Friday, July 1, 2011

Big Babies and Good Nutrition

It seems that doctors use two risks to prod pregnant women with Type I diabetes into induction and c-section. One is still birth, on which I wrote a post when I was 38ish weeks pregnant with my second child. I wrote about my subsequent induction here. My doctor strongly recommended the induction on the basis of an increased risk of still birth.

The second risk that doctors use to prod pregnant women with diabetes into induction and c-section is the threat of a big baby. I have a complicated relationship to this issue, because both of my boys were on the large side (8 lbs 1 oz and 9 lbs 8 oz). I also gained between 45 and 50 pounds with both pregnancies, which is more than "recommended."

I bristle when people talk about my newborns being "monsters" or "giants." Or, sometimes it's something along the lines of, "no wonder you looked so big when you were pregnant!" After my 9 lb 8 oz-er was born, my endocrinologist said, "that's a little larger than we like." (I'm not sure why he cared, since I'm pretty sure it was only my perineum and my OB's malpractice insurance on the line, but that's beside the point.) I'm sensitive about it because I know that doctors will assume that a large baby means I haven't taken good care of my blood sugars AND that I won't be able to have a vaginal delivery, which are both dear to me.

I've picked up some tips about babies that are LGA (large-for-gestational-age, or "too big"), and shared some ideas for dealing with growth ultrasounds that show a big baby in this post. I've been doing some more thinking and reading about it and have decided that in an effort to keep my babies as reasonably-sized as I can, I will try to incorporate some dietary changes during my next pregnancy. Heck, I may even start practicing sooner, so that I won't be scrambling to change my grocery shopping list when I feel sick and tired at the beginning of my next pregnancy.

A lot of this advice comes from the Navelgazing Midwife. She has some pretty lengthy posts about gestational diabetes. She hasn't addressed Type I diabetes, but I think most people would agree that there are enough similarities to make a comparison. She may tend towards the "skeptical-that-diabetics-really-can-or-do-take-care-of-themselves" camp, but she at least has some ideas about pregnancy management for women with diabetes that don't necessarily include induction or c-section.

Cut out dairy. Low-fat dairy has more sugar and high-fat dairy has more fat. Both can really pump up a baby's weight. Also, growth hormones used on cows may end up getting to your baby, too. This will be next to impossible for this milk- and cheese- and especially-during-pregnancy-cottage-cheese-lover. Here's to trying.

Eat "tree-bark carbs." I love this description. I already eat a lot of whole grains, but I could definitely try harder to avoid white rice and white pasta.

No sugar. You'd think a woman with Type I diabetes since age 9 would already be totally on board with this one, but I must confess that I've got a sweet tooth. Moderation, right? Well, maybe...but I'm probably better cutting it out all together. This poses a challenge for managing low blood sugars, but again, here's to trying.

Walk after every meal! That's a tall order. I'm not sure whether I'll be able to convince my sons that mommy absolutely has to take a stroll around the neighborhood and they have to sit in the stroller or keep up, but I'll do my best. I guess they'll get used to making sacrifices for their baby siblings early on.

Things I would add to her list are to avoid gorging myself at any one meal and eat smaller amounts more frequently, which I have mentioned before. Also, avoid eating after dinner. It throws off my bedtime blood sugars and can make things tricky over night. Plus, I've heard that post-dinner eating contributes to weight gain more than eating at other hours of the day.

Another thing she says is to eliminate juice, but I'm just not sure I can swing that with my low blood sugars. I'd love to hear suggestions if you have any!

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