Gestational Diabetes & Induction

Family, Education, Health and Pets
1
Hi,

I was just wondering if anyone has any experience with gestational diabetes here in Switzerland (Zürich)? I am 32 weeks pregnant and have GD but so far am able to control it with diet, and the baby is still an average size.

I know in other places women with GD are often induced around 37-39 weeks and I was wondering if it is common practice to do that here? I know it depends on circumstances etc. but I would like to hear from anyone who has had it and what their experience was.

Thanks.

Uchi

2
The fear with uncontrolled GD is that the baby will grow very big, but this is not likely to happen if your GD is well controlled.

My only advice is to avoid induction if possible - induction has a much higher risk of a c-section and brings with it lots of other potential difficulties.

Also, don't necessarily rely on ultrasounds to estimate the size of the baby - they aren't that accurate.

My children were 4.2, 3.8 and 4.7kg. No diabetes. The 4.7 could have been a challenge, but I had a planned homebirth with two midwives, one of whom was extremely experienced in that setting, and was excellent... and no stitches with any of my births! - just to say, it's possible to birth quite large babies without complications. My SIL had *UNcontrolled GD* and had a 5kg baby (fourth, the middle two were twins with a combined weight of 7kg).... and bled heavily with a lot of trouble, refused a blood transfusion because she was in shock (afterwards she actually said that in her 'right' mind she would have taken their offer of an infusion)....

Not sure what else to ask - certainly your choice of doctor or midwife will make a big difference in your odds of being 'encouraged' to accept an induction or a c-section. Personally, I had my three children all with midwife care (birthing centre, transferred to main delivery area for epidurals twice, third one homebirth unmedicated)....

Just stick to your healthy eating plan and try to focus on staying as healthy and positive as you can.

Oh, and another thing, some mums I know online express a little colostrum before the birth. One of the problems of GD is if the baby's blood sugar drops rapidly, they will possibly recommend formula. To avoid that it's possible to express the colostrum, which will give some nutrition - and definitely try to avoid being separated from the baby, and put the baby to the breast lots of times in the first few days - it will help your milk come in faster and keep your baby healthy...

3
I had an induction at 41 weeks (not due to GD though) and it was absolutely fine. Gave birth naturally with no pain relief - wasn't planned like that, but birth is not something that can be planned. My birth experience in CH was really positive - midwives and OBs were absolutely fantastic and supportive.

The ultrasounds I had predicted the weight of our baby pretty well.

Are you being monitored regularly? Have you discussed with your gynae? Personally I don't think they will look to do an induction unless they deem it medically necessary and it would only be done with your agreement. At the end of the day the most important thing is that you and the baby are well.

4
Had two pregnancies, both GDM - insulin dependent. Both kids were small, because the blood sugars were maintained well. I did have them in the US, but here they let you go further without induction. They are very good about not "pushing" the induction issue, unless it's needed. Talk to them about it and be open. I don't see near as many inductions here in CH compared to the US! The most important thing is.... Keep your sugars well maintained! Have fun! From one GDM to another ;-) let me know if you need tips, I might be able to help you with some stuff...

5
I had GD that was controlled through diet, my baby was big but we are a tall family. The plan was to induce at 41 weeks either by choice or because of medical reasons, but I went into labour on my due date and had a 3.79 kg daughter two days later. My doctor was the department head at the hospital and told me that induction was really a last resort because of increased complications, but I was closely monitored to make sure the baby didn't get too big all the same.

She was borderline hypoglycaemic at birth and was given a feeding supplement the first three days, and it had no effect on breastfeeding or milk supply.

