Continued...
The birth experience was intense and nothing like either of us expected. We went to "baby school" this summer but nothing can prepare you for the real thing.
All you experienced moms out there... you certainly downplayed the extreme nature of childbirth!
6:45pm Sunday (Zero Hour) -- water breaks, contractions start shortly thereafter
+6 hrs -- at the hospital, told cervix is 1-2cm dilated
+15 hrs -- Monica's OB/Gyn gives an exam and notes that cervix is 1 cm dilated -- previous exam was incorrect; drug inserted to help cervix along
+18 hrs -- full blown labour gets going, strong contractions happening up to 2:30 min apart
+23 hrs -- another exam; disappointing news; uterus is ahead of cervix; only 2cm dilated; facing another 12 hrs of labour M opts for epidural
+24 hrs -- epidural kicks in with three hours of pain relief and relative comfort
+29 hrs -- pain relief gone; M feeling pretty strung out and ragged; doctor recommends sleeping pill to enable M to sleep; doesn't force it but strongly recommends
+30 hrs -- M waives off sleeping pill; gets anaesthesiologist to refresh the epidural;
+31 hrs -- another three hours of pain relief; a couple of short naps; makes a huge difference
+34 hrs -- pain relief wanes; good news that M is 8.5 cm dilated (one needs to get to 10 cm)
+35 hrs -- pretty extreme pain through transition; M starts pushing; has to pause because she nearly pushes the baby out before the doctor can get to the room
+35:30 hrs -- childbirth!
Things that surprised us:
The extreme amounts of pain -- likely magnified by duration of labour and lack of sleep. Picture the most despair your have ever seen in an athlete... this didn't even come close! I'm guessing that you'd only see close having to watch young people die or see people broken via torture. It's a good thing that babies are so cute!
The main thing that surprised me (M didn't see) was the large amount of blood that came out after the birth -- between the placenta and the blood, there was a bucket full of post-baby-bits. Didn't freak me out but it certainly got my attention.
Tips for the guys:
Being in the room, and supportive, provides a HUGE opportunity to strengthen your marriage. In life, we only get a few opportunities to demonstrate character. Child-birth is a total-body experience for your wife, being able to share that can create a deep bond. She will always remember if you were there for her.
Besides, after you watch, you'll spend the rest of your life grateful that your wife is handling the birthing part of the relationship. Blew my mind!End.
"I agree, husbands should support their wives during labor."
Sunday, November 9, 2008
Saturday, November 8, 2008
Fit Pregnancy
Continued...
Monica's main worries prior to getting pregnant:
I will lose my body
I will lose fitness
I won't be able to do anything
I will get slow and never recover
I can relate to those concerns -- I share many of them every October and November!
The good news is you can maintain your body, your health and, most surprisingly, your fitness. Here's how she did it.
No Zeros -- Monica did some form of physical activity every single day, for her entire pregnancy - even the day her water broke. This performance was a lot better than Dad's record!
While our medical advice was not to commence a fitness program when you get pregnant, all our doctors said that it was OK to maintain a fitness program through pregnancy. Monica's doc also noted that there isn't much practical knowledge about pregnancy and the endurance athlete.
The warnings boiled down to:
Don't let your body overheat;
Stay well hydrated;
Don't get out of breath (steady effort, or lower); and Continued...
Listen to your body.
Monica read the blogs of athletic moms like Bree Wee and Paula Radcliffe -- seeking to learn from their experience. She also consulted with coaches of elite female triathletes to learn from their experience. Something that came out of that research is the risk of stress fractures that result when moms come back too quickly. We received a lot of warnings about late term and postpartum running.
While most people talk about trimesters, looking from the outside, I noticed shifts closer to ten week blocks within M's 40-week pregnancy.
First ten weeks -- hormonal changes, mainly impacted mood and appetite. Monica was lucky in that her cravings were fresh fruit (rather than sugar/starch) related.
Second ten weeks -- feeling much better, moderated volume and intensity with attitude of baby-comes-first.
Third ten weeks -- pregnancy starts to show, pubic bone discomfort at 26 weeks, stopped running at 30 weeks, shifted to the elliptical trainer 2x per week.
Final ten weeks -- months of high frequency swimming left her very economical in the water, some high volume swim weeks, hiking started around 34 weeks, elliptical reduced to 1x per week.
Here's a great stat... total swim distance across the pregnancy... 908,600 meters. Average weekly volume was 14 hours and 45 minutes (includes yoga & cross training but not mellow walks with me). That average volume was down from 19-23 hours per week before conception.
