Diabetes. There are two main kinds right? Type 1, the unavoidable one, that means a lifetime of insulin injections often from an early age; and Type 2, the one that people apparently bring on themselves later in life through poor lifestyle choices. Well it turns out there’s a third “type” that hangs out in the bodies of 1 in 20 pregnant ladies: gestational diabetes.
This is a total shitter of a disease, where pregnancy hormones interfere with the mother’s normal insulin production, meaning that whenever she eats anything, her body struggles to process any sugars in that food so it freely floats around her bloodstream until it crosses the umbilical cord and makes her baby unduly large.
A big baby isn’t the end of the world of course, but big babies can be trickier to deliver and babies born of mothers with GD come with a whole host of risk factors, from shoulder dystocia to an increased chance of stillbirth.
So it’s understandable that part of the antenatal booking questionnaire concerns the risk factors for GD: a pre-pregnant BMI of over 30 (classified as obese), a family history of diabetes, a previous big baby of 4.5kg (10lbs) or more, family origins that include south Asian, Chinese, African-Caribbean or Middle Eastern, and previous diagnosis of GD.
However, according to research undertaken by Gestational Diabetes UK as many as 10% of mums who develop GD have none of these known risk factors.
I was one of those mums. At booking, my BMI was 24 and was 22/23 before pregnancy so well within the “healthy” range; I was fit – running 3 times a week until I was 26 weeks and seeing a personal trainer until I was 34 weeks.
I also didn’t appear to have any of the symptoms. I wasn’t overly tired (who isn’t a bit worn out in the 3rd trimester?), I didn’t have particularly dry lips, I didn’t have increased thirst or a desperate need to pee… I just felt… pregnant?
And much to the disappointment of my sugar-a-holic husband I don’t really have a sweet tooth either and would probably pick a bowl of cereal or bag of crisps over a really sickly cake. We had even started eating organic when weaning my eldest, and I religiously cooked every meal from scratch as my little boy would take leftovers in for his lunch the next day at nursery. No artificial flavours, colours or sweeteners were allowed past the door of our house. I never added salt or sugar to anything I cooked: our family meals were dripping with healthiness.
Diabetes didn’t even cross my mind when I had the first shockingly large fundal measurement at 32 weeks.
The previous cross on the growth chart had fallen at 75th percentile, but this was way over the top 91st percentile line. I knew I was bigger than last time (I’d been “showing” since 5 weeks!), but the weight was all baby; the rest of me looked normal. I’d been reassured by friends and family that 2nd babies look bigger because your muscles have stretched after the last time and never quite get back to that pre-pregnancy tautness.
Added to which on both sides of the family tree we had big babies: my husband was 9lb11 and my aunt was over 11lbs! It just seemed like genetics was coming into play.
Admittedly, I did start to question the size of my bump from around 28/30 weeks when friends who were also pregnant with their 2nd didn’t seem anywhere the size of me, but I just discounted it. I’d grown out of most of my maternity clothes, but I wasn’t overeating. Maybe this was just a quick-growing bump and it would slow down closer to due date?
I did have a panic at the first large measurement, and called my consultant midwife and doula asking whether we should pay for a private scan rather than wait the customary 2 weeks to see if that measurement was an anomaly or not. Both of their advice was not to worry, and to hang on. So we sat tight, hoping for the best and leaning on their expertise.
Two weeks later and the second fundal measurement was exponentially higher – way up in the white space above the 91st centile line. The midwife who did the measurement was calm and urged us not to fret, but I felt sick to my stomach. Something must be going seriously wrong. Babies don’t grow that fast in such a short space of time. And how on earth was I going to get this giant baby out?
My plans for a healing, calm birth were in tatters.
We booked a private scan for that afternoon which gave a slightly more modest estimate of the size – around 98th percentile head and weight, with a raised level of amniotic fluid (called polyhydraminos). I called the consultant midwife at the hospital who immediately booked me in for an NHS scan and a glucose tolerance test – just to rule out the very unlikely possibility of diabetes.
Later that week (the first week of my maternity leave), the NHS scan confirmed the size estimates of the private scan and the sonographer briefed us that a known cause of increased size and fluid was gestational diabetes. It still seemed so far-fetched.
The following morning was a Friday and I returned to the hospital having not eaten since 9pm the night before, ready to give a “fasting” blood sample; then ingest their glucose solution and wait the required 2 hour period to see how my body metabolised the sugar. I’d find out the results over the weekend if there was any concern.
The call came at 4:30pm that afternoon: I had gestational diabetes. I needed to change my diet with immediate effect – absolutely no sugar in any form at all – and could I come in on Monday to discuss the diagnosis with the diabetic midwife? My head span. How could this have happened? I had no risk factors, no symptoms, and yet I must have been unwittingly poisoning my baby with unnecessary sugar.
Over the weekend, the severity of the diagnosis became clear as I received phonecalls from my GP and from a Doctor at the hospital just checking that I’d been made aware of the situation and that things were in hand.
I felt like the worst mother in the world.
