Gestational Diabetes: Glossary of Terms

by KMom

Copyright 1998 KMom@Vireday.Com. All rights reserved.


DISCLAIMER: The information on this website is not intended and should not be construed as medical advice. Consult your health provider. This particular web section on gd is designed to present more than one view of a controversial subject, pro and con. It should be re-emphasized that nothing herein should be considered medical advice.

 

GLOSSARY

 

There are a number of complex medical terms in this FAQ and it is too cumbersome to define them each time they are used. Here are some common terms and their abbreviations.

 

 

ACOG - an abbreviation for the American College of Obstetricians and Gynecologists, the association that makes policy and protocol recommendations for handling pregnancy in the USA. A member of this association is known as a Fellow of ACOG and would have the initials FACOG after his/her name.

ADA - abbreviation for the American Diabetes Association, the association which makes policy and treatment recommendations for diabetes issues in the USA.

AGA - Appropriate for Gestational Age. This term is sometimes used when the baby is judged to be of about average size for its age, not bigger than most others its gestational age, and not smaller.

Amniocentesis - the practice of inserting a very long needle into the mother's uterus and withdrawing some amniotic fluid for analysis. In early pregnancy it is usually used to check for birth defects; in late pregnancy, it is usually used to check to see if the fetus' lungs are mature enough for delivery. This is of special concern to the gd mother, since lung maturity tends to develop a bit later in some gd babies. If the provider is contemplating delivering the baby before 39 or so weeks, an amnio must be done to be sure the baby will not have breathing problems.

Amniotomy - the artificial breaking of the amniotic sac of waters. Some use it as a method of induction; some use it in conjunction with pitocin to speed up labor. Increases the risk of prolapsed umbilical cord and infection and can make labor much harder and more intense. Amniotomy is often routine for many labors but its use has come under increased fire in the past few years and should be carefully considered before using. In some cases it is appropriate, but in others, it may increase the c-section rate or rate of birth trauma.

Augmentation - the practice of adding artificial labor hormones (tradename: pitocin) to speed up slow labors or labors that have stalled. If pitocin is used from the beginning (or some other method, such as amniotomy is used), it is called an 'induction'. If labor is started spontaneously and is slow, stalls, or does not proceed on the artificial timeline the doctor imposes, the labor is said to be 'augmented' with pitocin. Induction/augmentation is very common in the US.

bfing - a shorthand way of writing 'breastfeeding'; commonly used in many internet groups and sites.

bG - blood glucose or blood sugar levels. In the USA it is expressed as mg/dl; in the rest of the world it is expressed as mmol/L. To convert from mg/dl to mmol/L, divide by 18 (or multiply by .055). To convert from mmol/L to mg/dl, multiply by 18. For example, the usual cutoff for needing further testing after the 1-hour glucose challenge test is 140 mg/dl or 7.8 mmol/L.

Biophysical Profile - a detailed exam of the baby using ultrasound, in addition to the NST (non-stress test, see below).

Bishop Score - a scale used to evaluate the cervix's readiness ('ripeness') for labor. If the Bishop score is low (cervix is closed, hard, and posterior, for example), then an induction is not likely to result in a vaginal birth. If the Bishop score is favorable (cervix is partially effaced and dilated, is soft, etc.) then the induction attempt is more likely to succeed.

Body Mass Index (BMI) - Body Mass Index is a measure of relative heaviness/obesity. It is your weight in kg divided by your height in meters squared. A BMI under 20 is considered too thin; a BMI from about 21-25 is considered normal. A BMI between 25-29 is considered overweight, and a BMI over 30 is considered obese. Because it considers both weight and height, it is usually the measure most often used in research for referring to relative sizes.

Carbohydrates - one of the three types of foods that we eat (protein, fats, and carbs). Carbs provide quick to medium-acting energy but do not generally provide long-term energy. Carbs include simple carbs such as sugar, milk, and fruits; or complex carbs which include starches like breads and pastas.

Cephalopelvic Disproportion (CPD)- a baby that is 'too big' for the mother's pelvis. This is a catch-all phrase that doesn't have a lot of meaning; the baby's presentation and position usually has more to do with CPD than the actual size of the baby. An 8 lb. baby that is malpresenting, for example, is likely to get stuck, whereas a 9+ lb. baby that is perfectly positioned and where the mother gets to use optimal delivery positions is likely to come right out. Many women who are given a c-section for CPD and told that their pelvises are 'too small' actually go on to later deliver a baby vaginally that is much bigger. The presentation/lie of the baby, maternal positioning, and forcing labor unnaturally are the keys in many cases. True CPD can occur, but is usually seen in mothers who have had pelvic injury or disease, had rickets, or who were chronically malnourished as children, although it is possible occasionally in normal circumstances too. CPD is most often actually a case of cephalopelvic malpresentation or 'failure to wait' by the physician, but this is often overlooked as a cause.

