Monday, December 06, 2010


I have two decisions I'm mulling over right now.

#1: prenatal RhoGAM. I am Rh- and have had the RhoGAM shot after both babies, although I chose not to have the 28-week shot. I'm one day shy of 29 weeks and need to make up my mind ASAP about the prenatal shot. I've read pretty much all there is to read and still feel undecided. My mother became sensitized some time before or during her fifth (and hence last) pregnancy, so there is a small but real risk with sensitization. My brother was induced at 37 weeks and was fine, except for being quite jaundiced. But the increasing risks of pregnancies after sensitization made her decide to stop having children at that point.

On the other hand, I am concerned the risks with the prenatal shot. I'm adding risks to my current baby, in the hopes of benefiting a hypothetical future baby. I'm fine taking the postpartum shot; the evidence is a lot clearer, the benefits are more substantial, and any possible risks fall on me alone.

#2: High-ish blood sugars and GTT. A few days ago, I tested my blood sugars over the course of 24 hours. They came back higher than we'd like to see...which makes me wonder if I should do the 3-hour GTT and see what's really going on. Here are the numbers (possibly complicated by the fact that I got a really high reading once immediately after swabbing with an alcohol wipe. 10 seconds later, it was 100 points lower once the alcohol had evaporated. I did use alcohol wipes before all of my tests. If I do any more finger sticks, I'll forgo the wipes and just wash with water):
am fasting: 121
2 hours after breakfast: 98
2 hours after brunch: 131
2 hours after dinner: 140
next am fasting: 105
If my sugars really are wonky this pregnancy, I'm more than fine with modifying my diet, etc to keep them in line. My midwife said that often just rearranging what you eat & when can make a huge difference, especially for women like me who already eat well (lots of fruits & vegetables, complex carbs, & proteins, little if any simple carbs or processed foods). At my prenatal appointment today, she gave me the drinks & blood sugar testing equipment for doing the 1-hour or 3-hour GTTs. It's up to me if I want to test, if I want to do nothing further, or if I want to go ahead and do some dietary modifications without further testing. If I decide to test and come back with not-so-good results, there's a GD class at a large tertiary hospital that my midwife said is excellent.

My biggest concern with testing is ingesting such a huge amount of glucose. Yuck-o.


  1. It would be interesting to see what your A1C reading is. I always feel that it's a good indication of what your blood sugar has been doing over the past couple of months. That helps reveal an underlying problem with glucose intolerance. Also, before you take the GTT, have you read the section in Anne Frye's book Understanding Diagnostic Tests in the Childbearing Year? She gives some tips on how to get a more realistic reading from the test,i.e. more related to how your body really handles glucose (since you aren't drinking Glucola on a regular basis). Just some thoughts.

  2. The risk of exposure to Rh+ blood during the last trimester is 1 1/2 percent, assuming you don't have any additional risk facts for exposure, such as a fall or motor vehicle accident where the belly gets bumped, an amniocentesis, etc.

    Please do not rely on blood sugars taken with a home meter. As the mother of a diabetic, I have learned that, in the US, meters are allowed to be as much as 20 percent off. Lab blood glucose tests are much more accurate. Also, if you don't want to drink the glucola, there are protocols for using Brach's brand jelly beans instead (do a Google search).

    I am a nurse-midwife.

  3. please edit to say "risk factors"

  4. My midwife used to do jelly beans but she found that no one could actually eat that many! Plus I absolutely abhor jelly beans and can't even eat that option is out for me. The nice thing is that I have no pressure either way from my midwife. Which means it's all on my head! Part of me wonders if I should just do some research on dietary modifications and implement those. It wouldn't hurt and would certainly make me more careful (and healthy!) in what I eat.

  5. Could you provide links to any of the reputable info that would discourage prenatal Rhogam? I hadn't realized that it was a particularly controversial practice. I did a little searching and am having trouble digging through a lot of really ridiculous sites to get to the useful ones.

  6. Sara Wickham's book on the topic is a great start. The issue with the prenatal Rhogam, for me, is that there's a much narrower margin of benefit and more questions about possible negative side effects, since your unborn baby is also exposed to the shot, not just you. I really worry about causing harm to this baby, since the possible benefits are for the next one, not the current one.

  7. I find the Rhogam arguments very interesting. I was just wondering if you could find actual cases of babies born to the negative effects from Rhogam because in all my searches in literature, I have not been able to find any but maybe you have better sources. I think one should consider, even in that small percentage, the bad things that can happen if the baby is sensitized. I did a short, month long rotation in the NICU a few months ago. In my time there I did see the birth of baby with hydrops fetalis due to RH factor sensitization (the mother had refused Rhogam), which was just a sad thing to see. I do not know if the baby survived or not, but things like that do occur and are important to consider. Also, while I was there, a baby was born full term with RH factor sensitization as well. He was health, born at home but he had to be brought in (to the NICU none the less) because hew as so jaundiced. He spent 3 weeks there with bili levels of 20 or so for most of the time with lights on all the time..he finally went home once the levels reached around 8. It was very frustrating for both the families and the staff. Anyways..just two small cases that made a huge impact to me on RH factor.

