Gestational Diabetes…
Optional Testing During Pregnancy
By Valerie Jacques, RN, CPM, NHCM
This is the second in a series of articles exploring testing procedures available for you and your baby during pregnancy.
Gestational diabetes is a form of the disease, which manifests itself in 2% to 5% of pregnant woman (only occurring during pregnancy). As with other forms of diabetes, the body is unable to effectively use glucose (a simple sugar that your body converts into energy). Normally, glucose is used by the cells of your body with the help of insulin (a hormone produced by the pancreas).
In the case of the pregnant Mom, insulin is blocked from doing its intended job by certain pregnancy hormones. When this happens, glucose builds up in Mom’s blood, and if not treated, can harm both Mom and baby. The risks associated with gestational diabetes include:
· Newborn hypoglycemia - low blood sugar in your baby
· Jaundice - your baby has a yellowish skin tone, which is associated with a buildup of red bile pigment (bilirubin) in his/her bloodstream.
· High blood pressure (Mom)
· Premature birth
· Macrosomia - birthing a very large baby (10 pounds or more), which occurs because your baby was exposed to high glucose levels in your body and has stored the glucose as fat.
· Birth trauma (for Mom and baby) – due to birthing a large baby
· Miscarriage
· Birth defects (rare)
· Stillbirth (rare)
Gestational diabetes usually manifests itself about halfway through the pregnancy, therefore the test for the disease is generally administered between 24 and 28 weeks into the pregnancy. The test requires Mom to give a blood sample, which is analyzed for glucose content. If the initial test is positive, it may be necessary to conduct a second, more sensitive test for the disease.
There may be no apparent symptoms prior to testing for the disease, therefore it important to have screening. If symptoms do occur however, they may include the following: increased thirst, increased urination, fatigue, nausea, vomiting, blurred vision and frequent infections (especially bladder, vaginal and skin infections).
Risk factors for gestational diabetes include: history of diabetes in your family, a previous pregnancy with gestational diabetes, age (Mom is over 25 years old), weight (Mom was overweight before becoming pregnant), having glucose present in Mom’s urine (glucosuria), hypertension, having too much amniotic fluid (polyhydramnios), having given birth previously to a very large baby, stillbirth, and race (Black, Hispanic, and Indian women are at more risk…the reasons are yet unclear).
Treatment consists of controlling the level of glucose in Mom’s bloodstream, and is essential in order to keep Mom and her baby healthy. The good new is that most Moms are able to control their blood sugar with diet and exercise. In some cases, however lifestyle changes and/or medication may be necessary in addition. If Mom is diagnosed with gestational diabetes, it will be necessary to monitor the level of glucose in her blood closely for the balance of the pregnancy, assuring that levels are staying in the normal range.
The more informed you are, the better prepared you will be to make decisions regarding your health and the health of your baby. For more information on these and other tests during pregnancy, speak with your health provider. Also, look for more information contained in the Informed Consent Agreement provided by your health professional. Knowledge is power.
Valerie Jacques is a NH Certified Midwife, a Certified Professional Midwife, an RN, and the owner/operator of Coastal Family Birth Retreat in Stratham, NH. She can be reached at 603-502-9452, or at www.coastalfamilybirthretreat.com.
Friday, October 10, 2008
Optional Testing During Pregnancy
Optional Testing During Pregnancy
Group Beta Streptococcus
By Valerie Jacques, RN, CPM, NHCM
This is the first in a series of articles exploring testing procedures available for you and your baby during pregnancy.
There are many decisions to be made when you become pregnant; one of the most important is the continued health of your baby. This article (and others to follow) will help explain the various testing procedures, when a particular test should be run (if at all), and what the benefits and drawbacks are.
Group Beta Streptococcus (GBS) is a common strain of bacteria found in about 4 out of 10 adults. Ordinarily, GBS does not cause a problem; in fact it is considered a normal organism. However, it does cause a potential problem for pregnant women. It is possible to pass the GBS organism from Mom to baby during birth, and it can be fatal in itself to your newborn (5%-15% fatality rate despite antibiotic treatment). Sepsis, serious infection throughout your baby’s body (also referred to as GBS disease) is the culprit. GBS can also be the cause of other potential life-threatening trauma such as pneumonia and meningitis. Permanent neurological damage to your newborn is also a possibility.
Babies who are most likely to develop GBS disease are born of mothers who are carriers of the GBS bacteria AND have one or more specific clinical risk factors. Those factors are: Previous baby with GBS disease, urinary tract infection during pregnancy (with GBS), onset of labor before 37 weeks, rupture of membranes before 37 weeks, rupture of membranes more than 18 hours before birth, and fever over 100.4 degrees Fahrenheit during labor. Other risks of GBS include: Urinary tract infection (Mom), and pre term labor.