Complex Carbs - a type of carbohydrate that is moderately converted into blood sugar; complex carbs include pasta, bread, and other starches. Simple carbs, on the other hand, are quickly converted into blood sugar and often cause a quick rise in bG. They include milk, fruit, fruit juices, and of course, sugar. Vegetables also contain complex carbs, though in small amounts (except for things like corn and peas).

Compliance - going along with the doctor's instructions; not all patients comply with gd protocols or dietary regulations.

Contraction Stress Test - a test where the baby's heart rate response to oxytocin is measured. The mother is given some intravenous oxytocin and the baby is monitored via electronic fetal monitors to check the response. Must be performed where all parties can be carefully monitored should fetal distress or true labor be triggered.

Cortisol - hormone that is very strongly diabetogenic and which peaks at about week 26, which is why testing for gd is usually scheduled to occur between weeks 26-28.

C-Section - short for Cesarean Section, a method of delivering a baby surgically through the abdominal wall. C-section rates for gd mothers are abnormally high, near 1 of 4 to 1 of 3 gd mothers in some studies, less and more in others. This is probably due to the high rate of induced labors and elective c-sections for babies thought to be 'large'; several studies have shown that the gd label alone increases the rate of c-sections, even independent of other risk factors such as macrosomia.

Dyslipidemia - excess levels of blood lipids such as cholesterol, high-density lipoproteins, triglycerides, etc. This condition is often associated with the occurence of true diabetes and is often also accompanied by high blood pressure (all of them together are sometimes called "Syndrome X"). A woman who has had gd should be tested yearly to track her blood lipids, since the may start becoming abnormal within a few years.

Edema - swelling or retaining of excess fluids in the tissues. Can occur normally or abnormally in the end of pregnancy; your provider can discuss the fine distinctions between normal edema and abnormal edema. Immersion of the affected parts in water and increasing your oral intake of fluids can help in many cases; Brewer also feels that increasing proteins and maintaining normal salt intake can also help but other providers may disagree. Edema is also very common after a pitocin-induced labor or after an epidural, where excess fluids are pumped into the mother in order to compensate for a possible fall of blood pressure. Post-partum edema mostly must be tolerated until it departs naturally within a few weeks.

EFM - abbreviation for External Fetal Monitoring. When giving birth in a hospital, women are often forced to wear these straps with instruments that monitor the baby's heartbeat during labor. A 20-minute sample strip is often required upon checking into the hospital; after that, monitoring is usually intermittent, unless drugs or artificial labor stimulants are used, at which time the monitoring must become continuous due to the danger of fetal distress. EFM has not been shown to improve fetal outcome except in high-risk cases or when drugs/labor stimulants are used, but because of the tremendous amount of litigation pressure in the USA, it is still used routinely, although it does increase the rate of unnecessary c-section. Whether a gd pregnancy and labor is considered 'high-risk' enough to justify use of continuous EFM is controversial and will depend on the provider's policies and the severity of the gd.

Endogenous - from inside the body; endogenous insulin is insulin produced by your own pancreas for your body's use. Most pregnancies experience some degree of insulin resistance, for example, but their own pancreas is able to increase its production in order to compensate. In type II diabetes (NIDDM) and in most gd, the body produces copious amounts of endogenous insulin, but insulin resistance keeps the body from using that insulin effectively. When insulin resistance become too severe, exogenous insulin (injected insulin from outside sources) is needed.

EPO - an abbreviation for Evening Primrose Oil, a substance favored by many midwives for ripening the cervix before term. Scientific evidence of its efficacy is lacking (lack of study!), but anecdotal reports are often favorable. Recommendations for usage will vary from provider to provider (many OBs will not be comfortable using it, but some will consent); it is generally thought to be effective only after usage of around 2 weeks or so (but should not be started too early). It is most often used as a vaginal suppository; a few midwives also advocate its use orally, though its safety has not really been studied. Consult your provider.

Estradiol - a type of estrogen hormone which is mildly diabetogenic and adds to the body's tendency towards gd in pregnancy. Starts at about 1 month and peaks at about week 26.

Euglycemia - even, normal blood glucose levels. No big highs or lows or swings, just nice and even results. This is the goal of treatment in GD. Also called 'normoglycemia'.

Exogenous - from outside sources; exogenous insulin is insulin that must be injected from the outside of your body in addition to whatever insulin your own pancreas provides.

