein, and your morning sugars are still above 90, it's probably time for insulin. The insulins we use are safe in pregnancy (either NPH or Levemir), and compared to all that you've already done, are super duper easy to administer. I know insulin sounds awful, but it really isn't bad at all. I swear.

    Feel free to email me if you have questions or want more details on the HAPO study. :)

  12. I love that you're monitoring Magpie so well. She's a special little girl and we want her to cook inside for a long time ;)

    I'm all for double and triple checking things. ALLLLLLLL for peace of mind, right?

  13. I'm so glad Shannon delurked to give you the scoop on the blood sugars--I work in endocrinology as well and we do not allow the fasting glucoses to go above 90-95 in our gestational patients. Good luck, I know you can do it!

  14. So glad that things are humming right along, even if clinical terminology can be (in my opinion) even worse than what a mean girl would say. Somehow it's OK to be called an 'elderly primigravida' but if someone on the bus said "Wow, aren't you to old for this to be your first?" someone (possibly me) would offer to deck him/her for you. Interesting. I'm glad that you're well monitored and so glad to see that you're in weeks that start with 3! Wahoo! Keep on cooking Ms. Magpie!

  15. Happy that everything continues to go well. It kind of sucks to see what's in your chart sometimes. While I had a pretty unremarkable pregnancy, the midwifery practice I started out with put "pregnancy complicated by obesity." While I am obese, I had no complications and kind of disliked being pigeon-holed like that.


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