GBS resides in the vaginal and/or rectal areas, and is tested for by a simple swab at or about 36 weeks of pregnancy. This is the best time in the pregnancy to get the most accurate prediction of whether or not Mom is a carrier of GBS. However, GBS can be erratic, appearing and disappearing without treatment. If the test is positive, relatively simple protocols of herbs, oral antibiotics, or intravenous antibiotics administered during labor are available.
But not all interested parties agree on who should be tested or if antibiotics should be administered. Some (the Group B Strep Association, for example) advocate universal testing for all pregnant women and antibiotic treatment for those who test positive for GBS. Others (The Centers for Disease Control and others) recommend one of two strategies: (1) universal testing followed by antibiotics for those testing positive, or (2) no universal testing but antibiotics for those with clinical risk factors (paragraph 3).
So why not test all Moms to be, and administer antibiotics to those who test positive, and be done with it? Because, of those Moms testing positive for GBS, about 95% of their babies would not get GBS even if not treated….and there are risks to administering antibiotics. Risks include: allergic reactions (from mild to possibly fatal…1 in 10,000 for penicillin, even for those with no prior known allergy to penicillin) and the fact that wide spread use of antibiotics can increase the chance that drug resistant strains of an organism will develop. Furthermore, even if Mom’s allergic reaction is not severe, dangerous complications sometimes resulting in permanent disability can occur in the baby.
So, here are your current choices (1) GBS culture and antibiotics during labor if positive for GBS (2) No GBS culture and antibiotics during labor if you have clinical risk factors (3) GBS culture and antibiotics during labor if positive AND you have clinical risk factors (4) No GBS culture and alternative or no treatment.
If you birth your baby at home or in a birth center, your midwives will review signs of infection that you should watch for in your baby. If any signs begin to occur, you or your midwife will need to contact your pre-arranged physician. Regardless of whether you had a GBS culture, or what the results were, if your baby shows signs of infection, the baby’s doctor will probably recommend lab studies and antibiotic treatment for your baby in the hospital.
If your baby is delivered in a hospital, treatment depends on whether you had a previous GBS culture, what the results were, and if you have any clinical risk factors. If your baby shows any signs of infection (as above), lab studies and treatment will likely follow.
If you had a positive GBS culture and received antibiotics for at least 4 hours during labor… with no signs of infection (in your baby) and no clinical risk factors, standard protocol in many hospitals is to perform a blood culture on your baby and observe for signs of infection for 48 hours (in hospital). Antibiotics will not usually be given to your baby unless symptoms occur.
If you had a positive GBS culture and received antibiotics for less than 4 hours during labor (or no antibiotics at all)… protocol in many hospitals is to perform a blood culture on your baby, and begin antibiotics immediately. If the culture comes back negative, the antibiotics are stopped and your baby is discharged.
If you had a negative GBS culture… there will be no prolonged observation, and your baby will usually be discharged when you are.
Knowledge is power. The more informed you are, the better prepared you will be to make decisions regarding your health and the health of your baby. For more information on these and other tests during pregnancy, speak with your health provider. Also, look for more information contained in the Informed Consent Agreement provided by your health professional.
Valerie Jacques is a NH Certified Midwife, a Certified Professional Midwife, an RN, and the owner/operator of Coastal Family Birth Retreat in Stratham, NH. She can be reached at 603-502-9452, or at www.coastalfamilybirthretreat.com.
Group Beta Streptococcus
By Valerie Jacques, RN, CPM, NHCM
This is the first in a series of articles exploring testing procedures available for you and your baby during pregnancy.
There are many decisions to be made when you become pregnant; one of the most important is the continued health of your baby. This article (and others to follow) will help explain the various testing procedures, when a particular test should be run (if at all), and what the benefits and drawbacks are.
Group Beta Streptococcus (GBS) is a common strain of bacteria found in about 4 out of 10 adults. Ordinarily, GBS does not cause a problem; in fact it is considered a normal organism. However, it does cause a potential problem for pregnant women. It is possible to pass the GBS organism from Mom to baby during birth, and it can be fatal in itself to your newborn (5%-15% fatality rate despite antibiotic treatment). Sepsis, serious infection throughout your baby’s body (also referred to as GBS disease) is the culprit. GBS can also be the cause of other potential life-threatening trauma such as pneumonia and meningitis. Permanent neurological damage to your newborn is also a possibility.
