So you failed your glucose test…Gestational Diabetes Screening in Pregnancy

I “failed” my glucose test…

You drank that not so wonderful orange (or maybe you go lemon-lime?) drink and got a call the next day.  You “failed”.  What does that mean and what happens now?

During pregnancy the placenta starts releasing a hormone that makes women insulin resistant.  Most of the time the body can still maintain blood sugars in a normal range, but approximately 6% of the time is pushes women over into diabetes. The insulin resistance is typically temporary and resolves after the placenta is delivered.

It is important not to miss the diagnosis of gestational diabetes as there is increased risk to both mom and baby.  Moms have an increased risk of blood pressure problems, preeclampsia or toxemia of pregnancy and long term are at higher risk of type 2 diabetes.  The fetus is at risk of growth problems, birth trauma such as shoulder dystocia, bone fracture and nerve palsy, as well as higher chance of still birth.  Scary as all of these issues are, they are largely avoidable if diabetes is diagnosed and well controlled.

So that we don’t miss anyone that might have gestational diabetes, the first orange drink test “failure” is set at a low enough level that it will catch everyone that has it.  The problem with the low cut-off is that it also catches a lot of people that do NOT have diabetes.  This is what we define as a screening test. So the next step is the diagnostic test to weed out the “false positive” results.  We do this through a longer, 3 hour test.  I will be honest- it is not a fun test.  Our office will give you instructions to carb load for a few days prior to the test.  This sounds counter-intuitive because we just told you your body may not be able to process carbs and now we want you to to eat extra carbs.  The reason behind this is that this gives the pancreas the best chance to prepare for the extra sugar load of the second drink.  The day of the actual test you will come to the lab fasting and get a blood test, drink another lovely orange drink, then get a blood sugar test every hour for 3 hours.  It’s long.  It’s boring.  You are pregnant and hungry.  So again- we know it’s not a fun test, but it is really important.

No one wants gestational diabetes.  But with appropriate testing and treatment we can work together to make sure that at the end of  the pregnancy you have a healthy baby and a healthy mama.

COVID-19 and Pregnancy

In this age of COVID-19, it is easy to be overwhelmed by all of the news reports and social media posts out there.  It is hard to tune out all the bad news we are given as well.   Recently, patients have been concerned about news reports of increased risks for miscarriage due to COVID-19. The reports refer to a recent article published in the Journal of American Medical Association (JAMA).  The article is a case study of a pregnant woman in Switzerland who tested positive for COVID-19 and unfortunately suffered a miscarriage at 19 weeks of pregnancy.  Testing attributed the loss to a placental infection with COVID-19.

This case is tragic, and we cannot disregard the experience of this patient.  It’s important to note, however, that it is a single case report, and does not indicate that every pregnancy is at risk for the same outcome. Because COVID-19 is a new virus, we are still learning about its effects in pregnancy. Despite the information presented in the JAMA article, the CDC advises that based on current information, pregnant women seem to carry the same risks for serious illness with COVID-19 as non-pregnant adults.

Even under normal circumstances, pregnancy and the postpartum period is a time of physical and emotional change.  Navigating these changes during a global pandemic is certainly challenging.  Your OB provider can help to explain information reported in the news, and hopefully give reassurance amid the uncertainty.  Above all, pregnant women should follow social distancing guidelines.  It is important to avoid people who are sick or have been exposed to the virus, clean and disinfect frequently touched surfaces daily, and wash your hands with soap and water or hand sanitizer frequently.

Upcoming visit?

As we all have experienced, the current COVID19 pandemic has changed the way we do even life’s simplest things.  Going to the grocery store, although it’s never been one of my favorite things, is now like finding my way through a maze of one-way aisles.

Like most places, things are a little different at Bedford Commons OB-GYN right now.  We are still the same awesome team and we really are excited to see you but there are a few things that you should know before you come for your visit:

  1. Visitors – It’s awesome to meet your partner, parent, and children but right now, we need to limit the number of people in our office to keep our environment safe for all of our patients and team.  Because of this, unless you are under the age of 18, or require assistance, or are coming in for an obstetric ultrasound, no visitors will be permitted to accompany you to your visit.  We know this can be difficult, especially with childcare challenges.  However, we are committed to keeping everyone healthy which is why we cannot make any exceptions to this rule.  We are happy to FaceTime or do a phone call during your visit so someone else can be a part of your care.
  2. Pre-visit check-in – You will receive a text message and email 1 day before you appointment from Phreesia asking you to “Check-in”.  This is not actually checking you in but is our way of having you verify all of your information is correct and complete any paperwork we would have had you do at your visit.  This process takes between 1-4 minutes.  Completing it ahead of your appointment prevents you from having to fill out actual paperwork when you come in.
  3. Let us know you’re here! – For appointments in our Bedford location ONLY, let us know when you arrive by texting us at 603-668-4646.  We will ask you a few questions about signs and symptoms of COVID19 and recent travel.  As long as you completed the pre-visit paperwork from Phreesia, you’ll wait in your car until a room is ready.  For our Derry and Windham locations, because we can get you quickly in a room, come on in and check in and we will bring you right back to an exam room.
  4. Recent travel?  If you have recently traveled outside of New England, we may ask you to reschedule your visit.  Traveling to any areas with a >5% positivity rate increases the possibility that you may be exposed to COVID19.  Please call us if you have traveled in the past 14 days and we will let you know if we need to reschedule your appointment.

Questions?  This is all a little confusing so if you have any questions, just give us a call.  We would love to help!