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

Preventing Pertussis or “Whooping Cough” in the newborn.

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Pertussis, also called “Whooping Cough” is a bacterial infection that you or your baby can catch when an infected person coughs or sneezes.  Infected droplets can travel through the air, and if you inhale the droplets you can become infected with pertussis.  Whooping cough begins like a cold, with a mild fever and runny nose.  Most adults do not have severe symptoms, but they can pass pertussis on to a newborn very easily without realizing it.

Whooping cough is especially dangerous for a newborn because their immune system is not fully mature and they cannot fight this infection.  Babies cannot get the vaccine for pertussis until they are two months old.  Even after they start the vaccinations, they are not fully protected by the vaccines until they are a year old and have had three vaccinations for pertussis.  Whooping cough in a newborn is a very serious illness, and it often requires that the baby be admitted to the hospital for breathing problems or pneumonia.  Some babies who get whooping cough do not cough at all – they just stop breathing.  Newborns can die from whooping cough.

The entire family can help protect your newborn from whooping cough.  All teenagers and adults who are around your baby should get a pertussis booster, called Tdap.  The Tdap shot is a tetanus vaccine that includes pertussis.  If you are pregnant, the best time to get the Tdap vaccine is between 27-36 weeks of pregnancy.  Your body will have time to make antibodies against pertussis.  These antibodies are passed through the placenta to protect your baby.  You can protect your baby with antibodies long before your baby is old enough to get the pertussis vaccine.  After the baby is born, the antibodies are passed through your breast milk.

For more information:  http://www.cdc.gov/features/pertussis

-Kirstin Johnson, Certified Nurse Midwife

The Force (for health) Awakens!

May the force be with you this winter, here are some great tips on staying healthy from our Jedi Knights on the dental team and our fun loving Darth Moorman. Be sure that these are not “a trap” and this is the advice “you’re looking for” this holiday season.

CHAS_KidsNews_Dec2015_DocTalk_PRINT1

-Written by Darth Moorman and team

BE A CHAMPION! PLEASE IMMUNIZE!

Community Health Association of Spokane Valley Clinic

It is National Vaccine Awareness Month and that means… it’s time to talk about immunizations.

I will keep this short and sweet as we want to stay focused. Please come in and talk to a provider at any time if you have any questions or concerns about vaccination so we can discuss why they are safe and so important for you, your family and your community.

 

  1. Starting in September CHAS will have flu shots available for anyone who comes to any of our clinics. We will be here and ready to go to help keep you healthy thus If you have an appointment prior to the start of September you can come back in at anytime for a nurse visit to get your annual flu vaccination. If you are wondering “Do I need a flu shot” this post from a nurse who questioned her need for the vaccine while pregnant  may be just for you. http://www.voicesforvaccines.org/nurses-vaccinate-to-protect-families-and-patients/

 

  1. Please ask our medical staff at every visit if you need any vaccines. We should check every time you come in so we take every opportunity to keep you protected and healthy. If you don’t ask, who will? One question and 30 seconds of your time could save your life or the life of someone you love.

 

  1. For Teens- In 2014, nationally, 4 out of 10 teen girls and 6 out of 10 teen boys had not even started the HPV vaccine (Gardisil) series making them vulnerable to cancers caused by HPV. Your teenager also needs to shots to protect them from meningitis and a TDaP to protect them from tetanus and Pertussis (whooping cough). Please start asking about HPV and if your teen starts this vaccine series, please remind them to finish it.

 

  1. Be a Champion! This month, I encourage everyone to be a champion for vaccine Please look up just one vaccine, any one of your choice and become passionate about it for your community. Be familiar with the results of getting such an infection and how not getting immunized can impact your community. Please go to http://www.immunize.org/vaccines/ this site will give you discussion points about each illness, pictures of what the illness looks like, and tons of resources to access so you can learn everything you need to know about vaccination. Let’s work together to make our community as safe as it can be. Please look at this resource  http://www.voicesforvaccines.org/ too as it helps you see each illness through the eyes of families and individuals affected by each preventable illness.

