OB appointment 27 weeks 4 days: It's official

As expected, I have now been officially diagnosed as having gestational diabetes. I saw my OB this morning and despite the news, she was very upbeat (as always). She came bounding in to the room, calling out "Sugar girl!" Overall, she was very reassuring and encouraging, giving two hugs and several high fives. Lots of "OMG, you'll be 28 weeks on Saturday! You're basically in the third trimester!! Look at you! Everything is going to be fine!" I really don't know where she gets her energy from.

Interestingly, I have gained no weight in the past month. Don't know if that could be diabetes-related or not, but given my worry about getting huge, or Magpie being huge, I don't see it as a bad thing. I've certainly not been restricting my food intake. I was in the normal range for BMI before getting pregnant, and I've gained 18 pounds so far this pregnancy, which is an appropriate amount according to the calculators I have found online.

We listened to the baby on the doppler - her heart rate was in the 140s. And the OB measured my fundal height, but didn't tell me the measurement (and I didn't ask).

In terms of the gestational diabetes, the plan is for me to see a nutritionist for now. They also drew an A1C level to see how my glucose levels have been over the past three months. She wants me to monitor my blood levels fasting and 1 or 2 hours after each meal. If my diet is consistent and my levels are consistently low, she may drop some of the finger sticks. I am also supposed to see a nutritionist, pronto, to get advice on how to manage my diet. Once the OB heard what my blood levels have been at home, though, she said she was very reassured and that she suspects I will do quite well and be able to control things by watching my food choices.

She also said we will begin non-stress tests at 32 weeks to keep a close eye on the baby. She said that between the gestational diabetes and my coagulation issues, she will not let me go past dates, preferring to induce me if I get to 40 weeks with no baby in sight. Not what I will be hoping for, but I'm not really interested in going past dates either.

Here are the actual numbers from the 3 hour oral glucose challenge test (far right column). Interestingly, all of the lab values are lower than what my finger sticks were showing. Still really elevated, mind you (except for the fasting level), but lower. So that's good to take into account when I'm drawing my bloods and trying to make sense of the numbers going forward.

TIME OF SAMPLE COLLECTION	AMERICAN CONGRESS OF OBSTETRICIANS AND GYNECOLOGISTS (ACOG) TARGET LEVELs	MO’S LEVELS ACCORDING TO HER GLUCOMETER	MO’S LEVELS ACCORDING TO venipuncture lab values
	Glucose load: Samples drawn after 100-gram glucose drink
Fasting (prior to glucose load)	< 95 mg/dL (5.3 mmol/L)	95-102 mg/dL	88 mg/dL
1 hour after glucose load	< 180 mg/dL (10.0 mmol/L)	233 mg/dL	219 mg/dL
2 hours after glucose load	< 155 mg/dL (8.6 mmol/L)	225 mg/dL	199 mg/dL
3 hours after glucose load	< 140 mg/dL (7.8 mmol/L)	176-184 mg/dL	145 mg/dL
Results interpretation	If TWO or more values meet or exceed the target level, gestational diabetes is diagnosed.

So that's it for now. Still processing this new reality, but it seems like a very manageable one. It's a little bit of an ego blow - I'm usually such a good test taker! But I have to remember this isn't a test I could study for and pass. It's not up to me. It's my body and Magpie's placenta calling the shots here.

Thank you again for all of your comments and stories about your own situations - it's been an invaluable help and made me feel so much better about this!

Mo

One reason why we'll be keeping a close eye on things!

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Today is a whole other day

So...still no official word yet if I have gestational diabetes or not...but in the meantime, thank you so very much for all of your comments and thoughts. It really, really helps to hear your experiences.

A special thank you from those of you who commented that you had GD but went on to have a normal sized baby. That was heartening and motivating to learn. It was also cool to hear that some of you went to a GD specialist or specialty clinic - I'll have to see if something like that is available here - I think it would help me keep a closer eye on things and stay on track.  Also really helpful to hear that exercise can help bring the glucose levels down if they are initially high. And thanks for the validation that being sick could have affected yesterday's test results (see below for more evidence of that). Also, really interesting to hear that these monitors have an error rate of 20% - that's a wide margin! I'm using the One Touch UltraSmart by the way, not the Freestyle. Not sure why they can't make these devices more accurate than they do...

Just to further confirm that something wonky was maybe going on yesterday, I thought I'd share these numbers from today...they seem so strangely low compared to yesterday's crazy values.

Fasting:                                                                             97 (ok, that's a little high - below 95 is target)


1 hour after breakfast (egg/cheese on 1/2 muffin):     105 (target is below 140)


1 hour after lunch (tuna sandwich on whole wheat):  118


1 hour after snack (banana + almonds):                         99

How can all these levels be so well...normal...when everything looked so wonky yesterday? Perhaps it was the being sick overnight. Or could it be that I just can't consume vast quantities of cake (or yucky glucola) but am otherwise ok?