FA - Fatty Acids

FFA - Free Fatty Acids

Failure to Progress (FTP) - also known as labor dystocia. This occurs when labor deviates from a normal or average pattern of labor, but is strongly subjective and differs greatly from one provider to the next. Midwives often call this "Failure to Wait" by the physician, since it can result from an impatient doctor or one who does not recognize that labors that deviate from the 'normal' labor are not necessarily pathological. Just what constitutes a normal labor and an abnormal labor that needs intervention is highly controversial and will differ significantly from provider to provider. True FTP can occur, of course, but it is difficult to separate out the cases that are caused by obstetric mismanagement vs. naturally-occuring cases. Common in induced labors.

Fasting bG - blood sugar measured after an 8-12 hour overnight fast but before breakfast. Sometimes known as the FPG (fasting plasma glucose), though that would measure slightly higher than self-testing, since it uses the plasma levels instead of capillary blood levels. Optimal level seems to be below 90, but insulin is not usually prescribed by most doctors until fasting levels exceed 105 mg/dl, though some advocate 95 instead. Fasting hyperglycemia is when the early morning fasting numbers are high; the post-meal numbers may be normal but more often are also high. Fasting hyperglycemia is thought to be more serious, though it depends on the opinion that you read.

Fuel-Mediated Teratogenesis - problems caused for the baby that occur because the mother is passing along too much fuel (various forms of foods and things) to baby, especially early in pregnancy. For example, if blood sugar is high at conception or during the formation of organs, major birth defects of the heart and spine can occur. "Teratogens" are substances that cause major problems for baby; "fuel-mediated" means that the problem comes from the process of nourishment of the baby, but that in excessive amounts or in unbalanced ratios, these fuels can cause problems instead of just helping the baby in normal developmental tasks.

Gestational Diabetes Mellitus (GDM or GD)- a kind of temporary diabetes or carbohydrate intolerance that develops in pregnancy and almost always goes away afterwards. May be a forerunner of type II diabetes.

Glycosylated Hemoglobin - a special test that measures the average blood sugar level over the last 2-3 months. It is the best measure of bG control but is not sensitive-enough to use to screen for gd.

GCT - Glucose Challenge Test; the screening test used to determine which patients need further, more sensitive testing. The Challenge Test contains 50g of glucola (half of the GTT used later in the US); blood is drawn one hour later. 140 mg/dl is the usual cutoff, though some providers use lower levels of 130 or 135, or occasionally lower with high-risk populations.

GTT - Glucose Tolerance Test; a special test given to test for diabetes. A special drink of very sweet glucola is given after fasting overnight; several blood draws are taken while fasting and then over the next several hours after the drink. Outside of pregnancy, the glucola drink contains 75g of carbohydrate and lasts for 2 hours; this is also the test used for pregnancy in many non-USA countires, as approved by the World Health Organization (WHO). In the USA, however, this test is not considered challenging enough for pregnancy levels, and a 100g, 3-hour test is used instead (after an initial 1-hour/50g screen). The 100g test is the one approved by ACOG and the ADA. In some research the GTT is abbreviated as the OGTT, which stands for Oral Glucose Tolerance Test.

HbA1c - the abbreviation for the glycosylated hemogloblin test (see above).

Human Chorionic Somatomammotropin - a hormone which has a fairly strong diabetogenic effect; it peaks at about week 26. Abbreviated hCS in some research. Previously referred to as human placental lactogen in earlier research; hCS is now the preferred term, apparently.

Hyperbilirubinemia - too much bilirubin, which is produced when extra blood cells needed before birth are broken down and gotten rid of. A too-high level of bilirubin can cause brain damage. Slightly elevated levels are pretty normal and not of great concern unless baby is premature or there are other medical considerations. In normal jaundice, early and frequent breastfeeding plus indirect sunlight exposure is the best treatment unless levels get severe; phototherapy can be used at higher levels. In severe cases, transfusions may be needed. There are basically three types of jaundice noted: Physiological ('normal') jaundice which is the kind most common in gd and what is usually referred to in discussions of gd; Pathological (usually early and very serious) jaundice; and so-called 'Breastmilk' (late or long-term) jaundice, which is a misnomer but is the common term, although there is controversy over exactly what constitutes this jaundice and how to treat it. Again, in discussions of gd, physiological or normal jaundice is what is usually being referred to. It is extremely common in gd babies, but some may be caused by the way doctors handle gd deliveries.

Hyperglycemia - too much blood sugar. Can be dangerous to the baby in the long run, but it is unknown at this time exactly at what level it becomes dangerous.

