Gestational Diabetes: Do I HAVE to drink that?

 

Short Answer:  Yes.

Long Answer:  You actually don’t HAVE to do anything you don’t want to do.  We won’t MAKE you do anything you don’t want to do.  This concept supports your autonomy as a patient.

However, you trust us to be the lifeguard of your pregnancy.  Throughout your pregnancy, we will monitor your blood work, vital signs, and the baby’s growth and development by using ultrasound, drawing your blood, listening to your baby’s heartbeat, and measuring the size of the uterus.  Trust us when we say that the second trimester glucose screen is very important to the health of both you and your baby.  We might even recommend it earlier in the first trimester if we are concerned about impaired glucose tolerance.

One complication of pregnancy that we screen for and treat is called gestational diabetes.  Gestational diabetes can occur in women of any size, even without a personal history of family history of diabetes.  Insulin is a hormone produced by the pancreas, and the body uses insulin to help transport blood glucose (sugar) from the bloodstream into the cells of the body.  The hormones of pregnancy can cause you to be resistant to insulin.  If you become resistant to insulin, your blood glucose levels become elevated and the glucose easily transports across the placenta to your baby.  This can cause the baby to grow very large, and at the same time it impairs the development of the baby’s lungs.  You can end up with a very large baby who, at the same time, has very immature lungs and needs help breathing after birth.

Maternal Complications of Gestational Diabetes:

  • You have a 70% chance of developing Type 2 Diabetes within 10 years
  • You are at a higher risk of high blood pressure or preeclampsia in pregnancy
  • You might require medication to help manage your blood glucose
  • You are at higher risk of miscarriage or stillbirth

 

Fetal Complications of Gestational Diabetes:

  • Your baby can grow very large
  • Your baby might experience a shoulder dystocia at delivery, which is an emergency situation where the head delivers but the large body is stuck behind your pelvic bones.  We might have to break the baby’s collar bone to help your baby deliver.
  • Your baby might require assistance breathing at delivery or in the first few days
  • Your baby might need to be observed or treated in the special care nursery for low blood glucose.

What happens if your one hour glucose screen comes back elevated? 

We will ask you to take a three hour glucose screen.  If the three hour glucose screen comes back elevated, you will have the diagnosis of Gestational Diabetes.  At that time, we will send you for a consultation with a Maternal Fetal Medicine physician called a Perinatologist.  These physicians are specially trained in high-risk pregnancy and obstetric ultrasound.  They can help us monitor the growth of your baby.  In addition, a diabetic educator will teach you how to test your blood glucose daily.  They will also teach you how to eat well to keep your blood glucose as stable as possible.  You will also be asked to increase your daily exercise, which will help your body be more sensitive to insulin and help you regular your blood glucose.

 

The glucose screen is usually done at the 24-28 week visit.  We ask that you eat normally that day, with good protein and not a heavy carbohydrate load.  Plan for the visit to take at least an hour because we have to draw your blood one hour after you finish drinking the liquid.  Pack a healthy snack with protein for the ride home.

 

So… yes.  Your midwives are aware that the glucose screen can cause nausea and discomfort.  You may not like the taste of the drink.  However, it is an important screening test that can help us provide the very best care for you and your baby.

 

For more information:

http://www.diabetes.org/diabetes-basics/gestational/

http://www2c.cdc.gov/podcasts/player.asp?f=11504&loc=WhatIsGestational

By: Kirsten Johnson | Certified Nurse Midwife

5 Things to know about open enrollment this year

  1. Open enrollment for the individual marketplace begins on November 1st, 2016 and ends on Jan 31st, 2017. During this time, consumers can select a new plan, renew their existing coverage, or change plans. It’s also a good time to review their application and report any changes in income or household size. The individual marketplaces for Washington and Idaho are the Washington Healthplanfinder (wahealthplanfinder.org) and Your Health Idaho (www.yourhealthidaho.org). Both sites are where individuals can purchase health plans and see if they qualify for free or low-cost health insurance. 
  2. At CHAS Health, all of our Patient Services Coordinators are available to help patients and community members to apply and enroll in Medicaid or Qualified Health Plans. Every CHAS Health PSC is a certified navigator in the Washington Healthplanfinder; the PSCs at Spokane Valley CHAS Health, Spokane Urgent Care – Valley, Lewis and Clark Health Center, and Latah Community Health are also certified Enrollment Counselors for Your Health Idaho. This means that they provide free, unbiased assistance to help consumers understand their options for health coverage to get covered and stay covered. To see a PSC, call 509.444.8200 to schedule an appointment or walk in to any CHAS Health location. For a list of information to bring with you to your appointment, click here. You don’t have to be a patient at CHAS to see one of our Patient Services Coordinators. We welcome everyone!raw
  3. New for 2017! WA Healthplanfinder is offering adult dental plans. One of the biggest disappointments for many Washington consumers over the last few years was the fact that the Qualified Health Plans offered on the WA Healthplanfinder did not provide dental coverage for adults. This year, adults will have the option to purchase an adult or family dental plan from Delta Dental, Dentegra, or Dental Health Services. An adult must purchase a health plan to also purchase a dental plan. Premium tax credits can only be applied to the health plan. Adult dental premiums range from approximately $19-$39 per month.
  4. Washington Healthplanfinder saw lower increases related to average premium and deductible increases from 2016 to 2017 than the national marketplace. Pat MacEwan, CEO of the Washington Health Benefit Exchange, said in a recent news release, “in contrast to much of the country, the Washington individual insurance market is competitive and healthy. Customers in Washington will find a choice of plans and carriers on the Exchange.” The amount of carriers offering health plans in the exchange has helped to create competition and keep prices low. While the national average for the second lowest cost silver plan increased 25%, Washington experienced an average increase of only 8%. Consumers in Washington will continue to have many affordable choices when it comes to choosing the health insurance that fits their individual needs. Read the full news release from Washington Health Benefit Exchange here.
  5. Enrollment in Medicaid programs is open all year, but ‘tis the season for WA Apple Health renewals! There are no open enrollment periods for Medicaid in Washington or Idaho so residents of either state can apply for Medicaid medical coverage at any time during the year. However, in Washington, many Apple Health (Medicaid) members will need to renew their coverage over the next few months. Apple Health renewals can be completed 1) online at wahealthplanfinder.org, 2) by calling WA Healthplanfinder Customer Support Center at 1-855-923-4633, 3) by paper, or 4) by seeing a certified navigator in the community. At CHAS, our Patient Service Coordinators are ready to help you with your Apple Health renewals. To see a PSC at CHAS, call 509-444-8200 to schedule an appointment or walk in to any CHAS Health location.

 

Happy Open Enrollment!

 

Julie Becker

Patient Services Administrator

 

Get covered. Stay Covered. Come see a CHAS Patient Services Coordinator today.