What could I have done to bring this on? I was so healthy! Monday rolled round and the diabetic midwife we met with was very kind but strict. I was a late diagnosis at 35 weeks so we didn’t have time to try things out; I needed her most strict meal plan. There were two options for breakfast: porridge or toast with peanut butter; lunch would be boiled eggs and toast with marmite; dinner should be protein-heavy with no more than 100g of pasta or rice, or 200g of potatoes. I needed to have 3 “snacks” a day, at mid-morning, mid-afternoon and one before bed. No fruit for breakfast or in the evening. I was to walk for 20-30 minutes after every meal, and then test my blood sugar an hour after eating and note it down in a special insert to my maternity notes. Two high readings and I was to phone immediately.
My finger prick testing kit was ceremoniously handed over and she talked me through how to use it for the first time. She promised it wouldn’t hurt and she was right – turns out the needles are too small too feel. Then I had to dab the blood bubble onto a testing strip and wait for the result to load on the digital monitor.
My first measurements were all well within range (less than 5.3 morning fasting levels and less than 7.8 an hour after eating) that it all seemed a bit overkill. The diet was basically what I ate anyway. Did I really have this disease?
And then I got my first high reading.
It turns out plain porridge wasn’t the safe option it was presented to be. It was a particularly miserable day outside too, so I hadn’t ventured out for a walk, and my result was 8.8. I was devastated. Porridge was previously the cornerstone of my diet. We’d have it 2-3 times a week. My son loved it and now it was the enemy. All the times I’d eaten it before diagnosis, without a single thought for how it might be spiking my blood sugar levels because surely porridge was the epitome of slow release carbs?
Well it turns out that most women diagnosed with gestational diabetes can’t tolerate porridge, or any breakfast cereals at all, to the extent that Gestational Diabetes UK refers to cereals as “GD Kryptonite”. I felt like a fool.
I had physical symptoms after the porridge: what’s known as a “hyper”. I felt lethargic, sweaty, thirsty and my heart was racing. And horrifyingly I realised that these were feelings I was familiar with but had just put down to general pregnancy malaise. I couldn’t stop thinking about the baby in my tummy and how he must feel. What had I been doing??
From then on, I cut out porridge and stuck to the walking plan religiously. I wasn’t going to put my baby at risk for the sake of oats or staying dry. And those walks became a real family event each day: it was a total joy going for a post-meal walk with my toddler – he never minded the weather, loving to jump in puddles and marvelling at the sights I would have tramped past without thinking. It got to the stage where we’d finish eating and he’d excitedly ask if we were going to go for “walkies”, immediately rushing to get his wellies. So there were positives!
Because of the estimated size of the baby, my new diabetic expert consultant suggested that we should opt for early induction at 39 weeks or earlier. Another scan suggested that the baby would be 4.5kg by 39 weeks, so that date ended up being moved forward to 38+4. We headed in, feeling positive, only to find that due to the excess fluid, the baby had what is known as “unstable lie” – i.e. he was floating in so much fluid he was constantly moving from position to position. Induction would be too dangerous – as would going home in case my waters broke and the cord came down first, cutting off the baby’s blood supply. A c section became the most viable option, which meant staying in hospital until I turned 39 weeks, walking the ward until they could fit me in.
The morning of the section rolled around, and baby had gone spontaneously head down overnight so a “stabilise induction” was suddenly a possibility. This would involve my husband donning scrubs (hot!), a spinal (in case things went awry and I needed an immediate c section), and then a doctor would perform a controlled rupture of membranes to prevent the cord coming down whilst another doctor physically held onto my bump, encouraging baby to head down into my pelvis. There were lots of hands… but the procedure went well and I had also dilated 2cm overnight so we were full of hope as we were wheeled round to the labour ward to start the syntocinon drip.
In the end, I got to 8cms but no further and we ended up with a section later that day.
Despite the monstrous scan estimates, our second beautiful baby boy was born a reasonable 8lb 14.5 – big but hardly the giant they had predicted. He cried immediately, latched on greedily, had stable blood sugars almost from the start (I’d expressed some colostrum which helped with this) and has grown like a weed ever since. A happy, healthy, bonny boy.
And as for me, I haemorrhaged during the section but the doctors were able to manage the situation with fluids and I didn’t need the blood transfusion I’d required with my first. I was encouraged to check my blood sugar levels the morning after which were a little high after having been low during the labour, but now I wasn’t incubating a child this was all fairly academic! I was sore from the section, but now able to resume my former diet – I could have porridge or cereal for every meal if I wanted to (and I really did want to!).
Healthy baby, healthy mummy, so far so good – but the worrying thing for me from now on is that I now have a 50% chance of developing Type 2 Diabetes in the next 5 years, and for every kilo I gain over my pre-pregnancy weight, I increase my chances of getting it by 40%. I’ll be tested annually for the rest of my life.
So to anyone reading this who has just been diagnosed, don’t be scared.
Your life will have changed forever by the diagnosis, but
a) you still get a baby, regardless of how they come out and
b) avoiding type 2 diabetes tends to be a case of staying healthy which is no bad thing in the long run.
Just take my advice and avoid porridge until baby comes out!