The Fifth M of Gestational Diabetes - Monitor
When you have diabetes in pregnancy, even if you are following a diet, exercising, and taking your medications, there are some increased risks.
Monitoring is the final pillar of managing your gestational diabetes well. All this may sound daunting. But if you follow the 5 M's I've laid out in this series, you will have little to fear and you can take back control of your health with confidence.
Monitoring for risks
To wrap up this series we're talking about fetal monitoring. So what are the increased risks that go along with gestational diabetes?
A larger baby – when your glucoses are elevated, so are your baby’s. Elevated blood glucoses may cause increased fetal growth, particularly in the shoulders and abdomen, resulting in an increased risk of:
Birth injuries - When the head is not the largest part of the baby, the shoulders and abdomen may be more difficult to deliver. Fractures of the collarbone may occur, or injury to the nerves supplying the arms. Or if extra time is needed to deliver the shoulders, the baby may not be receiving enough oxygen.
Newborn hypoglycemia – During pregnancy, your baby may be making more insulin in an effort to lower its blood glucoses. This may lead to low blood sugars after delivery when the baby is no longer receiving glucose from you.
Stillbirth – The worst risk of all is fetal death. With well-controlled diabetes, this risk is very low but still higher than in nondiabetic patients. For this reason, we recommend increased fetal surveillance in the third trimester
So how do we monitor fetal well-being?
Kick counts – There are several ways that moms can do kick counts. Some OBs have you record the time it takes for the fetus to move 10 times. Other methods have you count the number of movements in an hour. The point is to simply be aware of fetal movement or the lack of it. Although babies tend to sleep for longer periods of time as your due date nears, you should still be able to count 5-10 movements in an hour. If you are concerned about decreased fetal movement, you should contact your OB provider or go to the hospital.
Nonstress testing – The nonstress test (NST) involves placing a belt with a small round transducer on your abdomen; this monitors the baby’s heart rate. A second belt monitors contractions. The fetal heart rate is recorded for 20-30 minutes. The baby should have a normal baseline heart rate (between 110 and 160 beats per minute), and should have accelerations in the heart rate when he moves. We also look for dips, or decelerations, in the fetal heart rate. Some decelerations are normal in pregnancy, while others are concerning. The NST is typically performed once or twice weekly.
Biophysical profile - The biophysical profile, or BPP, is another method of monitoring fetal well-being. Using ultrasound, we give the baby a score based on fetal movement (0-2 points), muscle tone (0-2 points), amniotic fluid volume (0-2 points), and breathing motion (0-2 points). If an NST is performed along with the ultrasound, the reassuring heart rate tracing is also worth 0-2 points. Ideally, the baby should receive 10/10 points. If there is less amniotic fluid, fewer movements, or any concerns, testing may be performed more frequently.
Delivery before due date
Surveillance of fetal well-being helps to reduce the risk of stillbirth and predict potential complications. Different OB providers have different testing protocols; you may have NSTs, BPPs, or some combination of tests. If there are concerns about the fetus, you may be delivered earlier than your due date.
Even if you have no complications, diabetic patients are frequently delivered before the due date because of the increased risk of poor pregnancy outcome. Remember that there is more than one right way to manage a diabetic pregnancy. If you have questions about your glucoses, about your baby’s growth or movement, about delivery, or any aspect of your pregnancy, communicate with your OB!
And don’t forget that you need to be tested again after delivery, as many gestational diabetics remain diabetic or become diabetic within a few years.
In conclusion
Managing gestational diabetes successfully really comes down to a handful of habits and lifestyle factors. Although there are many approaches to diabetes, some basic principles apply to everyone.
By measuring your blood sugar, eating healthier meals, moving your body, taking the right medication, and monitoring your overall health and risks, you can take back some control of your health and successfully manage your gestational diabetes. I hope this series has helped you better understand diabetes in pregnancy.
If you have any questions about this topic, please feel free contact me so we can stay connected. Ultimately, this is your health and you are your own #1 health advocate! Follow the 5 M's of Successful Managment and you will be on your way to a healthy, happy pregnancy.