Hyperinsulinemia - too much insulin. In response to the mother's high blood sugar levels, the baby produces high levels of insulin. This, plus the high levels of blood sugar, can often cause the baby to grow too much or in abnormal patterns. This can cause problems with birth trauma or make baby overly heavy; too much insulin at birth can also cause baby to have hypoglycemia when born.

Hypocalcemia - too low a level of calcium in baby. In some diabetic mothers (especially severe cases), the placenta begins to calcify at the end of pregnancy. The baby receives too much calcium, so its parathyroid gland minimizes its own production. After birth, when mother's supply is cut off, the baby cannot supply enough calcium at first and levels drop too low. Can lead to seizures and other complications. Uncommon in gd, but possible. More common in true diabetic pregnancies.

Hypoglycemia - too little blood sugar. For the mother, hypoglycemia can occur if she doesn't eat regularly or enough, or if she is on insulin and has a reaction to it, or if she exercises without enough glucose energy to compensate for the energy output. For the gd baby, hypoglycemia is a fairly common risk after birth. If the mother's bG levels have been high, then the baby's pancreas produces too much insulin to compensate. After birth, mother's supply of blood sugar is cut off and the baby's high level of insulin can cause its own blood sugar to plummet. At low levels, this can cause brain damage and other problems. All gd babies need to be tested for hypoglycemia, but the risk is small if the mother's blood sugars have been even and normal in the last trimester and especially right before birth, although it sometimes occurs anyway. Frequent and early breastfeeding is the best treatment for mild or borderline cases; more severe cases may need glucose water or even IV glucose. Hypoglycemia is the most common complication for gd babies, although most cases are mild, transitory, and easily resolved with early and frequent breastfeeding. However, due to the danger of severe hypoglycemia, a gd newborn's bG should be carefully watched.

Hypomagnesemia - too little levels of magnesium in the newborn. A rare complication of gd.

Hypovolemia - too little blood pressure. Usually refers to the drop in maternal blood pressure during regional anesthesia such as epidurals; pushing fluids through an IV is often used to help compensate for this risk.

IBCLC - Internationally Board-Certified Lactation Consultant. These are the true professionals to help with breastfeeding problems. Many lactation consultants are not thoroughly-trained in all aspects of lactation and problem-solving; a label of 'IBCLC' ensures that you have a professional who has studied lactation issues thoroughly and is more competent to help. Doctors and non-IBCLC nurses can be helpful sometimes too, but sometimes they are woefully misinformed about many breastfeeding issues and can give incorrect advice. Any mom who has breastfeeding problems should consult an IBCLC.

ICAN - abbreviation for International Cesarean Awareness Network, a group devoted to helping mothers heal physically and emotionally from c-sections, and to preventing unnecessary cesarean sections. Excellent resource. For more information, contact www.childbirth.org/section/ICAN.html or ICANinc@aol.com.

IDDM - abbreviation for Insulin-Dependent Diabetes Mellitus, or what used to be called juvenile diabetes (although it can also occur in adulthood). In Type I Diabetes (IDDM), the pancreas' ability to produce insulin has been nearly or totally destroyed and the patient must receive outside (exogenous) sources of injected insulin in order to survive. In Type II Diabetes (NIDDM), the pancreas produces lots of insulin, but the body become resistant to its effects over time.

IGDM - Infant of a Gestational Diabetes Mellitus pregnancy; shorthand for a cumbersome term.

IGT (Impaired Glucose Tolerance) - a state which is borderline to true diabetes. Usually refers to a borderline state that exists outside of pregnancy (non-pregnant fasting levels >110 mg/dl or post-meal levels >140 mg/dl), but some researchers use a similar term for a state which is just short of gd in pregnancy. In this, a woman may be just shy of the cutoffs used to diagnose gd or she may have only 1 raised level on the glucose tolerance test instead of the usual 2. IGT often progresses on to true diabetes later in life, but sometimes it returns to normal levels or stays the same without problems.

Induction - artificially trying to start labor before it starts on its own. Inductions are extremely common in gd, due in part to the fear of an aging placenta, which may age faster in gd pregnancies than in normoglycemic pregnancies. Labor can be induced through several methods, including prostaglandin gel, breaking the amniotic sac, and use of artificial oxytocin (pitocin). The common practice of inducing gd pregnancies early is beginning to change but is controversial. The severity of the gd will also influence the decision about whether to induce early.

Insulin Resistance - the inability to use your own body's supply of insulin effectively. Among normoglycemic people, the body converts food into blood sugar for energy; insulin is produced by the pancreas in order to help get the blood sugar into the cells. When insulin resistance develops, the body becomes "resistant" to insulin's effect---it doesn't work as well anymore. The body must compensate by producing ever-higher amounts of insulin, which tends to tire out the pancreas, which can lead to type II diabetes (NIDDM) in some people. Insulin resistance can be decreased primarily by exercise; some drugs can also help but of course these cannot be used during pregnancy due to their possible harmful effects on the baby.