I tell ya, it's a head scratcher to me. Especially because I don't think my diet today has been particularly healthy.

I also wanted to get your thoughts before tomorrow's appointment on what else I should keep an eye out for as the pregnancy progresses. Once you were diagnosed GD, did your OB do anything differently in terms of doing growth scans or checking for lung maturity? I also read there is an increased risk of stillbirth with GD (shudder). Anything else I should be sure is occurring in terms of blood work, scans, etc., to give everything the best chance of being ok?

I promise I'm not freaking out...I just want to be thorough.

More tomorrow after I meet with the OB. My husband Will will be coming with me... stay tuned.

Mo


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3 hour glucose tolerance testing

I just completed my three-hour glucose tolerance testing. Things are not looking promising, I have to say.

The official bloods are being whisked to the lab at this moment, with results pending, but my husband Will recommended I start checking my blood sugars as soon as I failed the one hour test, and immediately provided me with a glucometer for that fun task. The values have been pretty ok the past week...sometimes a point or two over the ideal, but nothing too alarming.

But today. Today. Yikes.

According to my finger sticks, my fasting blood level today was between 95 and 102, the highest it has been all week (I tested twice - right when I got out of bed, and at the doctor's office. Weirdly, the higher level was at the doctor's office...I would have thought your glucose would continue to decline the longer you were fasting, but what do I know).

My one hour blood level after drinking the 100g of glucola (yuck!!) was 233. Seriously out of bounds, even if this meter isn't perfect.

My two hour blood level was 225.

And my three hour blood level was 176. I decided to wash my hands and do it again...resulting in an even more abysmal 184.

Here are the cutoffs to reach a diagnosis of GD...and my worrisome levels:

TIME OF SAMPLE COLLECTION	CURRENT American Congress of Obstetricians and gynecologists (ACOG)  TARGET LEVEL	Mo’s Levels according to her glucometer
	Glucose load: Samples drawn after 100-gram glucose drink
Fasting (prior to glucose load)	< 95 mg/dL (5.3 mmol/L)	95-102 mg/dL
1 hour after glucose load	< 180 mg/dL (10.0 mmol/L)	233 mg/dL
2 hours after glucose load	< 155 mg/dL (8.6 mmol/L)	225 mg/dL
3 hours after glucose load	< 140 mg/dL (7.8 mmol/L)	176-184 mg/dL
Results interpretation	If TWO or more values meet or exceed the target level, gestational diabetes is diagnosed.

We will see how these values line up with the official venipuncture results, but you see what I mean about things not looking good?

I have only two risk factors for gestational diabetes: my age, and a family history of diabetes. I guess that is enough.

I'm thinking whether I meet formal diagnostic criteria or not, I should handle this aggressively. Honestly, I can't imagine passing the test with numbers like these showing up on my finger sticks (yes, we calibrated the machine correctly), but I suppose you never know. Maybe my glucometer is waaaay broken. I can only hope.

Needless to say, I am seriously, seriously bummed.

So I ask you folks: What would you recommend in terms of optimal maintenance of this situation going forward? Is a nutritionist/dietitian all I need, or could I benefit even more from a consult with an endocrinologist? Do any endocrinologists specialize in pregnancy-related diabetes/glucose tolerance issues? Or is just having my OB as the only MD enough? I want to take care of this as thoroughly as possible to reduce my and Magpie's risks now and after delivery.

One thing I'll have to ask my doctor....I was really sick last night - simultaneous vomiting and diarrhea (I'm guessing food poisoning). It was really not pretty. I thought I was going to die, but felt better enough by this morning to go in and do the screening. I wonder if being sick like that could have screwed up the test in any way?

I go in for my next OB appointment on Wednesday. I am hoping the test results will be in by then.

All thoughts in the meantime are most welcome.

Mo

Interesting graph of the difference in blood levels for diabetic versus nondiabetic.

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1st glucose tolerance test: FAIL

Last Thursday I took the one hour glucose test. My doctor said she would call the next day if there were any abnormality, so when I didn't hear from her, I figured all was well.

The hospital where my doctor works has an online records system so that you can see your lab results, medications, appointments, allergies, etc. I received a notice today that there was a new lab result in the system. So I checked.

Not only did I fail the one-hour test, but I failed by what I think is a lot. My value was 179. Yikes! (cut off, I think, is 140).

I was immediately worried, and also really disappointed that I hadn't heard from my physician's office. It reinforced the idea I sometimes already have that I have to be the one to be on top of all of my data myself, that I can't depend on others. And this is pretty disappointing because I love my doctor. It was significantly confidence-reducing to feel that if I hadn't caught this who knows how long it would be until I heard from them? And what if it had been something more urgent?