Babies who are most likely to develop GBS disease are born of mothers who are carriers of the GBS bacteria AND have one or more specific clinical risk factors. Those factors are: Previous baby with GBS disease, urinary tract infection during pregnancy (with GBS), onset of labor before 37 weeks, rupture of membranes before 37 weeks, rupture of membranes more than 18 hours before birth, and fever over 100.4 degrees Fahrenheit during labor. Other risks of GBS include: Urinary tract infection (Mom), and pre term labor.
GBS resides in the vaginal and/or rectal areas, and is tested for by a simple swab at or about 36 weeks of pregnancy. This is the best time in the pregnancy to get the most accurate prediction of whether or not Mom is a carrier of GBS. However, GBS can be erratic, appearing and disappearing without treatment. If the test is positive, relatively simple protocols of herbs, oral antibiotics, or intravenous antibiotics administered during labor are available.
But not all interested parties agree on who should be tested or if antibiotics should be administered. Some (the Group B Strep Association, for example) advocate universal testing for all pregnant women and antibiotic treatment for those who test positive for GBS. Others (The Centers for Disease Control and others) recommend one of two strategies: (1) universal testing followed by antibiotics for those testing positive, or (2) no universal testing but antibiotics for those with clinical risk factors (paragraph 3).
So why not test all Moms to be, and administer antibiotics to those who test positive, and be done with it? Because, of those Moms testing positive for GBS, about 95% of their babies would not get GBS even if not treated….and there are risks to administering antibiotics. Risks include: allergic reactions (from mild to possibly fatal…1 in 10,000 for penicillin, even for those with no prior known allergy to penicillin) and the fact that wide spread use of antibiotics can increase the chance that drug resistant strains of an organism will develop. Furthermore, even if Mom’s allergic reaction is not severe, dangerous complications sometimes resulting in permanent disability can occur in the baby.
So, here are your current choices (1) GBS culture and antibiotics during labor if positive for GBS (2) No GBS culture and antibiotics during labor if you have clinical risk factors (3) GBS culture and antibiotics during labor if positive AND you have clinical risk factors (4) No GBS culture and alternative or no treatment.
If you birth your baby at home or in a birth center, your midwives will review signs of infection that you should watch for in your baby. If any signs begin to occur, you or your midwife will need to contact your pre-arranged physician. Regardless of whether you had a GBS culture, or what the results were, if your baby shows signs of infection, the baby’s doctor will probably recommend lab studies and antibiotic treatment for your baby in the hospital.
If your baby is delivered in a hospital, treatment depends on whether you had a previous GBS culture, what the results were, and if you have any clinical risk factors. If your baby shows any signs of infection (as above), lab studies and treatment will likely follow.
If you had a positive GBS culture and received antibiotics for at least 4 hours during labor… with no signs of infection (in your baby) and no clinical risk factors, standard protocol in many hospitals is to perform a blood culture on your baby and observe for signs of infection for 48 hours (in hospital). Antibiotics will not usually be given to your baby unless symptoms occur.
If you had a positive GBS culture and received antibiotics for less than 4 hours during labor (or no antibiotics at all)… protocol in many hospitals is to perform a blood culture on your baby, and begin antibiotics immediately. If the culture comes back negative, the antibiotics are stopped and your baby is discharged.
If you had a negative GBS culture… there will be no prolonged observation, and your baby will usually be discharged when you are.
Knowledge is power. The more informed you are, the better prepared you will be to make decisions regarding your health and the health of your baby. For more information on these and other tests during pregnancy, speak with your health provider. Also, look for more information contained in the Informed Consent Agreement provided by your health professional.
Valerie Jacques is a NH Certified Midwife, a Certified Professional Midwife, an RN, and the owner/operator of Coastal Family Birth Retreat in Stratham, NH. She can be reached at 603-502-9452, or at www.coastalfamilybirthretreat.com.
Sunday, October 5, 2008
Nuchal Translucency Screening.... Optional Testing During Pregnancy
Nuchal Translucency Screening …
Optional Testing During Pregnancy
By Valerie Jacques, RN, CPM, NHCM
This is the seventh in a series of articles exploring testing procedures available for you and your baby during pregnancy
This test, also called the Nuchal Fold Scan, is a prenatal screening test designed to help your healthcare professional access your baby’s risk for chromosomal abnormalities such as Down Syndrome. The test can also be used to detect major congenital heart problems. Testing must be performed when you are between 11 and 14 weeks pregnant (if you want the test performed, the last day that you can have it done is the day you turn 13 weeks and 6 days).