IUGR - IntraUterine Growth Retardation. A very serious problem in which the fetus is extra small and not developing as it should be, due to problems with the placenta, etc. Can have a number of causes, but is associated with very severe and uncontrolled diabetes, mothers who have very high blood pressure (which can sometimes accompany gd), mothers with vascular damage, or problems with blood clots in the placental blood supply.

Ketones - a breakdown product of fat produced when the body must access fat stores in order to create energy. This is probably not good for baby (large amounts have been shown to impair learning abilities), but the studies on this are controversial. Most doctors still take a play-it-safe attitude and do not want any ketones, which is probably most sensible. Ketones usually occur if a meal is skipped, not enough carbs or calories are being consumed, and if too large a gap between eating occurs. Ketonemia is the accumulation of the ketones in the blood; ketonuria is when these accumulate in amounts sufficient to 'spill' into the urine.

LGA - abbreviation for Large-for-Gestational-Age; a baby that is bigger on average than most babies at the same gestational stage. LGA babies are usually above the 90th percentile in size. At birth, this is most often defined as >4000g (8 lb., 13 oz.) but some researchers differ in the application of this term.

LMP - abbreviation for Last Menstrual Period. Most pregnancies are dated as lasting 40 weeks after the LMP, which assumes that your cycle is about 28 days long and that you ovulate on day 14. If your cycles are longer or you know from charting that you ovulate later than day 14, your due date will need to be adjusted. This is extremely important in gd pregnancies, where early inductions or inductions at a specified time are often routine. If your cycles last 35 days instead of 28, your LMP due date is actually a week earlier than it should be. If they induce you at 37 or so weeks, you may actually end up with a premature baby and may well have trouble with lung maturity, which is a special issue of importance in gd. If your provider 'allows' you to go to 40 or 41 weeks before inducing, you want that to be as accurate to your correct dates as possible, since an induction near your normal labor date is far more likely to be successful and can reduce your risk of a c-section.

Lochia - the blood and fluids that are discharged by the mother after the birth of a baby; they normally continue for 4-6 weeks after birth but an increase in the amount, redness, or clots can indicate a problem in the mother. Lochia occurs in both vaginal births and c-section births.

Macrosomia - an unusually big baby, usually above the 90th or 95th percentile. Problems with birth trauma or shoulders getting stuck can occur in some cases; can be more severe in diabetic pregnancies than for similarly-sized babies in non-diabetic pregnancies, due to possible abnormal growth patterns. Hypoglycemia is also more common with large babies, both in diabetic and non-diabetic pregnancies, so must be tested for carefully. Levels of macrosomia are defined differently in different places. Above 4000g (8 lb., 13 oz.) is usually considered "large-for-gestational-age" (LGA), while above 4500g (9 lb., 14 oz.) is usually considered macrosomic, although some research considers anything above 4000g macrosomic.

Morbidity - the non-fatal complications that can occur; for example, transient hypoglycemia in the newborn is considered part of the morbidity statistics, while stillbirth is part of the mortality statistics

Mortality - the fatal complications that can occur; the rate of perinatal mortality in gd is quite low, and with excellent control is rare and similar to that of the normoglycemic population.

NIDDM - an abbreviation for Non-Insulin Dependent Diabetes Mellitus, or what used to be called adult-onset diabetes. In Type I Diabetes (IDDM), the pancreas' ability to produce insulin has been nearly or totally destroyed and the patient must receive outside (exogenous) sources of injected insulin in order to survive. In Type II Diabetes (NIDDM), the pancreas produces lots of insulin, but the body become resistant to its effects over time. Treatment usually involves sensitizing the body to its own insulin again through diet, exercise, and various drugs, and if this is not sufficient, adding exogenous insulin.

Normoglycemia - even, normal blood glucose levels. No big highs or lows or swings, just nice and even results. This is the goal of treatment in GD. Also called 'euglycemia'.

NST (Non-Stess Test) - a test where the baby's heart is monitored to see if it accelerates after it moves, which means that all is probably well. If it does not, the baby could have problems, but it's important to remember that the baby could just be sleeping. The doctor will probably use several methods to stimulate the baby, including vibroacoustic stimulation (a beeper or electric shaver without a razor), a bit of juice (though often not with gd patients), or other techniques. NSTs are used more often and sometimes earlier with gd patients. More severe gd may require very early or very frequent testing, though the amount and frequency of testing varies with each provider.

