GD, but not really?

[Deleted]

Anyone else's OB tell them they must go on the GD diet and test sugars even though they passed the 3 hour? My OB says it's to "prevent a big baby" since my last child was over 8 lbs. I see her Wed to discuss and see what is involved and I really want to push back on this. I don't eat sugar 99% of the time because I went no sugar/mostly low carb long ago and I've read this can make me insulin resistant over time. I've also only gained 13 lbs (almost 31 weeks) and the baby is not measuring large.  I feel like I already eat very well for the most part and I don't eat a lot as compared to my other pregnancies. I feel like this is her covering her ass. WWYD?

[sparkythelawyer]

I think your OB is ridiculous.

[Deleted]

Oct 8, 2015 10:34:44 GMT -5 sparkythelawyer said:

I think your OB is ridiculous.

I do too, but how do I tell her that to her face? Ugh rock, hard place.

[sparkythelawyer]

Oct 8, 2015 10:37:50 GMT -5 @absinthe said:

Oct 8, 2015 10:34:44 GMT -5 sparkythelawyer said:

I think your OB is ridiculous.

I do too, but how do I tell her that to her face? Ugh rock, hard place.

Honestly?  All she can do here is make a recommendation.

And I know this is just my experience talking, but LOL, that the concern is that your first born was 8 pounds and OMG that's a big baby.  My baby was 9# 8oz and I had no diabetes.  And pushed her out just fine.

If you are otherwise watching what you eat, I don't think you need to do this.  Just let her know that you'll continue to be careful with your diet and leave it there. 

[Deleted]

Oct 8, 2015 10:54:37 GMT -5 sparkythelawyer said:

Oct 8, 2015 10:37:50 GMT -5 @absinthe said:

I do too, but how do I tell her that to her face? Ugh rock, hard place.

Honestly?  All she can do here is make a recommendation.

And I know this is just my experience talking, but LOL, that the concern is that your first born was 8 pounds and OMG that's a big baby.  My baby was 9# 8oz and I had no diabetes.  And pushed her out just fine.

If you are otherwise watching what you eat, I don't think you need to do this.  Just let her know that you'll continue to be careful with your diet and leave it there. 

This is my 4th pregnancy. I am not at all concerned about getting this baby out. My last child was 8 lbs 5 oz and came in one push. I'm going to tell her I will be happy to track my food for her, etc, but I am drawing the line and unnecessary testing, etc. Especially given there is no Dx here and I am pretty certain insurance will not pay for all these tests and monitorings without a Dx.

[Susie]

That sounds like it is totally not medically indicated. I'm on the GD diet because I have to be, and I don't wish it on anyone. I definitely would not be down for it just as some kind of weird preventative thing.

Did you press for details on what your blood glucose levels were at fasting and 1, 2, and 3 hours? (I asked for a copy of my lab results after hearing that I failed at hours 1 and 2. I wanted deets.) In an effort to be tactful in my unwillingness to just do it, I would probably take the conversation in that direction. What were my levels? How do they compare with what you would like have seen? How would this diet help bring my results in line with what you wanted to see? Either she can explain it or she can't. I think it's reasonable to say, if true, that since she can't explain how the diet change will positively change your blood sugar levels and bring them into line with a target, then it doesn't sound necessary so you aren't going to.

I would also be a tad wary of an OB who delves too deeply into nutrition/endocrinology unless that OB happens to have specific training in it.  When I failed my 3 hr. GTT my OB basically didn't touch it.  She ordered a growth u/s and saw me for the obstetrical aspects, but referred me that day to an endocrinology practice to actually manage the GD.  Diabetes itself is an endo issue, not an OB issue, it just happens to cause OB complications if unmanaged.  So you could also try asking if she would refer you to an endo.  It might shut shit down pretty quickly if it's unnecessary.

[Deleted]

I have my levels and I only failed the 1-hour by 5 points or so. The rest of the levels were well within the acceptable range, including my fasting level.

Those are great talking points, Susie


I know Tricare isn't going to pay for all of this "extra stuff" without a Dx of some kind, so I can also go at it from that angle.

[boiler717]

I passed the 3 hour and have been asked to continue to follow the GD diet, which I have been asked to do my entire pregnancy. Even though I passed all 4 draws I will likely have to retake the test later in pregnancy. Failing 1/4 draws (which I think is what you may have done) is indicative of insulin resistance and the recommendation is diet counseling and follow-up 3 hour test in 4 weeks.
There is a large gap in glucose levels of non-GD pregnant women and goals for pregnant women with GD. Evidence shows that there is a high risk of macrosomia in women who aren't diagnosed with GD who has risk factors for insulin resistance, with the theory that their "higher than normal but untreated" glucose elevations can contribute to macrosomia. This is certainly true for me. When I first started monitoring my glucose levels were glucose to GD ranges, and significantly higher than non-GD pregnant values. I was able to make some slight adjustments to my diet, mostly with respect to changing the timing of my meals, to have my glucose values more closely align with non-GD pregnant women. I feel like I definitely learned from the experience and am making actions that are helpful.
I'd go in with a somewhat open mind -- GD diet doesn't mean no sugar / low carb, although some Obs have low carb guidelines than others. The ADA recommends 175 g carb a day for pregnant women with GD, which is significantly greater than my pre-pregnancy carb intake. I'm not aware of the data you mention that low carb diets cause IR.
It's great that you are eating healthy already! Hopefully that means there are a few minor tweaks that your OB can suggest to help you, or maybe she will look at your diet logs and give you thumbs up from those alone.

[boiler717]

Oh, I think I misunderstood your one comment -- I first took it as you didn't want to eat low carb because low carb could make you IR. I see now you probably mean that you eat low sugar because it can cause IR. I'm sorry!

[madringal]

I would do absolutely no such thing. And I wouldn't even indulge her by tracking what you ate. She can go eff right off.