Prenatal Genetic Testing: There's a lot ot say.

I put off writing this post for quite sometime because of one of the most scary parts of prenatal genetic testing: the false positive.

My doctor advised, and I wanted to have a first round of non-invasive genetic testing. We had a sequential scan. This involved an ultrasound at 11 weeks to measure the baby's nuchal fold (the skin covering the back of the a baby's neck) and a blood test, followed by another blood test at 18 weeks.

The sequential scan looks at the nuchal fold measurement and four hormone and chemical markers in your blood to help pin down the risk a baby might have Down Syndrome (three copies of chromosome 21) Trisomy 18 (again, an extra copy of chromosome 18), a neural tube defect (like spinal bifida) or a congenital heart defect. This gives more information about risks that maternal age alone.

Every pregnant woman has the opportunity to have these tests done. Diabetic women may be counseled more strongly to have the tests because their risk of neural tube and congenital heart defects are already higher.

But, it's important to remember that the tests are completely your choice. If you know that a result will not change how you feel or what you do with a pregnancy, than by all means forgo the testing.

The second blood draw showed higher levels of a hormone called alpha-fetoprotein. This is an indicator of an increased risk of a neural tube defect. The increase was not high, so my risk for having a baby with a problem changed from 1 out of 150 to 1 out of 140 with the result... not too substantial, but definitely worth some tears.

The high AFP value could also indicate a variety of other situations. They ranged from, in the best case, a baby whose growth was a bit stunted, to, in the worst case, a pregnancy had that ended. Interestingly AFP is also a marker for some cancers.

Needless to say getting the call from the genetic councilor was terrifying, and the two week wait until the ultrasound was tense. My doctor reminded me that 1 out of 140 means that 139 babies are just perfect.

The ultrasound went better than well. We got to see the baby's spine and brain. I've never seen anything more lovely. The weird alpha-fetoprotein reading was an anomaly. The baby is growing well.

I have mixed feelings about the genetic screening process. I learned more information about my child's risk of some conditions, but was worried about another, unnecessarily. However, I think, given the increased concern with diabetic pregnancies, I gained some valuable information and I will likely go for it again if I decide to have another child.

Weight Gain

'Ten to fifteen pounds.' The doctor looked me straight in the eye and told me I should gain between ten and fifteen pounds. At my second appointment, I was already up five thanks to some Chinese food indiscretion and a heavy coat.

Surely she was joking. I later told my friend that 10 pounds was the equivalent of a 'bad vacation' and that it was likely my baby alone could weigh that much. However, at my next appointment, the doctor reassured me... they were dead serious.

Your pregnancy weight gain goals are determined by your pre-pregnancy body weight via your Body Mass Index. Here is some great information from the Mayo Clinic.

Gone are the days of eating for two. Exercise up to delivery and healthy eating are now expected parts of pregnancy. Know this, your health care provider will hold you accountable.

This is especially true for women with prior heath conditions. Have high cholesterol? Too much weight gain makes it harder to control. The same goes for high blood pressure and for diabetes. Increased body fat will exacerbate the insulin resistance all pregnant diabetic women cope with. Additionally, too much weight gain can lead to more difficult deliveries and make it harder to induce labor.

At 20 weeks, I've been able maintain my weight after the initial gain, I think largely because I continue to exercise regularly and didn't go crazy with dietary changes... by that I mean I have ice cream every OTHER day.

Scientists would say that I had already laid down the maternal fat stores needed during pregnancy (I am ALWAYS planning ahead), and so didn't need to gain fat like moms who start out at a normal weight.

Either way, it's easy to worry about too much or too little pregnancy weight gain. I frankly didn't believe I would gain any weight if I didn't change my eating habits... but the baby had other plans.

Second trimester: Insulin don't fail me now.

In one of many jokes of the diabetic pregnancy, just as you've become used to the lower insulin needs and increased sensitivity of the late first-early second trimester, your placenta throws you for a loop.

The placenta, masterful organ that it is, has one keen interest... keeping your baby well fed. It releases a hormone cocktail with many baby-promotiing properties, one of which is counteracting mom's insulin to keep more sugar circulating in the blood and consequently more available food for baby.

In non-diabetic moms, the pancreas pumps out more insulin to compensate. For some non-diabetic women, the placental hormones are too much for the pancreas to handle, causing a condition known as gestational diabetes. This is a temporary form of diabetes that goes away after delivery.

For those moms that are already diabetic, the 2nd trimester means you'll be taking more insulin, potentially LOTS of it. My doctors told me to expect to take double my pre-pregnancy insulin or more by the time pregnancy-induced insulin resistance peeks in the third trimester.

Currently, I've had to do one big bump at about 18 weeks. I changed my insulin to carb ratio from 1 unit to 7 grams to 1 unit to 4 grams (at breakfast) and 5 grams (rest of the day). I've also upped some of my morning basal rates. Now, because I'm taking so much more insulin, I'm changing my pump sites out once every two days instead of three. My insurance company understands at the moment, but I may switch back to plain old needles for some meal boluses to save costs.

I'd suggest not waiting too long to talk with the docs about changing your levels. You know it's coming, as do they. I found that making smaller changes more frequently is less traumatic then going for the big jumps, or seeing 200s and higher regularly.