Miscarriage and GDM

So I started this blog with the best of intentions, namely to keep myself motivated in the long, long 9 (10) months of pregnancy as a GDM mom. Not long after I posted my introduction, I miscarried.

We were at 9 weeks, had heard our Peanut's heartbeat, and were devastated. Even though the pregnancy was a bit of a surprise that required some financial finagling, we were going to be welcoming baby #2 by Christmas, and were hesitantly excited.

I couldn't really touch this blog until now. I didn't have anyting to say, really. But then I thought about the journey I have been on since I miscarried and I thought I should share.

A part of me was amazed at how quickly my blood sugars returned to normal afterwards. I kept testing for a few days after the official miscarriage began, and then sporadically until I had my next cycle. Normal, sometimes a tad high after we dined on "things-thou-shouldst-not-eat", but manageable, and not a cause for concern. I was concerned I had slipped into the Prediabetes or even Type 2 world, and was scared it was now going to be a full-time reality, not just a pregnant one.

I scheduled a visit with my doctor, of course, and he checked off every box on the bloodwork sheet when we discussed my overall health. He figured a physical might not be a bad idea to do, given we might find a problem, you never know. He checked B12 levels, since a deficiency in this vitamin can be risky in pregnancy. I think he also checked my iron and cholesterol levels to be sure. He tested me for PCOS (again), we did a random fasting bloodsugar, and did all kinds of hormone tests. Every test known to a doctor was done, I think, except for anything requiring my other bodily fluids I'd rather not mention here. Ew.

We discussed me, which I had expected. Yes, my weight needed to go lower, and my exercise level needed to be higher. Yes, I needed to keep going on eating better, as we had been doing since getting my test back high. He said to take someone with me to testing, since this was a lot of tests to take blood for, especially after fasting.

Whee! 7 vials of blood made the caffeine I put into my system afterwards very effective.

No red flags came up in the bloodwork, thankfully, and no mention of really high levels of fasting bloodsugar made my stress come down a notch or two on the "holycrapmylifeisover" meter. Likely, at my follow-up visit tomorrow, my awesome doctor will caution me that my levels were on the high end of normal, which they were last time we checked, but I was taking matters into my own hands with exercise and better eating already, and wasn't worried. Bring it on, man! *flex*

This whole thing got me thinking, though. Could my early diagnosis and high blood sugar levels have caused the miscarriage? When I was pregnant, I was scheduled to see the Diabetes doctor, but it was set for two weeks after I miscarried, so I was not able to get a perscription for insulin, and my sugars were getting harder to control each day. my levels were so wonky that I couldn't even look lovingly at a carb from across the table. A quarter cup of basmati rice was spiking me from a high 6 to a low 10! Not good. Not good at all.

I wondered - looking back at how difficult it was compared to my last pregnancy - if the lack of ability to control my bouncy blood sugar with diet was a contributing factor. So, with the thought of my GDM being a risk factor to miscarriage in the early days of pregnancy, I opened up the trusty Interwebs, and did some researching.

After looking through the Canadian Diabetes Association and the Public Health Agency of Canada, I found no convincing statistics that linked miscarriage to early onset GDM. It was mentioned, but each had conflicting stats, and thus, I couldn't verify anywhere else. Most mentioned that there was a risk, but identified more with type 2 Diabetes, rather than prediabetes, or GDM. In all cases, the percentage of risk was below 10%, and not a cause for major concern. Huh... ok, lets check some US sites.

US statistics and websites tended to be more fruitful. I did found a more concrete statement* while perusing the the WebMD network. The link to the page is here , with the following quoted from the section titled "Clinical":

Miscarriages

• In all women with preexisting diabetes mellitus, there is a 9-14% rate of miscarriage.
• Current data suggest a strong association between degree of glycemic control prior to pregnancy and miscarriage rate. Suboptimal glycemic control has been shown to double the miscarriage rate in women with diabetes. A correlation also exists between more advanced diabetes and miscarriage rates. Patients with long-standing (>10 y) and poorly controlled (glycohemoglobin exceeding 11%) diabetes have been shown to have a miscarriage rate of up to 44%. Conversely, reports demonstrate a normalization of miscarriage rate with excellent glycemic control.

I also found this statement on Healthsquare.com:

Illness

Miscarriages are much less common in the third trimester. Those that occur are more likely to be due to maternal factors, such as an illness in the mother, than to genetic abnormalities in the baby.

Women with poorly controlled diabetes are at great risk for miscarriage. Those whose diabetes is controlled, however, whether it existed before the pregnancy or developed after conception (gestational diabetes), are no more likely to lose a pregnancy than other women. A woman may not know that she has diabetes, however, until it is discovered during a search for the cause of repeated miscarriages. The routine blood and urine tests given during pregnancy are an effort to identify this problem while it still can be remedied.

Other diseases and conditions linked to increased risk of miscarriage include systemic lupus erythematosus (SLE, or lupus), high blood pressure, and certain infections, such as rubella (German measles), herpes simplex, and chlamydia. Experts disagree about the role of hypothyroidism, or an underactive thyroid gland, in miscarriage, but it's likely that a severe case increases the risk.

With conditions such as diabetes, treating or controlling the problem can improve the odds of a successful pregnancy. Special monitoring may also be required.

This was the first I read that my uncontrolled high levels might have contributed to the miscarriage. Should I feel guilty? Did I, because of my frustrating, unruly pancreas, cause my miscarriage?

