Gestational diabetes is a temporary form of diabetes that is diagnosed in the later half of pregnancy. It is thought to result from the hormones made by the placenta blocking the action of the birthing parent’s insulin in their body. Since they aren’t using insulin as effectively, the sugar builds up in their bloodstream.
We require a screening for gestational diabetes between 26 and 28 weeks. Usually, this test must be scheduled at the lab, and isn’t a walk-in test. The test is safe and simple. First, you drink a liquid that has sugar in it. Next, samples of your blood are taken. The glucose level is measured. If the level is high, more tests are done to find out if you have diabetes.
Your chances of having gestational diabetes are small. Babies born to undiagnosed and uncontrolled gestational diabetics are usually very large, and may have health problems. These babies have a higher risk of birth injury, respiratory problems at birth as well as problems controlling their own blood sugar levels. In addition, as they grow they are at increased risk for obesity and type 2 diabetes.
By diagnosing the gestational diabetes early, adhering to a special diet, and monitoring carefully, those with gestational diabetes can have a healthy baby and a normal delivery. Gestational diabetes does not always recur in subsequent pregnancies. However, 60% of gestational diabetics do develop glucose intolerance (adult onset diabetes) in the future.
People who have gestational diabetes that is controlled with diet and exercise alone do not risk out of the birth center. If oral medication is required, the midwives can care for the birthing parent at Magee.
IN THE EVENT THAT THE ONE HOUR GLUCOSE SCREEN IS HIGH, AND THE THREE HOUR TEST IS ORDERED…
Remember, if we call you and ask you to make an appointment with your lab for the 3-hour glucose tolerance test you have an 85% chance of NOT having gestational diabetes. Before taking the 3-hour test please read the following instructions:
1. No eating or drinking for a minimum of 8 hours before the test.
2. Bring a book and try to arrange childcare since the test lasts three hours.
3. Please do not eat, drink or chew gum during the test. The lab will draw a fasting sample, give you a bottle of glucose solution to drink, and then draw your blood at one, two and three hours.
4. Bring something to eat and drink as soon as the test is completed.
5. If you are unable to complete the test due to vomiting, please call The Midwife Center to discuss.
What is GBS?
GBS is a very common bacteria which is related to the bacteria that causes strep throat. Approximately 30% of people with vaginas carry GBS in their bodies at any given time. It is a normal GI colonizer. It is a transient bacteria, which means that it is present at some times and not others. However, some people always have it and some never do. It does not cause illness in a healthy pregnant person, unless the bacteria count is so high that it concentrates in their urine and causes a urinary tract infection.
Although this bacteria typically does not cause illness for healthy adults, it can be quite dangerous for a newborn to be exposed at birth. Medical understanding of GBS is growing, so opinions on the best way to treat people carrying GBS change frequently. This information is intended to give you the most current information about GBS so you can make an informed decision about testing and treatment. Understand that as knowledge about GBS grows, recommendations and treatment are certain to change.
What are the effects of GBS Disease?
Although so many people with a vagina carry GBS, the bacteria only affect 1 to 3 out of every 2,000 babies. About 80% of these babies develop early-onset disease. Early onset disease usually starts within 12 hours from birth. These babies usually develop pneumonia and sepsis (an infection in the blood). Between 6-20% of these babies will die. Babies with early-onset disease must usually spend at least 10 days in the hospital after birth to receive testing and intravenous antibiotics.
Late-onset disease begins after the baby is a week old. Babies with late-onset disease usually develop meningitis (an infection of the lining of the nerves), and 5 -15% die.
GBS can also sometimes cause a symptomatic illness for the postpartum birther, especially bladder infections and infections of the incision after a cesarean birth.
Are certain babies at greater risk from GBS disease?
There are groups of babies at greater risk of developing GBS disease. These include babies born before 37 weeks gestation. Gestational risk factors include having ruptured membranes for more than 18 hours before birth, having GBS in the pregnant person’s urine (this indicates a heavy level of bacteria), developing a fever or signs of infection while in labor, and having had a previous baby affected with GBS disease.
How do you test for GBS?
Sometimes the routine urine tests done on pregnant people will pick up GBS. It can be enough bacteria to cause a UTI, but most often just its presence is detected. If the urine test in the first trimester does not detect GBS, pregnant people will be tested at 35-37 weeks of pregnancy. This is done by a culture. A sterile cotton swab is inserted into the vagina and swabbed around once in a circle. It is then inserted through the rectum (no worries, it’s a small swab). You can do the swab yourself in the bathroom. The swab is then sent to the lab to see if GBS can be grown from it. If any GBS grows, the test is considered positive.
If I am positive for GBS, what is the treatment?
Studies so far have not found that treating pregnant people for GBS before they go into labor is effective. When they are treated with antibiotics during the pregnancy for GBS, two out of three pregnant people still test positive for GBS when they are in labor.
The more effective treatment is to treat with antibiotics during labor with intravenous (IV) antibiotics. This treatment is recommended for all those who test positive for GBS. This treatment greatly decreases but does not eliminate risk to the baby from GBS. The treatment can be administered in either the birth center or the hospital. Ideally, the birthing person will receive antibiotics at least four hours before the birth.
If the the birthing person receives two doses of antibiotics, they are considered “adequately treated.” If two doses are received, the couplet may be discharged at 4-6 hours. If one dose of antibiotics is received, or if the birth occurs prior to getting any doses, we recommend a 12- hour postpartum stay at The Midwife Center. As explained previously, the vast majority of babies who get early-onset disease show signs in the first 12 hours. The CDC recommends that all babies whose birthing parents carry GBS be observed for 48 hours after birth. This can be accomplished by home nursing visits.
During pregnancy, you will have a blood test to find out your blood type and whether your blood has the Rh factor. If your blood lacks the Rh factor, it is called Rh negative. If it has the Rh factor, it is called Rh positive. More people are Rh positive. Problems can arise when the fetus's blood has the Rh factor and the pregnant person's blood does not. These problems can be prevented with early treatment.
If during the course of pregnancy or birth some of the baby’s Rh positive blood enters the pregnant person’s blood stream, the pregnant person’s immune system may form antibodies to eliminate these foreign (baby’s) blood cells. This process is called isoimmunization. Antibodies can then cross the placenta from the pregnant person to baby and begin to attack the baby’s blood cells while the pregnancy continues. The baby will be mildly to severely affected depending on how many blood cells are lost. If isoimmunization occurs at birth, the next baby will be affected.
The virtual elimination of Rh hemolytic disease of the newborn has been possible since the development of Rh-immune globulin (often called RhoGam). Giving RhoGam to the unsensitized person with uterus prevents their body from forming antibodies to Rh positive blood. In the uncomplicated pregnancy, two injections of RhoGam are given, one at approximately 28 weeks gestation, and the second within 72 hours after delivery if the baby is found to be Rh positive. This protects the person with uterus from developing antibodies during pregnancy and birth, increasing protection for the next pregnancy. Less the 1% of those treated with RhoGam develop antibodies.