I called my OB's office and they said she wasn't in. That a nurse could return my call. Then they asked, Who had given me the initial results?

When I told them no one had contacted me, that I'd gotten the results myself online, they put me on hold.

A minute or two later, my OB was on the line. She's working in labor and delivery today and they had put my call through to her. She was deeply apologetic, said the results hadn't come in until Saturday and that the nurse was supposed to call me yesterday.

She also calmed me a lot about the test result. Said I need to do the three-hour test, but that it may be normal. And that just because I had a massive fail on the one-hour test does not mean I will fail the three-hour. I don't totally believe her, but it will be what it will be. She said if I have gestational diabetes, we will deal with it. That I won't have a 15-lb. baby. That it will be ok.

I just keep thinking I should have been much more careful about my diet up to this point. I don't think I've been terrible, but I haven't been monitoring every morsel I eat, and perhaps I should have been.

I hope that Ms. Magpie hasn't been adversely affected. I feel like I'm screwing up as a mother already and she's not even here yet!

I'm going in for the three hour test on Monday. I guess sometime next week I'll know the results.

Ugh. Count me as more than a little bit worried.

Mo

P.S. If interested, click here for a simply worded explanation of the risks of gestational diabetes to mom and baby.

More of this yummy (not!) stuff is in my future!

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Fewer than 100

We are down to double digits in this pregnancy...96 days left until my due date, give or take a couple of weeks!

Wow.

Cue me dumbfounded.

I still don't think I have completely accepted that Will and I are even pregnant. It still feels surreal that it is finally happening after so many false starts, after so long in the making.

And on the other hand, some aspects of pregnancy have begun to feel "normal." Normal to have a basketball -sized stomach, normal to have people comment about my belly, normal to have swelling and clumsiness, normal (and wonderful) to feel funny bumps and thumps and flutters in my abdomen at all hours of the day and night.

The idea that this expanding abdomen could signal that we are a few months away from actually having a child? A child who we will parent for the next couple of decades? Well, that definitely hasn't sunk in. It is beginning to sink in that anything growing this big will have to come out somehow...and thusly we are beginning to prepare for a birth. But that birth isn't so connected yet to what comes afterward...the family we have waited for, have wanted for so long.

So here we are. And one day keeps leading to the next. This pregnancy seemingly cooking along, pretty much of its own accord. So strange after so so many interventions could not get a pregnancy going, could not keep it going, that now, it seems this pregnancy is unfolding....dare I say almost naturally?

We feel so so lucky, so blessed. One day at a time, edging ever closer.

Oh my goodness.

Mo

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OB appointment 25 weeks 5 days

From a single-celled egg (and sperm) to an eggplant.
Who would ever have thought?

Sorry for the silence - I have been very busy. The summary of this post is: All is continuing to go well.

I saw my OB yesterday and the first thing she said was, "Did you know you just made it through the two most important weeks of this pregnancy?!" and then, "Mo, I think you are going to be a mother!"

Huh! Maybe, just maybe, I am! So weird.

Tomorrow is 26 weeks! According to my research, this little girl's chances of survival if she were born now has increased to 80%. Still don't want her here anytime soon, but things are looking brighter. Someone asked in a comment if I had any reason to think I was at risk for preterm birth. The answer is no, I have no rational reason. It is just that when you have lost 6 pregnancies in a row that you tend to lose faith that things will go the way there are supposed to. There is definitely a sense of waiting for the other shoe to drop sometimes. So getting this little baby far enough along that she has a good chance of making it...well, it is very reassuring indeed.

In terms of the appointment, my belly is measuring 27 weeks - so one week ahead. According to one of the websites I read, Ms. Magpie is the size of an eggplant now. Holy Mackerel! My blood pressure is still looking good (117/79, I think?) and I actually lost a pound in the past two weeks (up 17 pounds total), but they weren't concerned. She didn't check my cervix this time - says it doesn't need to be checked. I was surprisingly OK with this. She asked me if I am feeling the baby move every day (yes). I asked her if the fluttering/shuddering movements I sometimes feel are normal, or if they could be seizures. She said I wasn't the first person to ask this, and that those movements were normal.

I had freaked myself out a bit looking at some literature from our hospital that listed episiotomy as being used  in 48.8 percent of vaginal births at this facility (yikes!). I talked to my OB yesterday and she said for her group of 3 OBs, the rate is more like 5%, which sounds much more reasonable to me.

She gave me a referral for a fetal echocardiogram with the pediatrics department, just to triple check there is no damage from my high vitamin E intake earlier in the pregnancy. My husband Will isn't that into getting it done (what if we find something?, he said), but I'd rather know if there's anything there so we can be prepared - even for small things - that may be an issue. I'm not expecting an issue, so mostly I think it will be reassuring, but if there were anything, I would want to know. Will, apparently, prefers blissful ignorance (opposites attract?)