Nuchal Translucency Screening is painless, and poses no risk to you or your baby. However, it does not provide definitive diagnostic data, but is much less invasive than other tests such as CVS (testing a sample of Mom’s chorionic villi cells from her placenta), or amniocentesis (testing a sample of Mom’s amniotic fluid), and it can help you to decide if you want to have additional testing performed.
Ultrasound is used to measure the translucent space in the tissue at the back of your baby’s neck… that measurement is the key to determining risk. Babies with more fluid in the translucent space described above (during the first trimester), cause this space to be larger, indicating potential problems. Babies accumulating more fluid at the back of their neck during the first trimester are more likely to have abnormalities, although this test is not conclusive.
To begin the test, the sonographer confirms your baby’s gestational age. This is done by measuring the length of your baby from head to rump and comparing the measurement to standard data to determine if he/she is about the right size for his/her age. Next, a sensor (transducer) is positioned over Mom’s abdomen so that baby’s nuchal fold area shows up on the monitor. Finally, the sonographer uses a caliper (measuring device) to measure the thickness of the space in the fold.
Your baby’s nuchal fold measurement (which normally gets thicker every day) will be used in a formula (which includes your baby’s gestational age and your age) to determine your baby’s chances of having a chromosomal abnormality. Previous data gathered from this test (from thousands of babies) have allowed researchers to build a statistical database, which makes this possible. In general, the thicker the nuchal fold measurement at a given gestational age, the higher chance for chromosomal problems.
Knowledge is power! The more informed you are, the better prepared you will be to make decisions regarding your health and the health of your baby. For more information on these and other tests during pregnancy, speak with your health provider. Also, look for more information contained in the Informed Consent Agreement provided by your health professional.
Valerie Jacques is a NH Certified Midwife, a Certified Professional Midwife, an RN, and the owner/operator of Coastal Family Birth Retreat in Stratham, NH. She can be reached at 603-502-9452, or at http://www.coastalfamilybirthretreat.com/.
Optional Testing During Pregnancy
By Valerie Jacques, RN, CPM, NHCM
This is the seventh in a series of articles exploring testing procedures available for you and your baby during pregnancy
This test, also called the Nuchal Fold Scan, is a prenatal screening test designed to help your healthcare professional access your baby’s risk for chromosomal abnormalities such as Down Syndrome. The test can also be used to detect major congenital heart problems. Testing must be performed when you are between 11 and 14 weeks pregnant (if you want the test performed, the last day that you can have it done is the day you turn 13 weeks and 6 days).
Nuchal Translucency Screening is painless, and poses no risk to you or your baby. However, it does not provide definitive diagnostic data, but is much less invasive than other tests such as CVS (testing a sample of Mom’s chorionic villi cells from her placenta), or amniocentesis (testing a sample of Mom’s amniotic fluid), and it can help you to decide if you want to have additional testing performed.
Ultrasound is used to measure the translucent space in the tissue at the back of your baby’s neck… that measurement is the key to determining risk. Babies with more fluid in the translucent space described above (during the first trimester), cause this space to be larger, indicating potential problems. Babies accumulating more fluid at the back of their neck during the first trimester are more likely to have abnormalities, although this test is not conclusive.
To begin the test, the sonographer confirms your baby’s gestational age. This is done by measuring the length of your baby from head to rump and comparing the measurement to standard data to determine if he/she is about the right size for his/her age. Next, a sensor (transducer) is positioned over Mom’s abdomen so that baby’s nuchal fold area shows up on the monitor. Finally, the sonographer uses a caliper (measuring device) to measure the thickness of the space in the fold.
Your baby’s nuchal fold measurement (which normally gets thicker every day) will be used in a formula (which includes your baby’s gestational age and your age) to determine your baby’s chances of having a chromosomal abnormality. Previous data gathered from this test (from thousands of babies) have allowed researchers to build a statistical database, which makes this possible. In general, the thicker the nuchal fold measurement at a given gestational age, the higher chance for chromosomal problems.
Knowledge is power! The more informed you are, the better prepared you will be to make decisions regarding your health and the health of your baby. For more information on these and other tests during pregnancy, speak with your health provider. Also, look for more information contained in the Informed Consent Agreement provided by your health professional.
Valerie Jacques is a NH Certified Midwife, a Certified Professional Midwife, an RN, and the owner/operator of Coastal Family Birth Retreat in Stratham, NH. She can be reached at 603-502-9452, or at http://www.coastalfamilybirthretreat.com/.
Subscribe to:
Posts (Atom)