The most surprising thing for me was that across her third trimester, Monica had returned to a level of aerobic swim economy that was on-par with where she was preconception.
To sum up Monica's focus:
Pre-pregnancy -- health, not race fitness
During pregnancy -- baby comes first, no zeros
The biggest mental challenges Monica faced were:
not stopping;
coping with weight gain;
coping with her body changing; and
coping with peer group response.
There will be days where you feel like everyone wants you to get huge, slow down and be uncomfortable. Those feelings are normal and it helps to know that all pregnant ladies are dealing with them.
If she had to give you one piece of advice with your pregnancy then she would encourage you to remain active, moderately, every day. Also remember that if you plan on breast feeding you'll burn off your baby weight safely and gradually.
Monica's main worries prior to getting pregnant:
I will lose my body
I will lose fitness
I won't be able to do anything
I will get slow and never recover
I can relate to those concerns -- I share many of them every October and November!
The good news is you can maintain your body, your health and, most surprisingly, your fitness. Here's how she did it.
No Zeros -- Monica did some form of physical activity every single day, for her entire pregnancy - even the day her water broke. This performance was a lot better than Dad's record!
While our medical advice was not to commence a fitness program when you get pregnant, all our doctors said that it was OK to maintain a fitness program through pregnancy. Monica's doc also noted that there isn't much practical knowledge about pregnancy and the endurance athlete.
The warnings boiled down to:
Don't let your body overheat;
Stay well hydrated;
Don't get out of breath (steady effort, or lower); and Continued...
Listen to your body.
Monica read the blogs of athletic moms like Bree Wee and Paula Radcliffe -- seeking to learn from their experience. She also consulted with coaches of elite female triathletes to learn from their experience. Something that came out of that research is the risk of stress fractures that result when moms come back too quickly. We received a lot of warnings about late term and postpartum running.
While most people talk about trimesters, looking from the outside, I noticed shifts closer to ten week blocks within M's 40-week pregnancy.
First ten weeks -- hormonal changes, mainly impacted mood and appetite. Monica was lucky in that her cravings were fresh fruit (rather than sugar/starch) related.
Second ten weeks -- feeling much better, moderated volume and intensity with attitude of baby-comes-first.
Third ten weeks -- pregnancy starts to show, pubic bone discomfort at 26 weeks, stopped running at 30 weeks, shifted to the elliptical trainer 2x per week.
Final ten weeks -- months of high frequency swimming left her very economical in the water, some high volume swim weeks, hiking started around 34 weeks, elliptical reduced to 1x per week.
Here's a great stat... total swim distance across the pregnancy... 908,600 meters. Average weekly volume was 14 hours and 45 minutes (includes yoga & cross training but not mellow walks with me). That average volume was down from 19-23 hours per week before conception.
The most surprising thing for me was that across her third trimester, Monica had returned to a level of aerobic swim economy that was on-par with where she was preconception.
To sum up Monica's focus:
Pre-pregnancy -- health, not race fitness
During pregnancy -- baby comes first, no zeros
The biggest mental challenges Monica faced were:
not stopping;
coping with weight gain;
coping with her body changing; and
coping with peer group response.
There will be days where you feel like everyone wants you to get huge, slow down and be uncomfortable. Those feelings are normal and it helps to know that all pregnant ladies are dealing with them.
If she had to give you one piece of advice with your pregnancy then she would encourage you to remain active, moderately, every day. Also remember that if you plan on breast feeding you'll burn off your baby weight safely and gradually.
Friday, November 7, 2008
Fit Pregnancy
By Gordo Byrn
On October 14th, Monica gave birth to our daughter Alexandra (she's the one in the photo above). Seeing as I'm the writer in the family, I will share some observations across the last ten months.
We have all heard stories about massive weight gain during pregnancy. I've heard stories of women gaining up to 80 pounds across their pregnancies. Listening to these tales, many women must wonder if large amounts of baby weight are the norm. Do I have to become huge, to have a healthy baby? Monica's experience might be relevant to you.
Before we start with the pregnancy, I want to mention a little bit about the year before the pregnancy. When you look at the athletes racing in Kona, or ITU Worlds, you will see that most participants are optimized for performance, rather than personal health. In fact, I'd guess that many very fast elite athletes (male and female) would have trouble conceiving when they are peak athletic condition.
So my first recommendation for athletes seeking to conceive is to get a medical check-up and shift the basis of your athletics from performance, to health. That is something that Monica and I did across last winter. Although I continued to ride my bike, my overall training stress was low enough that I had sufficient energy to devote to fatherly duties...