The OB also recommended two doulas who work frequently with her practice. I am interviewing one of them tomorrow. It turns out she was also my sister in law's doula for her three births. So she's pretty highly recommended! Assuming we (me and her and her covering doula) click tomorrow, we will hire her.

So that's the pregnancy update for now. I will not leave you waiting again so long for the next post, I promise!

Mo

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Worst IVIG yet...treatment #5

Yesterday afternoon, I had IVIG infusion #5. I had really hoped that IVIG infusion #4, sucky as it was, would be the last, but my reproductive immunologist's blood work showed a spike in my TH1:TH2 levels...not just a little jump, but a good sized one, so I reluctantly opted for another treatment. I did refuse, after how dreadful the last infusion was, to do it in the office again. He must have heard in advance from the nurse that there was no way I would agree to that again, so he relented and let me have the treatment at home with a private nurse (I have to pay for her time if it's in the office too, so this was not an added expense).

If done at the usual speed, it's a four hour infusion. I usually feel "okayish" for the first half hour or so and then get clammy and cold and pale, then get a low-grade fever, which starts to lower by the time the infusion completes. They dose me up with two tylenol and two benadryl ahead of time, so I'm a bit groggy.

This time, I actually felt pretty good at first and opted to sit up on the couch and read for a bit...then all the sudden, I thought I should probably lie down. By the time the nurse got me into bed with the IV hung up, I was shaking violently. I couldn't tell if I was having chills or just tremors of some sort. It was a bit wild. I also felt very short of breath and was kind of panting. She wanted to turn off the infusion, and I wanted her to keep going (so we could finish and she could leave). We ended up turning it off until the shaking reduced some and then continuing. I spiked the usual 101 degree fever, but then was able to sleep through a couple of hours of it, which helped a lot.

So one more infusion behind me. But yuck!

The whole time I was shaking and feverish, I was worried about Ms. Magpie. If *I* was having this reaction, how was she doing? Was this hurting her in any way? She was very quiet last night and into this morning, which had me worried, but by mid-day today she was her usual kicky and squirmy self (much to my relief).

My reproductive immunologist is making noises about me continuing this treatment until I reach 34 weeks.

God, I hope not. Of course I would do anything to make this pregnancy a success. I just wish I believed in this treatment a bit more (at all?).

Mo

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Oh my! You're carrying so small! or...Not!

Two amusing exchanges in the past seven days:

-----

I am at the pharmacy to pick up a prescription for Will. The pharmacist asks, "Are you having a boy or a girl?"

Girl, I say.

"Oh, that's what I thought! Because you're carrying so small!"

(Puzzled look from me...since she's never seen me before).

"How far along are you? [...pause...] Seven months?"

Chuckle from me. Six, I tell her (and really, I'm just at the beginning of six).

"Oh!"

-----

I get into a taxi cab on my way to work (I am strongly supporting the taxi industry these days).

"I don't mean to be rude, ma'am, but are you pregnant?"

Yes.

Much information and excitement about this gentleman's eight grandchildren....the youngest of whom is three months.

"When are you due? [...pause...] Next month?"

October. (and really, the end of October).

Much excitement and talk ensues from taxi driver about pumpkins, which is perhaps what it looks like I am carrying.

-----

I will post a picture soon so you can draw your own conclusions about my potential hugeness.


Mo

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Viability?

We are 24 weeks, 0 days today. And I believe, if I understood my OB correctly, that today is the first day they would try to intervene if the baby made an early appearance.

I have no desires for her to come anytime soon, but it feels like a big milestone that they would even try to save her life at this point. I feel her moving around a lot these days and sometimes you can see her bulging through my stomach, like she's doing a dance in there or something. She is so obviously alive. And I am so definitely falling in love with her, that it helps to know that if she came now they wouldn't just say "Sorry," but would actually at least try to save her if she came.

It would be a very dire situation, as evidenced by this chart I found through the March of Dimes:

Length of Pregnancy	Likelihood of Survival
23 weeks	17%
24 weeks	39%
25 weeks	50%
26 weeks	80%
27 weeks	90%
28-31 weeks	90-95%
32-33 weeks	95%
34+ weeks	Almost as likely as a full-term baby
Sources: March of Dimes, Quint Boenker Preemie Survival Foundation

But still. There would be a chance. I have a section on my blog roll now linking to preemie blogs and there are a few folks with live babies born in the under 25 weeks gestation category. It's not an exhaustive list but lists some of my current favorites.

So, Ms. Magpie, if you came - please know we would now be able to try to save you! But please, please just stay in there. Stay healthy. Stay in there. We've got about three months to go, you and I. I want to meet you, but not until then!!

Mo

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