Love Them. Protect Them. Immunize Them.

Community Health Association of Spokane Valley Clinic With it being National Infant Immunization Week (NIIW), it is a great time to make sure we are promoting, encouraging, educating and reminding parents to have their children immunized. If infants are not immunized the consequences can be severe and in some cases the preventable diseases can even be fatal. It’s easy for us to believe that these preventable diseases are a thing of the past but, as we have seen with the recent cases of measles and pertussis in our community, these diseases still exist.

CHAS offers immunizations through the Vaccines for Children’s program. The program is federally funded and provides vaccinations for children through the age of 18 at no cost.

Infant immunization protects from vaccine-preventable diseases throughout their life and offers protection against the 14 diseases below:

Hepatitis A – A virus that causes liver infection.

Hepatitis B – A virus that causes liver infection. In some cases, Hepatitis B remains in the liver for life and can lead to further complications including liver cancer.

Diphtheria– A potentially fatal condition in which the airways can become blocked, restricting breathing. Also associated with heart problems and paralysis of throat muscles needed for swallowing.

Hib Disease (Haemophilus Influenzae Type b) – A serious disease which can cause meningitis and pneumonia.

Pertussis (whooping cough) – A potentially fatal bacteria that is very contagious with symptoms including persistent violent coughing and choking which can last for weeks. It is particularly worrisome in infants and young children.

Pneumococcal Disease – A potentially fatal bacterial infection which can cause pneumonia.

Polio – A viral infection with possible symptoms of fever, pain, sore throat, head ache and in some cases paralysis and death.

Influenza (flu) – A bacteria that can cause respiratory complications and can result in hospitalization or death. Infants, young children, pregnant women, and the elderly are at higher risk of complications related to influenza.

Measles -A potentially fatal disease caused by a virus whose symptoms include cough, fever and rash. In severe cases, measles can cause brain damage, pneumonia, and seizures.

Mumps – A virus that causes headaches, fever, pain and swelling in the salivary glands.

Rotavirus – A virus that causes severe diarrhea and vomiting which usually lasts days. Complications can include severe dehydration and possible hospitalization.

Rubella (German Measles) – A virus with of fever, rash and swollen glands. A pregnant woman with rubella is at greater risk of miscarriage and her baby may have physical defects including loss of sight or hearing and heart problems.

Tetanus (Lockjaw) – A condition caused by bacteria, which affects the muscles, causing them to spasm. A person may experience headaches, increased blood pressure, elevated body temperature and muscle pain. The jaw muscles may spasm causing the jaw to ‘lock’.

Varicella (Chickenpox) – A highly contagious virus whose symptoms cause blister-like rash, sever itching, fever. Can cause severe complications that can lead to hospitalization.

So let’s do our part in making sure that parents and caregivers are educated on the importance of vaccinating and protecting their children against vaccine-preventable diseases.

References:

www.cdc.gov

www.immunize.org

 

-By Shereen Martin, Medical Support Supervisor

Back to School Time!

Well its back to school time and that means getting your kids ready for the next school year. Im also sure as a parent you are thinking about the well being of your child over this next year and  ways to keep them healthy and active. One way to do this is to encourage physical activity and playing school sports or extra curricular sports activites. Please remember that schools need a Sports form filled out yearly so they can ensure that your child is healthy enough to participate. We can do this at their yearly physical or we can see them for a sports physical to get them playing right away.The difference in the two checkups is we have more time to discuss other health concerns or even old medical concerns at a Well Child Checkup. Please schedule either checkup today if your child needs one.
Its also time to start thinking about Immunizations for the year as well. Influenza season is coming and we will be looking to get everyone immunized over the next several months. Please consider this immunization and call us to discuss if your child is up to date on all of their immunizations. Recent changes to vaccines and new guidelines are making it very important for your Medical provider to closely review the immunization records to ensure that you and your child are fully protected from vaccine preventable diseases. Please let us know how we can help you.

Dan Moorman, M.D.

Dramamine