Keeping weight gain in pregnancy in check

Keeping weight gain in pregnancy in check

Controlling weight gain in pregnancy is a challenge.  Weight gain is normal but too much carries more risk for a large baby, for gestational diabetes and maybe even long term risk for obesity in the offspring.  In a previous blog we have looked at what amount of weight gain is normal but for many the pounds just seem to pour on regardless of what they do.  Keeping track of your weight is useful to guide things and you may find the chart we made from the Institute of Medicine recommendations useful. What can be done to keep the weight gain in check.  A recent study came up with a simple approach which seemed to work and may help.

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What is A1c and is it an accurate reflection of blood sugar in pregnancy?

What is A1c and is it an accurate reflection of blood sugar in pregnancy?

In diabetes a lot of attention is paid to the A1c. What is it and is it good at reflecting over sugar levels?
Simple average blood sugars are not that great at telling how the blood sugar control is really like.  Consider Mr Smith who has sugars ranging from 2 to 20 mmol/l (36 – 360 mgs/dl) and Mrs Dixon with sugars of 10 to 12 mmol/l (180 – 216 mgs/dl).  Both have the same average of 11 mmol/l (198 mgs/dl) but the control of sugar in Mr Smith sounds much worse.  The A1c is a much more stable reflection of overall sugar control.

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Just how low can a normal blood sugar go in pregnancy?

Just how low can a normal blood sugar go in pregnancy?

Recently in the clinic I was asked “Is 3.8 mmol/l (68 mgs/dl) two hours after my lunch too low? The blood sugar normally varies though out the day:  lower before breakfast, peaking just over an hour after a meal and coming back down by two hours.  Firstly, sugars at this level do not harm the baby but let us look at what normal sugars in people without GDM are and then we can look at the situation in gestational diabetes and for those with pre-existing diabetes, either Type 1 or Type 2 diabetes.

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Why the fuss about the A1c in early pregnancy?

Why the fuss about the A1c in early pregnancy?

When someone with Type 1 or Type 2 diabetes becomes pregnant the main things to think about are: the mom’s own situation with regards to diabetes complications, her blood sugars and the baby.  The big issues for the baby are that he or she might have a congenital malformation, be too large at birth or have low blood sugars just after birth.  Of these the congenital malformation is by far the most important.  A large baby can be delivered by Caesarian section, a low sugar in the baby is readily treated but if the heart, kidney or spine are not formed correctly we can’t turn back the clock.

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Early Gestational Diabetes

Early Gestational Diabetes

A couple of weeks ago in the clinic we had a woman, just over three months gestation, who was diagnosed with gestational diabetes (GDM).  She had GDM on the last pregnancy when it was found at 28 weeks so was surprised when she got it so early this time round. What is going on?

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Big babies in diabetes

Big babies in diabetes

Some women with diabetes who become pregnant or women who have been diagnosed with gestational diabetes become worried when they read of  women with diabetes delivering huge babies.  In a large Scandinavian study of over 10,000 women with GDM only 8% had babies over 4.5 kg  (nearly 10 lbs) and we know treatment will lessen this chance.   In another large study of  babies of women with Type 1 diabetes the average birth weight was 205 g (7 oz) heavier than the general population.  There is a problem but not as big as some expect; so why does diabetes cause big babies?   Sometimes in a simplistic manner it is stated that the high sugar goes into the baby and is converted into fat.  It is more complex (see below) but what is important to remember is that diabetes is only one of many contributors to the size of the baby, an important one, and one that we can do something about but it is not the only thing to determine the size of the baby.

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Weight Gain in Pregnancy

Weight Gain in Pregnancy

Just how much weight gain is normal in pregnancy?  We know the baby, placenta and fluid around the baby comes to about 5 Kg (11 lbs) but the mom also has a bigger blood volume, lays down some more fat stores and may carry excess fluid.  The Institute of Medicine in the US released suggestions for weight gain in pregnancy in May 2009 and Health Canada are using much the same.  I find it easiest to plot the weight gain on a page over the course of the pregnancy. You can down load the sheet I created based on the IOM recommendations as a PDF file, found under charting,  just print it in landscape format and use it yourself.

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Morning sugar rise

Morning sugar rise

 

My sugar rises in the early morning even if I don’t eat!

A puzzling and frustrating issue for many with diabetes and pregnancy is that the blood sugar may rise coming into breakfast time even though no food was taken.  The usual scenario is the woman checks  her sugar when going to the bathroom at five or six in the morning,  takes nothing, goes back to bed and then at eight AM the sugar is higher by 1 mmol/lI (18 mgs/dl). Just what is going on?

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