  8. My issue with the 3-hour (or the 1-hour) GTT is this: what are you going to do with the results? If some high numbers suggest that you should adopt a better/different diet...why not just adopt that diet now? Do you really need to shock your system with 100 g of glucose (and dye...) to tell you that?

    I would love to hear more about the RhoGam, too. Some quick research I did into it didn't really answer my question about the 28 week standard - if anything, it seems more arbitrary than I would like. For instance...why take a "12 week" shot at 28 weeks if there's a good chance baby won't come until 41? I see in other countries, 28-32 weeks is recommended...and that another is actually recommended in the US at 40 weeks if baby hasn't come, though I don't hear of moms having this suggested...

  9. I am also Rh- , and here in New Zealand where I live the 28week shot isn't even offered. You get it post-natally or not at all. I haven't done all the reading you have, but the fact that its not routine here at all (in a country that does midwife-led care) makes me think that its not really necessary?

  10. My midwife had us drink a little mini bottle of Welch's grape juice. (Sorry I can't remember how many ounces.) It was much easier to drink that that glucose stuff, but it still had 49 (!!!!!) grams of sugar.

  11. My sister had an elevated 1 hour gtt with her first pregnancy and vomited the glucola with her 3 hr gtt. She just followed the recommended diet for gestational diabetics and tested her blood sugars for the duration of her pregnancy (which were fine). With her second pregnancy she skipped the tests and followed the diet. Both babies were average size and she had no problems with the diet. Also with the blood sugars, are you wiping away the first drop of blood? We are required per policy at my hospital to do this as alcohol can alter results.

  12. I did the glucola test with my first pregnancy. Coincidence or not, I'm not sure - but it was the evening of that test that my issues with my gallbladder started and continued every 2-3 days for the rest of the (41w3d) pregnancy.

    With my second, I did a specific carbohydrate diet. I don't have the links for that right now, but it was recommended to me by another pregnant mom. It was something like 2 pieces of toast, OJ, eggs, bacon, fruit. I know it was a LOT of food and calories, but I didn't feel like I was going to throw up from sugar overload because it was also balanced out with proteins.

    This time around - I'm just testing at home. I saw a PCP the other day who did an A1C (I don't have the results yet), but my midwife said she recently read A1Cs aren't accurate in pregnancy anyway.

  13. You're right, those are not normal results BUT I wouldn't do the GTT or get very excited about these results until you repeat them WITHOUT the alcohol wipe. Yes, that can totally throw off your results and might well be what's going on here.

    I monitor my blood sugar closely in pregnancy because I have PCOS. I've experienced the alcohol wipe thing too. I also had a really high reading once from slicing up some fruit for a toddler, doing something else, then thinking I'd washed my hands and I hadn't. The leftover fruit juice on my fingers gave a false positive very high reading.

    So I would say, repeat these tests with scrupulous technique, THEN decide where to go from there based on what you see. I'd also make sure your meter is accurate (do you have a control solution to check it?) and that your testing strips are not outdated. How you store the strips can cause changes too. All those things can cause falsely high readings.

    I've got lots of info on GD on my website, My caveat is that I wrote some of the sections very early in my writing career and wince now at some of it, plus I need to add some more up-to-date citations. Revising it is on the to-do list, but way low down.

    Still, much of the info there is good, if a little overwrought and not quite up-to-date. You might benefit from the section on "Troubleshooting High Readings."

    What you need to do is be sure you are getting accurate readings and see what your readings are like on a daily basis for a week or so before you take further action. In the meantime, you can add some more exercise to your routine, just in case, and be sure to always eat protein with your carbs.

    You need accurate data on which to base a decision, and I'm not sure you have that yet. Double-check.

    Email me privately if you'd like to chat about more specifics.

  14. p.s. The A1c test is sort of an "average" blood sugar over the last 3 months or so. It cannot be used to *diagnose* GD, because in pregnancy the changes can happen fairly fast and this test wouldn't reflect that.

    So someone could be getting really abnormal fasting and post-prandial readings at 28 weeks but still have a normal A1c because it's reflecting things from 2 months ago.

    However, if a provider suspects pre-existing diabetes or wants to rule that out, an A1c can show whether blood sugar has been elevated for a while or not.

    So it's not completely useless in pregnancy, but it's NOT diagnostic and is not that useful in most cases. It's not really used much unless the woman has pre-existing diabetes or gets really high results.

    I'm not a big fan of the GTT because it's such a huge load of sugar at once, it makes a lot of women very ill, and it's not reliable in a way that such tests should be (see Henci Goer's info).

    Personally, I'd rather see what someone's readings are doing on a daily basis throughout the day, in response to their normal intake. I think that's more informative about risk than the GTT....just my opinion, though.