Monica didn't ride and focused her training on swimming, running and yoga. She was in excellent health and physical condition. While we were trying to conceive, she kept both the volume, and intensity, of her program. She didn't do much fast running but she would swim fast three times per week.Continued...
On October 14th, Monica gave birth to our daughter Alexandra (she's the one in the photo above). Seeing as I'm the writer in the family, I will share some observations across the last ten months.
We have all heard stories about massive weight gain during pregnancy. I've heard stories of women gaining up to 80 pounds across their pregnancies. Listening to these tales, many women must wonder if large amounts of baby weight are the norm. Do I have to become huge, to have a healthy baby? Monica's experience might be relevant to you.
Before we start with the pregnancy, I want to mention a little bit about the year before the pregnancy. When you look at the athletes racing in Kona, or ITU Worlds, you will see that most participants are optimized for performance, rather than personal health. In fact, I'd guess that many very fast elite athletes (male and female) would have trouble conceiving when they are peak athletic condition.
So my first recommendation for athletes seeking to conceive is to get a medical check-up and shift the basis of your athletics from performance, to health. That is something that Monica and I did across last winter. Although I continued to ride my bike, my overall training stress was low enough that I had sufficient energy to devote to fatherly duties...
Monica didn't ride and focused her training on swimming, running and yoga. She was in excellent health and physical condition. While we were trying to conceive, she kept both the volume, and intensity, of her program. She didn't do much fast running but she would swim fast three times per week.Continued...
Thursday, November 6, 2008
Counting blessings, not the aches
Continued...
By some miracle of fate, love and medicine, Maria was able to carry her son to the 28th week. The doctors were hoping for two or three extra weeks. They got six instead.
Each time I visited her at the hospital, Maria had a smile on her face.
“I'm staying as optimistic as possible. What else can I do?” she'd say. “Every day he stays inside is a blessing.”
Indeed.
Her son was born weighing about 3 pounds, bigger than most babies at that stage. He stayed in the NICU for 12 weeks.
Medically fragile, he was quarantined at home for almost 10 months — as was Maria, as his caregiver.
I have a hard time staying inside the house the whole day, but when Maria emerged from the fog of quarantine, she had the same smile on her face.
“He's doing really well, considering all that he's gone through,” she'd say.
And that remains true today.
Though medications remain a part of the daily routine, Maria is also busy making sure her second son isn't jumping off couches, walking off a high stairwell or attempting other age-inappropriate acrobatics. Sometimes, she has complained about being tired from chasing him all over the yard.
But, she has never complained about her time in isolation, the emergency bed rest, or the constant fear or worry with which she lived for the first year of her son's life.
As I write this, my son is at 28 weeks and getting heavier each day. To steal a line from Maria, every day he stays inside is a blessing, despite the aches and pains. End.
"Mothers should be given a reward. They hurdle the pain and suffering in order to make a better life for their children. I love my mom. I hope that I can return the favor she had done but I know I can't. If it is my turn to do the same with my children, I pray that I will be like her."
By some miracle of fate, love and medicine, Maria was able to carry her son to the 28th week. The doctors were hoping for two or three extra weeks. They got six instead.
Each time I visited her at the hospital, Maria had a smile on her face.
“I'm staying as optimistic as possible. What else can I do?” she'd say. “Every day he stays inside is a blessing.”
Indeed.
Her son was born weighing about 3 pounds, bigger than most babies at that stage. He stayed in the NICU for 12 weeks.
Medically fragile, he was quarantined at home for almost 10 months — as was Maria, as his caregiver.
I have a hard time staying inside the house the whole day, but when Maria emerged from the fog of quarantine, she had the same smile on her face.
“He's doing really well, considering all that he's gone through,” she'd say.
And that remains true today.
Though medications remain a part of the daily routine, Maria is also busy making sure her second son isn't jumping off couches, walking off a high stairwell or attempting other age-inappropriate acrobatics. Sometimes, she has complained about being tired from chasing him all over the yard.
But, she has never complained about her time in isolation, the emergency bed rest, or the constant fear or worry with which she lived for the first year of her son's life.
As I write this, my son is at 28 weeks and getting heavier each day. To steal a line from Maria, every day he stays inside is a blessing, despite the aches and pains. End.
"Mothers should be given a reward. They hurdle the pain and suffering in order to make a better life for their children. I love my mom. I hope that I can return the favor she had done but I know I can't. If it is my turn to do the same with my children, I pray that I will be like her."