ODM - Offspring of Diabetic Mothers. The latest trend in research (to justify the identification and screening for gd, among other reasons) is to examine the long-term effect of diabetes on the baby as it grows up. There is some evidence that babies born from a diabetic pregnancy (pre-existing or gdm) tend to have more obesity, more and earlier diabetes, and in more severe cases, possible intellectual or behavioral deficits. An interesting area of research but one rife with size prejudice and overgeneralizations. More research is needed.

Organomegaly - where certain organs of the fetus grow extra large, out of their proper proportions. Fetuses whose mothers do not have good bG control can sometimes develop assymetrically, with their trunks and certain organs growing overly large.

Oxytocin - the naturally-occurring drug that helps to cause labor and contractions in the body when the body is receptive to its influence. Nipple stimulation and orgasm can bring on oxytocin but unless the body is sensitive to the stimuli yet, it won't have much effect. Around term, the body's receptors become sensitive to it. There is also an artificially-produced drug to try and simulate the natural drug (trade name: 'pitocin'), though its effects are not quite the same, since labor usually involves more than one hormone, not just oxytocin. It often hyperstimulates the uterus instead, and the fetus must be carefully monitored for fetal distress during its use.

Pancreas - the organ in the body which produces the insulin which helps the body 'unlock' the cells to receive the blood glucose. In Type I Diabetes (IDDM), the pancreas' ability to produce insulin has been nearly or totally destroyed and the patient must receive outside (exogenous) sources of injected insulin in order to survive. In Type II Diabetes (NIDDM), the pancreas produces lots of insulin, but the body become resistant to its effects over time.

PCOS - abbreviation for PolyCystic Ovarian Syndrome; see below. Other common abbreviations include PCOD (D=disorder) or just plain PCO.

PIH - abbreviation for Pregnancy-Induced Hypertension, also known as pre-eclampsia or toxemia. GD mothers have slightly higher rates of PIH, although many gd moms do not get PIH either. PIH can be very mild and just need extra monitoring or some bedrest, or it can be very severe and cause extremely serious problems. The earlier it occurs, the more serious it tends to be.

Pitocin - trade name for artificial oxytocin (see above), the hormone that causes contractions during labor. Often called 'pit'.

PolyCystic Ovarian Syndrome - an umbrella term for a series of related metabolic/hormonal disorders that can cause multiple problems for the woman involved, including insulin resistance, anovulation, adult-onset acne, hirsutism (excess facial and body hair), hair loss, weight gain, cystic ovaries, etc. In terms solely of its influence on pregnancy issues (more information on the total disorder can be found at www.prairienet.org/~eah/pcopage.html or www.ccnet.com/~bafertil/pcos.html), it can increase infertility and the woman may need help ovulating, especially as she gets older. During the pregnancy, pco moms also tend to have higher rates of Pregnancy-Induced Hypertension (PIH) and Gestational Diabetes. After pregnancy, a few pco moms have found difficulties in producing enough milk supply, although others have breastfed successfully. (Since pco is an umbrella term for what is probably a series of inter-related orders, this may help explain the wide variance of women's experiences with pco's effects.)

Polycythemia - too many red blood cells in the baby (causes problems with the viscosity of baby's blood). Treatment includes removing some blood and infusing some plasma to decrease the number of red blood cells present. An unusual complication.

Polyhydramnios - too much amniotic fluid. Not that common, but possible. Can cause pre-term labor.

Postprandial bG - blood sugar measured after a meal. The amount of time varies between providers. The most common requirement is to have a bG <120 two hours after the START of a meal. However, some providers want 140 or 120 one-hour after a meal (but they measure this from the beginning or the end). A very few providers will require post-prandial measurements below 107 mg/dl in the hopes of preventing macrosomia.

pp - abbreviation for post-prandial, which means blood sugar measured after a meal or food intake. See above.

Pre-Eclampsia - also known sometimes as toxemia or Pregnancy-Induced Hypertension (PIH). A temporary rise in blood pressure during pregnancy, although sometimes the lines between pre-existing and pregnancy-induced hypertension are blurred. Pre-eclampsia is sometimes associated with gd, but many women with gd do not get it either, so it is not a foregone conclusion. Usually is accompanied by protein in the urine, edema (excess fluids under the skin), and can possibly involve various body organs and systems in very severe cases. This can be very serious in its more severe forms and early induction or delivery may be needed, even at very early gestational stages. If it progresses to Eclampsia, it can cause death, although Eclampsia is rare.

Pre-gestational Diabetes - Diabetes that exists before pregnancy; women who are type I or type II diabetics before conception occurs. Pregnancies that occur with pre-existing diabetes are much more risky than gd, in most cases.

