Hi everyone,
I'm 19 weeks along with my second baby. The first one was 9 lbs, 13 oz at 38 weeks, delivered by c-section, despite A1cs between 5.8-6.5. It was a fairly traumatic experience for various reasons, so I'm really hoping to avoid another macrosomic baby this time around.
The other day I had my anatomy ultrasound (it's a girl!), which showed the baby's abdominal circumference measuring in the 92nd percentile. My OB assured me that doesn't mean anything at this stage, however, it definitely got me worrying, so I came home and started to do some research.
Long story short, I came across this great article by Dr. Jovanovic:
http://care.diabetesjournals.org/content/24/8/1317.full
The two main things I learned from it are 1)nondiabetic, pregnant women have lower than normal blood glucose (around 55-105) and 2)peak postprandial blood glucose, whether that occurs 30 minutes or 2 hours after eating, is the MAIN indicator of whether or not you will have a macrosomic baby. Obviously that's fairly logical, since those numbers tend to be your highest, but I had never heard it put quite like that. Often doctors have told me that it doesn't really matter if my glucose spikes after eating, as long as it comes down quickly. And it definitely gave me some evidence to support testing at 1 hour after meals rather than 2 hours after (which is what my doctors want me to do).
I emailed Dr. Jovanovic, and she wrote back and sent me a chart listing which foods to avoid and which to eat to help achieve good postprandial numbers. If anyone's interested, I can post that, too.
Hope that's helpful to someone. Hope everyone is doing well!
Elizabeth
Yes please do share. It would be very helpful.
Tia
Kathy
I am not pregnant, but would like to see the chart, as well. My metabolism seems to be slow, so it takes a while for insulin to address the food I intake, and then blood PP blood-sugars seem to stay high for a longer time, as well..... I am sure there are lots of things I could do to help with this, first of which is to test more to get a better picture of it, but eating foods that would help instead of hinder would be great, too. Good luck with this pregnancy - and congratulations!
Here is the chart. It's very basic and very restricted. I'd be curious to know whether she really advocates only eating the foods on the "limit" and "enjoy" lists, or whether there are other foods she would consider okay to eat on a limited basis. Also I wonder how many grams of total carb she advocates eating in a day.
1554-NutritionChart.pdf (188 KB)
Thanks! Good luck to you, too, in general! One thing that has really helped me is getting a continuous glucose monitor. I have the Dexcom G4 and it's amazing--so accurate, and you can see exactly what your blood sugar is doing after you eat.
Thanks for sharing! The "enjoy" list is much more comprehensive that Dr. Bernstein's recommended foods. I tried to go very-low carb, and for two weeks was very successful, but I just couldn't sustain it. Maybe it is psychological, but I just obsessed after those two weeks with chips and cake and stuff that I didn't eat even before trying the very-low carb thing! The fruit is the hardest thing for me to avoid - especially tomatoes in the summer time! But people do it, and have much better A1Cs than I have! I will ask my endo about CGM at next appt. Maybe that would scare me into keeping a closer eye on things.
E Louise I have asked my nurse about CGM but she told me only useful really to see trends like if your sugars continually drop. Im seeing consultant today as well as nurse so will ask today. I cant see chart but im on my phone so I guess when I finally get on the laptop I will be able to see it
What your nurse said was completely true about the other CGM I tried, the Minimed one. It was really inaccurate and was constantly alarming when I wasn't actually high or low. The G4 is just incredibly better than the Minimed. Like I said, it's very accurate, so it is extremely helpful in seeing what your bg does after eating. It's also great because it shows arrows to tell you whether your bg is constant, slowly rising, quickly rising, or vice versa. I have found that feature really useful when I have to take a wild guess at carbs (like at a restaurant). I can bolus and then check it 15-20 minutes later--if the arrows show rapid rising, I can take another small bolus and keep watching it. This has helped me avoid serious highs when eating out. Good luck! Check out the CGM group for a more detailed discussion of the G4.
This makes sense. With my first baby, I kept my A1c between 5.2 and 5.4 the ENTIRE time, which is totally a number any person without diabetes might have. But my son was still on the larger side of average: 8 pounds 10 oz.
This time, my A1c has been more like 5.4 ro 5.9, still good, but the baby has been measuring two weeks ahead.
So it's obviously not all about averages.
Do you have it on the NHS or have to pay for it? My nurse said no chance of getting it funded 
Good article. I’m of the opinion that most of the baby’s size is determined by genetics,even non-D women are having larger babies these days. There is no possible way I could have pulled off those kinds of numbers during pregnancy, (without going into a coma every other week) I thought the “average” bg(of non-PWD women) in the 50’s was mind-blowing. (my a1cs were in the 6’s,& my baby was of average size. I was certainly no D-rock star, and I’m amazed with people who have gotten their a1cs in the 4’s and 5’s.) D pregnancy is very hard and we do the best we can with what we’ve got.
Haha, I'm in the US, so no NHS here! I have private insurance with a pretty high deductible, so right now I'm paying out of pocket until we meet the deductible. Definitely not ideal, and I'm not sure I'd do it if I weren't pregnant.
If you have trouble with cravings, it might be worth it to check out the 21-Day Sugar Detox (google it). For 21 days, you basically cut out everything that has a lot of carbs and everything that tastes sweet. It's based on the paleo diet, which I don't completely agree with, so when I did it, I allowed myself to eat beans, legumes, full-fat cheese and plain yogurt, and brown rice, which are all blood-sugar-friendly for me. After a couple of weeks, I really didn't crave carbs anymore. Really. Of course it's not a permanent effect--as soon as you slip and eat something sweet, you'll start wanting it again. But it's a useful and interesting experience, I thought.
Thanks E. Louise! I will check it out.
Heidi98, there is a distinction between large babies and macrosomic babies. The baby of a nondiabetic mother might be large but still be able to be delivered vaginally because its shoulders are not too big. The macrosomic baby of a diabetic mother has extra fat stores in its face and shoulders, meaning that it is much more likely that even if the head can be delivered, the shoulders will get stuck in the birth canal, which is obviously very dangerous. There are also risks associated with being born macrosomic, including an increased risk of type 2 diabetes later in life.
I wish I were someone who could have my A1c in the 6's and have a normal weight baby, but it doesn't seem to work that way for me, who knows why? I'm certainly glad for you that you did!
I think I just wish someone had told me this with my first baby. The myth is that if you have good control, you will have a normal weight baby. Everything you read about macrosomia refers to "poorly controlled diabetes" which obviously neither of us has. And clearly some people have good but not incredible control and have normal weight babies--I wonder what makes us different.