Wednesday, November 5, 2008
Counting blessings, not the aches
Now that I am hauling around 18 extra pounds, people have freely been asking me: “How's the pregnancy going?”
I stop myself from talking about the pain from the swollen veins near my rear, the headaches from the increased blood flow to my brain, or the looseness in the hips because of hormonal changes or the split in my abdominal muscles, both of which make heaving around 18 extra pounds more difficult.
No, instead, I answer: “I shouldn't complain. Things are going well.”
And they really are. When you're making a new person from scratch, it's not a pretty process, nor is it comfortable. All pregnant women go through their own variations of headaches, pains and discomfort.
As one grandmother told me: “Even if you did complain, nobody would listen.”
When I start to get whiny about this pregnancy thing, I think about my friend Maria. She is the real inspiration for this attitude.
Maria was the mother of two preemies. Today, they are two rambunctious little boys, ages 5 and 2.
But their starts in life involved extensive time in the Newborn Intensive Care Unit and a lot of worry and fears about their viability.
Because of a medical condition she hadn't previously known about, Maria couldn't carry either boy to term. So, her first son was born two months early. And her second was born almost three months early, at 28 weeks. Babies born before 37 weeks of pregnancy are considered premature.
Before giving birth to her second son, Maria was ordered to emergency bed rest at the hospital, because her water bag burst at 22 weeks.Continued...
"I admire Maria's courage."
I stop myself from talking about the pain from the swollen veins near my rear, the headaches from the increased blood flow to my brain, or the looseness in the hips because of hormonal changes or the split in my abdominal muscles, both of which make heaving around 18 extra pounds more difficult.
No, instead, I answer: “I shouldn't complain. Things are going well.”
And they really are. When you're making a new person from scratch, it's not a pretty process, nor is it comfortable. All pregnant women go through their own variations of headaches, pains and discomfort.
As one grandmother told me: “Even if you did complain, nobody would listen.”
When I start to get whiny about this pregnancy thing, I think about my friend Maria. She is the real inspiration for this attitude.
Maria was the mother of two preemies. Today, they are two rambunctious little boys, ages 5 and 2.
But their starts in life involved extensive time in the Newborn Intensive Care Unit and a lot of worry and fears about their viability.
Because of a medical condition she hadn't previously known about, Maria couldn't carry either boy to term. So, her first son was born two months early. And her second was born almost three months early, at 28 weeks. Babies born before 37 weeks of pregnancy are considered premature.
Before giving birth to her second son, Maria was ordered to emergency bed rest at the hospital, because her water bag burst at 22 weeks.Continued...
"I admire Maria's courage."
Tuesday, November 4, 2008
Maryland triplets defy odds
Continued...
Lori Titus said the program was considering her total revenue and not just her profits.
She asked the program to take another look at her application but went ahead with the surgery as planned, taking the hospital's word that they would work out a payment plan with her if needed.
"They really encourage people to do what they feel is right and worry about the money later, which I believe is the right thing to do, but at the same time it's still very frustrating," said Lori Titus. "I knew that I was racking up a bill with the hospital that's the price of a house."
The Tituses were ecstatic when all three babies survived the surgery, but Baschat, their surgeon, reminded them to think only in small victories.
"I've done this for a long time, and there are stories that are heartbreaking," said Baschat. "We always say, don't thank us before you hear the babies scream."
Three months later, at three months premature and just one week after she was cleared for state health insurance, Arthur, Brannon and Charles Titus were born. Charles needed to be resuscitated at birth and received a blood transfusion, but by all other accounts the triplets did exceedingly well.
In September the triplets came home. While they need to be closely monitored for developmental problems, the daily challenges for the Tituses now are daunting in a different way.
Diapers for the triplets run $300 monthly, and there's always the possibility of mistaken identity, forcing the parents to keep the babies arranged in alphabetical order - Arthur, Brannon and Charles.
"A couple of weeks ago we flipped the order we keep them in, and we switched them up," said Dave Titus. "Lori had the hospital footprints out to match up which one was which."End.
"Miracles really happen. Just have faith."
Lori Titus said the program was considering her total revenue and not just her profits.
She asked the program to take another look at her application but went ahead with the surgery as planned, taking the hospital's word that they would work out a payment plan with her if needed.
"They really encourage people to do what they feel is right and worry about the money later, which I believe is the right thing to do, but at the same time it's still very frustrating," said Lori Titus. "I knew that I was racking up a bill with the hospital that's the price of a house."
The Tituses were ecstatic when all three babies survived the surgery, but Baschat, their surgeon, reminded them to think only in small victories.