6
Thanks for all your comments. I should mention it's not my first baby but it is the first time with GD. The last birth was natural and I went into labour on my due date. I'm having the baby at the UniSpital and have got all appointments there now. Naturally I'll be asking lots of questions at my next appointment, I'm just impatient to find things out

7
I had gestational diabetes (borderline) but I managed to control it via a proper healthy diet. I delivered my son at exactly 37 weeks via C Section as he was not getting enough nutrients in the womb (due to some resistance in the umbilical cord) and was hardly any growth recorded from the 34th week onwards. I wanted to go for natural birth (induced) but my gynae advised me to go for C section instead as the baby was exhibiting signs of distress (accelerated heart rate which was higher than normal). My gynae was of the view that its better to deliver earlier so that the baby could obtain better nourishment outside the womb. My problem was caused by my placenta which he explained was nearing its expiry date of 9 months and hence was not functioning normally. My baby was 2.3 kg at birth and had some complications after birth as his blood sugar dropped immediately and had to be warded in the Neo Natal for close to a month. This is rather unusual actually as I was informed most babies with similar problems only need about 3-4 days to regulate their sugar level. My son is now a healthy happy baby at 51/2 months. He has tripled his weight since then.

8
Hi,

I had borderline GD and my nutritionist gave me a list of foods to avoid (potatoes and rice were top of the list). Delivered a healthy 2.5 kg baby in week 41...had to be induced but induction had nothing to do with GD and everything to do with `high time for the lil one to be born`. It was a normal delivery .

Look after yourself and all will be fine. Good luck!

9
I failed my first blood test this week and need to go back for the 3 hour one on Friday

For those of you who had GD did your doc put you in touch with a nutritionist? Or do they just give you a pamphlet kind of thing?

10
I was borderline so mine gave me a verbal list of do's and don'ts and was very strict thereafter at every examination. However, I did seek out a nutritionist on my own....found one at the Unispital Zurich who made a personalized diet chart for me.

11
My doctor made an appointment for me with the outpatient clinic at the hospital and I saw a nurse and dietician on alternate weeks. With the dietician, it was basically analyzing my diet and tweaking it. The nurse also did a test that showed my average glycemic level over a number of months.

I really hope your test goes well, but even if you have a blood sugar problem, you'll be followed very closely and everything will be fine. It's just a little hard to give up sugary treats

12
Mine was also borderline but I brought it back under control by dropping my sugar intake to a less crazy level (mad cravings ).

13
Thanks all, this is very helpful! The sugary treats I can do without, but not being able to eat tons of summer fruits really sucks. Over the weekend I bought 2k each of apricots, nectarines and peaches, plus strawberries and blueberries. I'll eat this within a few days....all I want is fruit!

14
Essential that you keep you sugar in line (us standard is 126). effects on baby can be severe so this is important.

see a nutritionist. anything that breaks down to sugar (can carbohydrates) are generally bad and have to be avoided. bread bad, potatoes bad, rice bad, etc etc if it's white it's probably bad . general rule of thumb (even milk and milk products) !

expect to start insulin therapy immediately.

get a blood sugar tester. use it alot at first. maybe 3 times a day.

don't hesitate a day. go to DOC NOW get insulin and start therapy.

don't endanger the baby. you will survive! fortunately you are far enough along that baby will have some beta cell production - but very limited.

15
I think a doctor should be consulted before pregnant ladies start cutting swathes of food groups out of their diets, especially if GD is only mildly borderline. You could do more harm than good.

16
I just saw a new reply that you posted about eating 3 kg of fruits. that could easily cause you to fail the blood test. !!

get teste d again. 3 fails means get insulin.

but nutritionist (as i said before) is essential.

17
How and when do you know if you have GD? I'm on my 25th weeks and i ate lots of carbs and chocolate.

18

Your doctor normally checks for it (and other pregnant mum conditions/complications) each time you go for a check up. If your doctor normally takes blood and you have to wee in a cup, you can assume they are monitoring all the usual things.

19
I'm currently 28 weeks and have peed in a cup at each appt, which has tested negative for sugar.

This week I had a simple blood test, I was required to fast from midnight the night before. They called me later that afternoon to say my glucose levels were "borderline" and I needed to come back for the long test.

So now I have to go in Friday (fast again) and drink some sugary orange juice and my blood will be checked 3 times in a 2.5 hour period. That's what they told me at least.

From what I've read they can ask you to have the blood drawn between 25-29 weeks, but I've been in holiday since the first of June and was only back last week.

20
yep the orange syrup stuff is the normal GD test. that will clarify the issue for you. however, if you are eating lots of chocolate etc then i wouldn't worry too much. "borderline" happens to any of us who indulge too much! just lay off for a day or two prior to the test. you'll be fine.