Progesterone - a hormone that is very strongly diabetogenic, second only to cortisol. Its peak elevation is not until 32 weeks or so, so it is possible to test negative at 28 weeks for gd and still develop it in the third trimester. Some researchers advocate retesting in the third trimester at about 32 weeks just for this reason. Women diagnosed with gd at 28 weeks or earlier will often find their bG numbers the most difficult to control at about 32 weeks or just after, probably due to the peak levels of progesterone present at this point. It should also be noted that women who take progesterone supplements early in pregnancy as an assist to maintaining the pregnancy will also experience a rise in bG; this should be accounted for if testing early in pregnancy for gd. In addition, birth control methods that rely on heavy doses of progesterone (such as DepoProvera or Norplant) are contraindicated for women who have had gd, as they may worsen bG control post-partum so significantly that they hasten true diabetes.

Prolactin - a hormone that occurs early in pregnancy and then again in late pregnancy/postpartum. In early pregnancy, it has mild diabetogenic properties and peaks at about week 10. Its function in early pregnancy is not known for sure. Its function in late pregnancy is to assist lactation (breastfeeding). It is sometimes abbreviated as hPRL.

Prostaglandin Gel - a substance that can be put up near the cervix to ripen it artificially and get it more ready for labor. Although prostaglandin gel can sometimes induce labor to start on its own, it usually is used to prepare the cervix so it will respond more effectively to pitocin. It often takes several doses of prostaglandin gel to ripen the cervix, and sometimes it is not effective. There are also other, new substances to assist in artificially ripening the cervix for labor, but at this time, prostaglandin gel is still the most-commonly used.

Post-partum - the period after giving birth

PPD - abbreviation for Post-Partum Depression.

Post-Traumatic Stress Disorder - a psychological disturbance or anxiety that can occur after traumas, such as violent incidents, war, etc. An under-recognized malady in childbirth, it can affect women who have had traumatic or very difficult births. Flashbacks, depression/anxiety, hypervigilance, etc. are symptoms; it is sometimes misdiagnosed in post-partum women as simply Post-Partum Depression and women may not receive sufficient treatment for it.

Prophylactic Insulin - the practice of giving insulin at levels lower than usually clinically accepted in order to hopefully prevent macrosomia and other problems. Its efficacy is mixed; some studies show that it helps while others show that it does not, especially among obese women. May introduce its own risks as well, and may shorten the timeline for delivery too. At this time it is promoted by some researchers but it is still considered too early (and the results too mixed) to recommend for routine use.

PTSD - abbreviation for Post-Traumatic Stress Disorder; see above.

Respiratory Distress Syndrome - a condition that can occur when baby is delivered before its lungs are fully mature or before surfactant is formed in sufficient quantities. A fairly common condition for preemies or c-section babies (who may not have gotten the full beneficial effects of labor contractions and their hormones which help prepare the lungs for birth). Is of special significance to the gd baby because their lungs tend to mature less quickly than babies of normal pregnancies (possibly because hyperinsulinemia may slow down the formation of surfactant). If pre-term labor is threatened or the provider is contemplating delivering before 39 weeks or so, an amniocentesis will be performed to determine the baby's L/S ratio (how much surfactant it has) to be sure the lungs are ready to perform outside in the real world.

Serial Induction - the practice of some providers of allowing successive inductions of labor, should the first one not 'take'. The mother is given prostaglandin gels of various sorts first to ripen the cervix, then is given artificial oxytocin (pitocin), usually the next day. If nothing happens all day long, the providers may decide to send the mom home and try again in a few days, as long as the mother's amniotic sac has not broken or been broken by the provider. Data is lacking on the success of serial induction, but anecdotal evidence seems to indicate that it works for many women who may well have ended with c-sections had the issue been forced with an amniotomy. However, some medical conditions may prevent some serial inductions.

Serial Ultrasonography - the practice of using successive ultrasounds to track the fetus' growth throughout the pregnancy, usually in the third trimester. Used more commonly by some providers in gd pregnancies, since there is a danger of macrosomia or uneven growth (extra large trunk, etc.). A single ultrasound, used to judge the baby's potential size, is generally highly inaccurate at predicting macrosomia (it's reportedly fairly effective at predicting babies of average size, but very inaccurate in predicting babies that are extra large or extra small). Because of this notorious unreliability, many providers will order serial ultrasounds instead, in hopes of improving accuracy. The effectiveness of this approach is unknown at this time but is probably better than using a single ultrasound.