"I've done this for a long time, and there are stories that are heartbreaking," said Baschat. "We always say, don't thank us before you hear the babies scream."
Three months later, at three months premature and just one week after she was cleared for state health insurance, Arthur, Brannon and Charles Titus were born. Charles needed to be resuscitated at birth and received a blood transfusion, but by all other accounts the triplets did exceedingly well.
In September the triplets came home. While they need to be closely monitored for developmental problems, the daily challenges for the Tituses now are daunting in a different way.
Diapers for the triplets run $300 monthly, and there's always the possibility of mistaken identity, forcing the parents to keep the babies arranged in alphabetical order - Arthur, Brannon and Charles.
"A couple of weeks ago we flipped the order we keep them in, and we switched them up," said Dave Titus. "Lori had the hospital footprints out to match up which one was which."End.
"Miracles really happen. Just have faith."
Monday, November 3, 2008
Maryland triplets defy odds
Continued...
The Tituses, who already have a 3-year-old daughter and had not planned on having more than two children, were given three options. They could either let nature take its course, opt for a procedure to simply ease the discomfort of the pregnancy, or try a risky surgery that had the potential to save their children but could also terminate the pregnancy.
The surgery, known as laser coagulation, isolates and seals off the blood vessels where the imbalanced blood volume sharing occurs between the fetuses. While the surgery provides the best overall chance of survival, there was still a 50 percent chance both babies wouldn't survive the procedure.
Five days later Lori Titus was ready for surgery.
The couple said the choice was obvious because while the numbers were grim, it still gave their children the best chance of survival.
But calling the choice obvious seems more extraordinary when considering the Tituses had no idea what the surgery cost or how they were going to pay for it since Lori Titus couldn't get health coverage. Doctors at the hospital estimated the total cost for this type of pregnancy would be around $150,000 out of pocket.
In 2006, Lori Titus quit her day job after her husband had a stroke while she was pregnant with their daughter. She obtained COBRA, a limited extended insurance option, but the coverage ran out in April, mid-pregnancy.
When she went to apply for private coverage, she was repeatedly turned down.
She then applied for the Maryland State Health Insurance Program, but was turned down because her income was too high. The couple's income now comes entirely from their home-run beekeeping business in Mount Airy, Md.Continued...
The Tituses, who already have a 3-year-old daughter and had not planned on having more than two children, were given three options. They could either let nature take its course, opt for a procedure to simply ease the discomfort of the pregnancy, or try a risky surgery that had the potential to save their children but could also terminate the pregnancy.
The surgery, known as laser coagulation, isolates and seals off the blood vessels where the imbalanced blood volume sharing occurs between the fetuses. While the surgery provides the best overall chance of survival, there was still a 50 percent chance both babies wouldn't survive the procedure.
Five days later Lori Titus was ready for surgery.
The couple said the choice was obvious because while the numbers were grim, it still gave their children the best chance of survival.
But calling the choice obvious seems more extraordinary when considering the Tituses had no idea what the surgery cost or how they were going to pay for it since Lori Titus couldn't get health coverage. Doctors at the hospital estimated the total cost for this type of pregnancy would be around $150,000 out of pocket.
In 2006, Lori Titus quit her day job after her husband had a stroke while she was pregnant with their daughter. She obtained COBRA, a limited extended insurance option, but the coverage ran out in April, mid-pregnancy.
When she went to apply for private coverage, she was repeatedly turned down.
She then applied for the Maryland State Health Insurance Program, but was turned down because her income was too high. The couple's income now comes entirely from their home-run beekeeping business in Mount Airy, Md.Continued...
Sunday, November 2, 2008
Maryland triplets defy odds
By JENN BOGDAN
When Lori and Dave Titus learned in March they were expecting naturally conceived identical triplets, they wondered how they would meet what they thought was their challenge of a lifetime.
Three months later, the Tituses had more important things on their minds. Their triplets had developed a rare and often fatal condition known as twin-to-twin transfusion syndrome, and Lori Titus could not get health insurance.
Twin-to-twin transfusion syndrome is a condition affecting pregnancies of identical multiples. The syndrome can develop when the fetuses receive an unequal supply of blood and nutrients from the mother, leaving one baby overloaded with supplies and the other malnourished.
In the Tituses' case, one baby was unaffected, while the other two were struggling. Left untreated, there was a more than 70 percent chance both babies would die.
"I went from having a nice, healthy, normal pregnancy to almost overnight finding out that my babies could have major brain and heart problems and that I might lose them in the process of trying to save them," said 38-year-old Lori Titus. "I was completely in tears."