  15. Not relevant to Rixa's dilemma, but man my GTT made me sick. So sick I thought I was going to die, and I didn't even have to fast. But I had hyperemesis, and I had never been able to ingest 8 oz of ANY liquid in less than 3 hours at any point in my pregnancy. (It's common for women with HG to have more trouble ingesting liquids than solids.) So to drink so much so fast was excruciating. I looked so gray by the time I got the phlebotomist, she actually blurted out: "Please don't throw up on me!" And the worst was that I know I have low blood sugar, and that this persists in pg. My 1st GTT had revealed a blood sugar level of 67!! And the second time it was just as low.

  16. I am pregnant with my 4th, at home birth - If my midwife does a pancake breakfast test if she thinks there is a problem. We'll have pancakes, syrup, OJ and then test after one hour and three. I like this because I've just done this at home for myself each time. Only once have I had issues with my sugar levels but was able to control it with diet. I'd opt out of the glucose test and just keep watching your early morning readings and how you react to real food...

  17. I just had my first at home three weeks ago.

    I did the "trucker's breakfast" as the previous poster mentioned--biscuits with sausage gravy, two eggs, and a big chocolate chip pancake. Test at 2hrs.

    I am Rh-. I didn't want the prenatal shot for so many reasons--including that it's a blood product. Just reading the package insert gave me pause!

    I was tested for sensitization at 28 weeks so that I could make an informed decision based on that moment in my pregnancy.

    I had it after Tessa's birth because she's A+. FYI for those wondering, it's $185 if you pay out of pocket.

    Tessa developed some wicked jaundice, but not enough to go to the hospital--lots of nursing and time in the sunlight.

  18. I didn't have to worry about the Rhogam shot, but as for the GTT, I opted out and continued to eat a healthy diet. If you are concerned about it I would definitely try to control for other factors before putting yourself through the test. The pancake breakfast sounds good, also!

  19. So glad WRM spoke up! I was going to link her stuff. It helped me tremendously during my pregnancy. Declined all labs, didn't even speak to my midwife about it because I didn't want any of it in my chart (in case I had to be transferred). Just tested my sugars at home and ate to keep them in check.

  20. The reason I suggested the A1C is that it can uncover an underlying glucose intolerance, not because I think it's diagnostic of GD. Of course, it would be more informative if done early in the pregnancy so you'd have a picture of what had been going on PRIOR to the changes of pregnancy. Every pregnancy involves metabolic changes that increase insulin resistance. This is a physiological adaptation. The big problem is not GD, which has never really been shown to have any specific ill effects for mother or baby (in spite of recent ballyhoo- important to read the studies carefully). The problem is with women who have undiagnosed REAL diabetes or prediabetes that pre-existed the pregnancy. Hence the early A1C. Later in the pregnancy, I think you get a pretty good picture by doing the home testing as you describe but continuing it for 4 days. That way, even if the glucometer is slightly off, you'll see how your body actually handles food. And you can learn how to eat and exercise (which is almost more important) in order to keep your sugar level steady. The bottom line is learning to be healthy, and as several people have stated, the good diet and exercise is what everyone needs to do, whether or not they have "GD".
    As for the RhoGam, if you hesitate to have an unnecessary procedure ( I don't blame you), you're right that you can be tested for sensitization. But it needs to be repeated in a few weeks. I'm a student CPM about to take my board exam. I work in a busy practice,and these are some of the conclusions I've come to after much research and observation, but I'm not saying they're the only truth.

  21. It's worthwhile to control any GD if it is going on. I had GD. I have since read that not only can GD affect a mother's health (and future frank type 2 development) but there is research suggesting that abnormal glucose during prenatal development can "kindle" metabolic changes in the fetus, predisposing the child to obesity and type 2 him/herself.

  22. Had GTT with my first, tested high. However, they wouldn't let me put it off -- and I had had an emergency root canal the day before. Went back to eating normally (which was essentially their diet anyways.) Kid was normal.

    Second preg. blood sugar never tested off AT ALL except right after a jelly donut =/ (what can i say? I was stuck in traffic for 2 hours and starving trying to et to the lab) was over 10 lbs.

    My family has a history of babies over 9 1/2 lbs, and my husbands family history is babies over 10 lbs.

    I guess I just plan to watch my diet if we have a third, and possibly even forgo the basic testing. While a 10 lb baby isn't a piece of cake, I cannot find good evidence for doing otherwise, esp outside the US.

  23. My sugar levels were also high when I was pregnant. What worked for me was eating enough proteins throughout the day and particularly before any carbs or sugars, even fruits. It made a significant difference, and made me feel much better. I didn't take the glucose test, but at each visit my midwife did check my sugar level. I hope there is an easy remedy for you!

  24. my 3 hour glucose test with Eska was a nightmare, i was VERY ill and it was horrid.

  25. Hi there!

    I was just wondering what you decided regarding the prenatal rh shot. Do you currently have a midwive and is she supportive of you opting out?


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