SGA - Small for Gestational Age. When a baby is considered extra small for its developmental state, compared to other babies its gestational age. This can be caused by IUGR (intrauterine growth retardation) or simply by too-tight glycemic control (bG that is kept too low on average).

Shoulder Dystocia - a potentially very serious complication where the baby's head is delivered but the shoulders get stuck. There are a number of maneuvers that can free the shoulders if the provider knows of these, though many providers today are not familiar with these less interventive techniques. The clavicle (baby's collarbone) can also be broken in extreme cases in order to deliver the baby, or the baby can possibly be pushed back inside in order to perform an emergency c-section, though this is controversial. Shoulder dystocia is a bit more common with infants of diabetic pregnancies because the baby's hyperinsulinism can result in disproportional growth around the trunk and shoulder areas. A macrosomic baby is also a bit more likely to have shoulder dystocia, but it's important to remember that a significant number of shoulder dystocia cases occur in babies that are of average-size. A lot also has to do with the obstetric management of the delivery (maternal position, use of pitocin, etc.) and since diabetic pregnancies are often highly managed, it is difficult to separate out the true rate of shoulder dystocia from the rates caused or added to by obstetric mismanagement. However, it is clear that it is more common in diabetic pregnancies and potentially very serious. Most shoulder dystocia injuries to baby do end up resolving without serious long-term effects, but not all do, and death is also possible as well. This is why doctors worry disproportionately about this uncommon but potentially very grim complication.

Simple Carbs - a type of carbohydrate which converts very quickly to blood sugar, often causing a quick rise in bG. Sugar, fruit juices, fruit, and milk are examples of simple carbs. Carbs that convert more slowly are called complex carbs and include pasta, breads, and other starches.

Stripping the Membranes - the practice of many OBs and some midwives of using a finger to separate the amniotic sac from the surrounding tissue of the cervix when near term, though the amniotic sac is not broken. They may also stimulate the cervix or massage it lightly in addition to stripping the membranes in hopes of speeding labor. This is often an uncomfortable procedure and may result in a fair amount of blood, though it is usually not serious. Some providers feel that this can help start a labor within a few days; its use is controversial. For women facing certain induction on a tight deadline, it may be worth using, though it should be done only with the mother's informed consent (something very often ommitted!). For others, its use is more debatable. It does introduce a small risk of infection and also increases the risk of the amniotic sac breaking prematurely, which tends to make a labor harder and more at risk for infection, and may increase malpresentations. In some cases, the risks are outweighed by the benefits, but its routine use should be avoided. A pregnant woman should make this clear to her provider prior to the last month of pregnancy, since many providers do it automatically as term approaches, and she may even need to verbally remind the provider of her wishes each visit, since its use is so routine by some practitioners. (Women can also refuse to permit vaginal exams at any point in pregnancy, which are of very little real use in most pregnancies and can possibly introduce infections.)

Surfactant - a substance in the lungs that develops late in pregnancy that will enable the baby to breathe outside the womb.

Term - the word used to describe a pregnancy that lasts the full gestational length. 40 weeks is considered the usual average gestational period (40 weeks after Last Menstrual Period, or 38 weeks after ovulation if you have longer cycles). Although term is actually 40 weeks, in reality any baby that is past 37 weeks is considered to be a 'term' baby and likely to survive, even though the last few weeks do have a number of developmental tasks still to accomplish (most notably lung maturity, especially for gd babies). Remember, though, that most babies arrive after the due date by a few days; first babies are often overdue by 8 days on average and this is not abnormal. However, in gd pregnancies, the concern (which is controversial) is whether the placenta is aging more quickly due to the diabetes, so many providers have in the past advocated inducing early or at term. Nowadays, mild gd cases can be induced anywhere from 38 weeks to 42 weeks, depending on the provider and the medical condition of mother and baby. The practice of early induction or induction at term is coming under further scrutiny though no conclusions have been reached yet.

Toxemia - another term for pre-eclampsia or Pregnancy-Induced Hypertension (PIH); see above.

VBAC - an abbreviation for Vaginal Birth After Cesarean. Considering the very high number of gd mothers who end up with c-sections and the fact that gd usually recurs, VBAC is a special issue of concern to gd mothers. Just because a woman ended with a c-section in a previous gd pregnancy does not mean she will have to have one in her next pregnancy; a VBAC is actually overall safer to have than a repeat elective section. However, each case must be judged on its own merit. Since some practitioners are now loosening their requirements on early induction somewhat, this may improve a gd mother's chances for VBAC, although the attitude and practices of the provider towards VBAC remain the single strongest factor in achieving VBACs. However, having gd does not contraindicate a VBAC automatically at all. Many gd mothers with previous c-sections have indeed achieved VBACs.

 


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