The condition the triplets developed occurs in about 10 percent of identical twins, but the same data for identical triplets is thin.
"Identical triplets with twin-to-twin transfusion syndrome are exceedingly rare. I know of maybe four or five other people who have worked with cases worldwide," said Dr. Ahmet Baschat, a fetal medicine specialist at the University of Maryland Medical Center who treated Lori Titus. "The chance that this happens must be in the region of 1 in 15,000."Continued...
"How sad. I pray that the babies will survive. Miracles can happen."
When Lori and Dave Titus learned in March they were expecting naturally conceived identical triplets, they wondered how they would meet what they thought was their challenge of a lifetime.
Three months later, the Tituses had more important things on their minds. Their triplets had developed a rare and often fatal condition known as twin-to-twin transfusion syndrome, and Lori Titus could not get health insurance.
Twin-to-twin transfusion syndrome is a condition affecting pregnancies of identical multiples. The syndrome can develop when the fetuses receive an unequal supply of blood and nutrients from the mother, leaving one baby overloaded with supplies and the other malnourished.
In the Tituses' case, one baby was unaffected, while the other two were struggling. Left untreated, there was a more than 70 percent chance both babies would die.
"I went from having a nice, healthy, normal pregnancy to almost overnight finding out that my babies could have major brain and heart problems and that I might lose them in the process of trying to save them," said 38-year-old Lori Titus. "I was completely in tears."
The condition the triplets developed occurs in about 10 percent of identical twins, but the same data for identical triplets is thin.
"Identical triplets with twin-to-twin transfusion syndrome are exceedingly rare. I know of maybe four or five other people who have worked with cases worldwide," said Dr. Ahmet Baschat, a fetal medicine specialist at the University of Maryland Medical Center who treated Lori Titus. "The chance that this happens must be in the region of 1 in 15,000."Continued...
"How sad. I pray that the babies will survive. Miracles can happen."
Saturday, November 1, 2008
Diabetes Is a Risk in Pregnancy That Carries Risks Beyond
Continued...
Staying on Track
The treatment goal, as Ms. Bloustein was told, is to maintain a normal blood sugar level, and to keep the level as even as possible throughout the day.
The woman should follow a sensible meal plan consisting of three small, well-spaced meals and up to three snacks each day, and limit sweets and refined starches. She must know when and how much carbohydrate-rich food to consume, and her diet should include fiber-rich vegetables, fruits, dried beans and peas, and whole grains.
Regular physical exercise is also important. Daily walking and swimming are especially good in pregnancy.
If such self-help measures do not normalize blood sugar, the woman may also require insulin, which she can inject herself. In some cases, an oral medication, metformin, may be prescribed with or without insulin.
To be sure blood sugar levels stay on target, a woman should test herself via a finger prick and blood glucose monitor at regular times: when she wakes up, before meals, and an hour or two after meals. According to the National Institutes of Health, desirable blood sugar targets are 95 or less upon awakening, 140 or less an hour after meals, and 120 or less two hours after meals.
In 6 to 12 weeks after giving birth, a woman who has had gestational diabetes should be retested. And she should keep her own — and her child’s — weight down and be tested periodically for signs of diabetes as she ages.End.
Source
Staying on Track
The treatment goal, as Ms. Bloustein was told, is to maintain a normal blood sugar level, and to keep the level as even as possible throughout the day.
The woman should follow a sensible meal plan consisting of three small, well-spaced meals and up to three snacks each day, and limit sweets and refined starches. She must know when and how much carbohydrate-rich food to consume, and her diet should include fiber-rich vegetables, fruits, dried beans and peas, and whole grains.
Regular physical exercise is also important. Daily walking and swimming are especially good in pregnancy.
If such self-help measures do not normalize blood sugar, the woman may also require insulin, which she can inject herself. In some cases, an oral medication, metformin, may be prescribed with or without insulin.
To be sure blood sugar levels stay on target, a woman should test herself via a finger prick and blood glucose monitor at regular times: when she wakes up, before meals, and an hour or two after meals. According to the National Institutes of Health, desirable blood sugar targets are 95 or less upon awakening, 140 or less an hour after meals, and 120 or less two hours after meals.
In 6 to 12 weeks after giving birth, a woman who has had gestational diabetes should be retested. And she should keep her own — and her child’s — weight down and be tested periodically for signs of diabetes as she ages.End.
Source
Friday, October 31, 2008
Diabetes Is a Risk in Pregnancy That Carries Risks Beyond
Continued...