I wasn't sure I wanted to put that heavy guilt burden on myself. I am no different than most women who go through miscarriage. You wonder if that bumpy carnival ride was to blame, or if the wand ultrasound technician-sadist who poked holes in your ovaries caused too much trauma, or the hot room yoga you were doing (before you knew you were preggo) made it happen. We look for causes, look for someone or something to blame other than simple nature and randomness of life.

I decided that no, I can't. Sometimes, it is what it is. We take the lesson and move forward, better prepared for the next curve ball. I think any pre-existing or high-risk condition in pregnancy can cause miscarriage, or other problems, it just depends on the individual, and their genetic makeup. Sometimes, even with best effort, things happen.

Next time, I will be better prepared to handle the onslaught of crazy my body will go through. Next time I will expect an early, if not immediate GDM problem, and act accordingly upon the positive pee-stick result. And because of my efforts to eat better and move more now, it might just be easier. I hope. We'll see.

* I can't verify all of this information, so please remember that when researching on the Internet, it is important to find several sources that say the same thing, are reputable, and reference other works themselves. Please take the statements quoted in this email with a grain of salt, and talk to your doctor about your concerns. He'sthe expert, not me.

I've got what?

"I've got what?" were the first words out of my mouth as I stood at the nurse's desk that day. I was pregnant, around 18 weeks in, and a nurse primly informed me I had Gestational Diabetes Mellitus. I suppose I had the deer-in-headlights look, because she started speaking to me as if I was twelve, and gently led me (and my apoplectic husband) to a chair in the waiting room and told to "wait for a nurse". Oi.

I had no idea the journey that simple statement would send me on. If I'd known, I would have... well, I have no idea what I would have done, but it likely involved chocolate.

What followed that whirlwind headache-inducing first briefing with a Diabetes nurse was a few weeks of fear, anxiety, frustration, and severe sugar cravings for Pineapple Dairy Queen sundaes. With the help of a Diabetes doctor, nurse, dietitian, high-risk nurse, experimental hubby-chef, Splenda and countless Internet searches, I did manage to tame the Diabetes beast, and had a beautiful healthy baby boy who, against all odds, was not eleventy-billion pounds and roly-poly.

I was blessed, and all my hard work had paid off. And let me tell you, it is hard work figuring out what you can eat, what you can't, when to test your sugars, how to give yourself needles, and having low blood sugar attacks when you are out for groceries, being forced to tear into a box of crackers because you forgot your glucose tablets. And on top of that, you have to figure it all out in less than nine months. Yikes!

Now that I am pregnant again, I knew I would have to go through the gauntlet of blood glucose testing, insulin, diet changes and low-carb bread that turns to packing styrofoam when toasted. I was quietly determined not to let the eventual diagnosis ruin a perfectly good barbeque season, or a trip to my favorite ice cream place (planned forthwith before my sugars could go all wacky, like last time). I was prepared, like any good Girl Scout, and took my glucose tester and insulin pens out of storage and gave them a good inspection, ready to go when we were told to go get test strips. I even put a lock on the drawer to keep them in, so that my curious toddler stayed safe. Go mama!

My diagnosis has come early this time, at 9 weeks gestation. It wasn't totally unexpected, based on my research that said if you had GDM in your last pregnancy, guess what, your odds are great you're gonna get it again. I wasn't prepared to deal with in first trimester. I have 31 weeks to go!

I'm not so afraid this time, more resigned to the fact I cannot have cinnamon buns, cream in my coffee, or Wonder bread peanut butter and banana sandwiches for awhile. I have formally relinquished my stash of Dove chocolate, and the jelly beans on my work desk got given away. I have said goodbye to Fettuccine Alfredo, fries, and yes, ice cream.

As I say to my husband, its not about me anymore, its the health of the wee teeny peanut down there that makes me cry if I listen to country music. It is my responsibility to ensure said Peanut can be born healthy. If that means I can't have Godiva truffles or Chicken Fried Rice, then so be it.

As I perused the Internet for low-carb recipes and poked around the iPhone App store for Glucose logs, I also looked for a way to share my experience with other moms who have gone through this battle with their own bodies. Not so much for information on "How-to-beat-GDM" but more of the life stories, the emotions, the hardships, the failed attempts at low-carb cookies, and coping strategies. I was at a low point when I searched, feeling alone in my struggle (with no chocolate to soothe me!), and I closed my FireFox sadly. I found a few personal blogs, but not many, and none that I could say were current.

Note: If you have a great GDM blog to recommend, please let me know!

Even though I felt alone, I know I am far from the only woman with GDM. According to the Canadian Diabetes Association, Gestational Diabetes affects approximately 2 to 4 per cent of all pregnancies in Canada (in the non-Aboriginal population). If you add in our Native Canadian population, that number skyrockets, since they are a spectrum of the population more susceptible to Diabetes and GDM. Source: http://www.diabetes.ca/about-diabetes/what/facts/.

So, since I am a blogger by nature, I decided maybe instead of searching for camaraderie in my journey, I should create a blog about my pregnancy with Gestational Diabetes! One where I can share the things that have worked for me, the down days, my own experiences, the funny things, the process. Maybe other moms would come to my blog and share their experiences if I did that.

So here I am. Here in this space, I am going to share my walk with Gestational Diabetes, my ups and downs, my favorite meals, recipes, cheats, funny stories, and maybe even research and news I come across. I hope that you, the Gestational Diabetic mom (or sister, brother, spouse of a GDM mom) reading this, will share your experience with me, and we can walk this journey together.

Thanks, and chat with you again soon!