Mmm, lunch. Actually it was pretty awesome.
WHAAAAAAAAAAAAAAAAAAAAAAT a week. What a month, really. What a past five months, even. Double-plus un-fun crappytimes.
Last week at a routine visit with the midwife I received the unwelcome news that I tested positive for gestational diabetes, which is the glorious cherry of suck on top of the stress cake that this whole pregnancy has been. I've given birth to two babies weighing over nine pounds, I myself weighed over nine at birth, and I'm obese, so this isn't anything shocking, but it does throw me into a slightly different mode of care than what I would prefer. BOO.
I'm not someone to nod and smile and follow directions under most circumstances, let alone when I've been given a medical label that means a pretty significant change in pregnancy management and delivery protocol, so I spent a couple of days poring over research articles trying to figure out what exactly I'm dealing with rather than be satisfied by the bullet points my healthcare practice has prepared.
I poked at the testing standards a bit, which vary significantly by region and medical body, and then took a look at the driving force behind a significant testing revision made in the last year by my healthcare organization: a huge, recently published study called the Hyperglycemia and Adverse Pregnancy Outcome (HAPO) Study. It was FASCINATING. No, really. I have a touch of nerd and I find this sort of thing unendingly compelling.
I'll let HAPO speak to the salient point here:
One of the most critical observations of the HAPO Study was that the associations of various adverse outcomes with OGTT (Oral Glucose Tolerance Test) results were continuous, and no clear inflection points could be identified. The relationships held even down to the most “normal” maternal glucose levels. This led to two conclusions: (1) the relationship between maternal glucose levels and fetal growth and fetal outcome appears to be a basic biological phenomenon, and not a clearly demarcated disease state; (2) the construction of diagnostic criteria for a condition called “gestational diabetes” was not going to be easily accomplished directly from the configuration of significant associations between maternal glycemia and outcomes.
Now, you might ask, what is the big goddamn deal with being labeled with a disease? Suck it up, buttercup!
My problem lies in the ways that this body state is often treated. What is actually going on here is a very clear continuum, with specific risks (the biggest one they identify is having a huge baby; I've done that twice already with no trouble) rising in perfect linear fashion at each level of insulin reactivity; picking a cut off and calling it "gestational diabetes" is arbitrary.
The higher your blood sugars go, even within the lowest end of the normal range, the greater your chances of encountering a handful of moderately shitty situations: having a huge baby, having a first c-section, having a baby with low blood sugar, and having a baby that has excess insulin in the blood. At the very highest end of maternal glucose intolerance, these complications hit about 25% of women and babies, and about 5% at the very lowest. Big difference? Sure. Should I follow the protocol of care and eat an appropriate diet and monitor my blood sugar to make sure I don't trip on up into a place where my baby is swimming in toxic sugars? Hell yes.
But I was aware from the get-go that slapping on that GD label brings with it certain risks of its own, such as induction of labor (with no attendant reduction in perinatal complications), admitting the infant to the nursery, supplementing the infant, and performing prophylactic surgical births (again, not a practice supported by the research). As someone who intends to exclusively breastfeed, and who has had the rewarding experience of quick recoveries from healthy vaginal births, I feel defensive on those scores.
Thank HAPO, I have found myself a nice patch of ground to stand on. I feel very much comforted that this isn't an actual disease, it's falling on the wrong side of a line drawn in the sands of odds ratios. Unless alarming biometric data suddenly show up, I have every right to a low-intervention labor and delivery.
As an obese woman who has figured out a thing or fifty about nutrition and what makes my body really, really sad and what makes it happy (and no, this has not suddenly resulted in magazine-cover-worthy weight loss, thanks for asking), the idea that sugar is not my friend, particularly in a shifted and shifting hormonal state, is not even remotely shocking. I've said all along that I intend to do what I reasonably can nutritionally to aim for a trim-ish third baby; now I just get to do it with the obnoxious aid of four-times-daily finger pricks and the likely somewhat dubious advice of a dietician.
Annoying? Oh my, yes. IS THE SKY FALLING? God no.
Another unexpected silver lining: I had an amazing conversation with my oldest about the gestational diabetes situation, which segued into talk about nutrition, disease risk, fat bodies and thin bodies, movement, and social stigma. That's a whole 'nother post, though. Suffice to say she's a down kid, that one. Even if she did at one point say something like "You're my fat mama and I like that you're squishy."