Routine Screening
Gestational diabetes, which affects about 4 percent of pregnant women, usually occurs midpregnancy, by the 28th week of gestation. Though its causes are unclear, there are some clues, namely placental hormones that suppress the action of insulin in the mother. This can result in insulin resistance: the mother’s pancreas continues to spew out insulin but her body’s cells fail to use it properly to process blood sugar, causing sugar levels to rise in the mother’s blood.
This extra sugar, though not the mother’s insulin, crosses the placenta and raises the baby’s blood sugar level, giving the baby more energy than it needs to grow normally. The result is macrosomia, a “fat” baby often too big to be born naturally without injury to the baby, mother or both.
The baby’s pancreas, stimulated by sugar from the mother, may produce extra insulin, resulting in low blood sugar at birth and an increased risk of breathing problems. These babies are also more likely to become obese children and diabetic adults.
In addition to an added risk of diabetes later in life, a woman with gestational diabetes can develop high blood pressure during pregnancy and may need a Caesarean section to deliver an overly large baby.
Women are at higher than average risk of gestational diabetes if they are overweight, older than 25, have a strong family history of diabetes, have had gestational diabetes during a prior pregnancy, have previously given birth to a baby weighing nine or more pounds, or have been told they are “prediabetic” with blood sugar levels higher than normal. The risk is greater in African-American, Asian and Hispanic women than in Caucasians.
A pregnant woman is unlikely to know her blood sugar is running high unless she is tested. For those with risk factors, a screening test for blood sugar should be done at the first prenatal visit, Dr. Metzger said.
Women not at high risk for gestational diabetes should be tested between weeks 24 and 28 of pregnancy. In this screening test, now routine in prenatal care, the woman swallows a concentrated solution of glucose, and her blood sugar is measured an hour later.
If the result is abnormal, a fasting test for blood sugar is next. After about 14 hours of no food or drink other than sips of water, the woman is given another dose of glucose, and her blood levels are measured hourly for three hours. If those levels are abnormal on two or three measurements, the woman is said to have gestational diabetes, though some doctors think even one abnormal level is a bad sign.Continued...
Routine Screening
Gestational diabetes, which affects about 4 percent of pregnant women, usually occurs midpregnancy, by the 28th week of gestation. Though its causes are unclear, there are some clues, namely placental hormones that suppress the action of insulin in the mother. This can result in insulin resistance: the mother’s pancreas continues to spew out insulin but her body’s cells fail to use it properly to process blood sugar, causing sugar levels to rise in the mother’s blood.
This extra sugar, though not the mother’s insulin, crosses the placenta and raises the baby’s blood sugar level, giving the baby more energy than it needs to grow normally. The result is macrosomia, a “fat” baby often too big to be born naturally without injury to the baby, mother or both.
The baby’s pancreas, stimulated by sugar from the mother, may produce extra insulin, resulting in low blood sugar at birth and an increased risk of breathing problems. These babies are also more likely to become obese children and diabetic adults.
In addition to an added risk of diabetes later in life, a woman with gestational diabetes can develop high blood pressure during pregnancy and may need a Caesarean section to deliver an overly large baby.
Women are at higher than average risk of gestational diabetes if they are overweight, older than 25, have a strong family history of diabetes, have had gestational diabetes during a prior pregnancy, have previously given birth to a baby weighing nine or more pounds, or have been told they are “prediabetic” with blood sugar levels higher than normal. The risk is greater in African-American, Asian and Hispanic women than in Caucasians.
A pregnant woman is unlikely to know her blood sugar is running high unless she is tested. For those with risk factors, a screening test for blood sugar should be done at the first prenatal visit, Dr. Metzger said.
Women not at high risk for gestational diabetes should be tested between weeks 24 and 28 of pregnancy. In this screening test, now routine in prenatal care, the woman swallows a concentrated solution of glucose, and her blood sugar is measured an hour later.
If the result is abnormal, a fasting test for blood sugar is next. After about 14 hours of no food or drink other than sips of water, the woman is given another dose of glucose, and her blood levels are measured hourly for three hours. If those levels are abnormal on two or three measurements, the woman is said to have gestational diabetes, though some doctors think even one abnormal level is a bad sign.Continued...
Wednesday, October 29, 2008
Diabetes Is a Risk in Pregnancy That Carries Risks Beyond
By JANE E. BRODY
Elise Bloustein, always slender and healthy, was 38 when she became pregnant with her first child in 1990. Her joy was tempered by the results of tests that revealed two problems: anemia and gestational diabetes, which Ms. Bloustein believes may have been caused by stress associated with the deaths of her parents.
Regardless of the cause, the conditions required close attention to what she ate. The doctor sent her to a nutritionist who put her on a diabetes diet and told her to self-test her blood sugar levels several times a day. The goal was to keep her blood sugar from spiking by eating lots of fiber-rich foods and limiting simple and refined carbohydrates.
Frequent sonograms were done to monitor the baby’s growth and prevent a stillbirth, a risk of gestational diabetes. Ultimately, the baby was born normal and healthy, weighing seven pounds. But Ms. Bloustein was cautioned that gestational diabetes could recur in a future pregnancy (it didn’t) and that she was at high risk of later developing mature-onset (now called Type 2) diabetes.
“So far, 18 years later, there’s no sign of diabetes,” Ms. Bloustein, now 55, said in an interview. “But it’s very much in my mind, and I watch my diet and my weight and have an annual physical.”
In the years since Ms. Bloustein’s first pregnancy, the incidence of gestational diabetes has nearly doubled, a result of the rise in prepregnancy weight among American women, Dr. Boyd E. Metzger, an endocrinologist at Northwestern University Feinberg School of Medicine, said in an interview. At the same time, much has been learned about the disorder and its possible effects on newborns and their mothers.
It is now known, for example, that even small blood-sugar abnormalities can cause trouble.
A seven-year international study directed by Dr. Metzger, which was released last year at the American Diabetes Association’s annual meeting and published in May in The New England Journal of Medicine, showed clear links between blood sugar levels and pregnancy outcomes, even when the mother’s sugar levels are not high enough to be called diabetes.
The study, which followed the pregnancies of more than 23,000 nondiabetic women, revealed that as blood sugar levels increased during pregnancy, the risk of having a baby too large to be born vaginally rose too, as did the baby’s chances of being born with low blood sugar and high levels of insulin.
“At levels well below what we would consider to be diabetes, we’re seeing morbidity,” reported Dr. Robert Ratner of the Georgetown University Medical School in Washington.
The study found a continuous increase in risk as the mothers’ blood sugar levels rose, with no cutoff point below which the risks were minimal.Continued...
Elise Bloustein, always slender and healthy, was 38 when she became pregnant with her first child in 1990. Her joy was tempered by the results of tests that revealed two problems: anemia and gestational diabetes, which Ms. Bloustein believes may have been caused by stress associated with the deaths of her parents.
Regardless of the cause, the conditions required close attention to what she ate. The doctor sent her to a nutritionist who put her on a diabetes diet and told her to self-test her blood sugar levels several times a day. The goal was to keep her blood sugar from spiking by eating lots of fiber-rich foods and limiting simple and refined carbohydrates.
Frequent sonograms were done to monitor the baby’s growth and prevent a stillbirth, a risk of gestational diabetes. Ultimately, the baby was born normal and healthy, weighing seven pounds. But Ms. Bloustein was cautioned that gestational diabetes could recur in a future pregnancy (it didn’t) and that she was at high risk of later developing mature-onset (now called Type 2) diabetes.
“So far, 18 years later, there’s no sign of diabetes,” Ms. Bloustein, now 55, said in an interview. “But it’s very much in my mind, and I watch my diet and my weight and have an annual physical.”
In the years since Ms. Bloustein’s first pregnancy, the incidence of gestational diabetes has nearly doubled, a result of the rise in prepregnancy weight among American women, Dr. Boyd E. Metzger, an endocrinologist at Northwestern University Feinberg School of Medicine, said in an interview. At the same time, much has been learned about the disorder and its possible effects on newborns and their mothers.
It is now known, for example, that even small blood-sugar abnormalities can cause trouble.
A seven-year international study directed by Dr. Metzger, which was released last year at the American Diabetes Association’s annual meeting and published in May in The New England Journal of Medicine, showed clear links between blood sugar levels and pregnancy outcomes, even when the mother’s sugar levels are not high enough to be called diabetes.
The study, which followed the pregnancies of more than 23,000 nondiabetic women, revealed that as blood sugar levels increased during pregnancy, the risk of having a baby too large to be born vaginally rose too, as did the baby’s chances of being born with low blood sugar and high levels of insulin.
“At levels well below what we would consider to be diabetes, we’re seeing morbidity,” reported Dr. Robert Ratner of the Georgetown University Medical School in Washington.
The study found a continuous increase in risk as the mothers’ blood sugar levels rose, with no cutoff point below which the risks were minimal.Continued...
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