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Pregnant with abnormal glucose and anemia

What do these tests really mean?  Should we worry?  Have any of you had this experience?  Lisa is starting her second trimester with her first child, and she has just moved to Portland.  She is looking for some reassurance and insight:

I just received an email from my ob this morning that I had an abnormal glucose test AND am anemic. I am physically active and feel like I eat really well and am very bummed about receiving these news. I need to now follow-up with further testing and increase my iron supplement, but have received no guidance yet on either from Kaiser. Can anyone tell me if the results of these tests are normal? Or if you had experience with either of these tests?

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Hey Lisa,

From my understanding and experience this is really REALLY common so please don't worry.

In my own experience, I was so sick my first trimester that I couldn't keep my prenatal vitamins down. My midwives (I attended the Providence maternity clinic and saw several) told me it was okay to stop taking them until I could keep them down.

As a result I got the same letter you did - that I was anemic and needed to take extra iron supplements. So I did, along with regular prenatals, and everything worked out just fine.

I recommend voicing your concerns with your doctor or midwife, but please try not to worry - it is a very common thing, and you have enough on your mind right now as it is!

:-)

My experience with Kaiser is they have a "wait and see" policy about just about everything. Everything else they throw a cast on (ha). You will probably need to be really pro-active about getting answers that you seek. So, although this is a pretty common pregnancy issue, it is a good chance for you to practice voicing your concern until you are heard! Best wishes-

I didn't experience either of these while pregnant but I did want to pass on the name of my Kaiser ob-gyn. Dr. Wendy Smith is an amazing doctor. She thoroughly explained any issues or concerns I had during my pregnancy and I never felt rushed or talked down to. I live in NE Portland but went to her at the Beaverton Kaiser because I felt she was so fantastic. Good luck with everything!

My experience with both of these results was as follows:

Glucose: after the first test came back high, I had to go back to the office for a second test which involved chugging down a bottle of VERY sweet liquid, and then having my blood drawn a few times over the course of four hours to check the levels to see how my body was dealing with it. The main side effect was getting REALLY tired from that huge spike in blood sugar. This second series of tests came back totally normal. In retrospect, both my doctor and I agreed that the first high test was probably because I ate a piece of fruit on the way to the office right before the test. (They hadn't told me to fast.)

Anemia: Iron supplements totally took care of it!

I wouldn't worry too much, just get your followup care and don't be afraid to call your doctor with ANY concerns or questions.

Congrats on your pregnancy and welcome to Portland!

I'm a kaiser patient and had gestational diabetes. The results from my 1 hour test were slightly high; my understanding is that most people who take the subsequent 3 hour test have normal results. I didn't: I had normal fasting, but was slightly high on the other numbers. I recommend taking someone with you to the second test if possible, and taking a laluna bar or equivalent with you to eat immediately afterwards, since you have to fastbeforehand and during the test. Also, I found out my results my calling Kaiser directly and just asking, rather than waiting for them to call.

Once the results were back, I then had a nutritional counseling appointment with a specialist, watched a video on the topic at Kaiser and had a nurse that I checked in with on my blood testing results via telephone. At first I checked 5 times a day every day (first thing in the morning and two hours after every meal). After all my results were within the bounds, this testing was gradually reduced to (eventually) testing once a week.

I recommend this article: http://www.aafp.org/afp/20031101/1767.html as a good summary on gestational diabetes. It appears that the standards re g.d. vary, both within the US and internationally, and that the standards have changed over the years. The standards also vary from regular diabetes testing and standards (i.e., they are stricter with gestational diabetes standards, you drink more sugar in the 3-hour test than the standard diabetes test, etc). Also, treatment/recommendations/concerns vary a great deal between those with diet/exercise controlled g.d. and those who end up needing insulin.

I was surprised by the diagnosis. I had a healthy diet and weight pre-pregnancy and had to work a bit to put on weight during the pregnancy. I also worked out regularly. They never found sugar in my urine. I varied my diet slightly (more protein and fats) and counted carbs. I went on to have a normal vaginal delivery - my son was born slightly past his due date at 7 lbs, 2 ounces. His blood sugar was tested afterwards (they are concerned it doesn't plummet) and he was fine. No complications.

I also had slightly low iron in my last trimester, took supplements. They tested me after delivery, and I was fine, I was told to stop supplementing and just keep my regular multivitamin.


I also had gestational diabetes during my pregnancy & the previous poster put up a lot of great information.

Essentially, the placenta/pregnancy changes the way that the body utilizes & responds to insulin. Most women have no problems with diabetes once the pregnancy is delivered, although a small percentage of GD is actually picking up women who were pre-diabetic anyway and the pregnancy screening picked it up.

My daughter came a few days before her due date, also about 7 lbs

The literature suggests that some women who themselves were SMALL babies might be at higher risk of developing GD; it's not necessarily related to how well you eat or not, but rather how your body uses the insulin.

The good news of having GD is that most women can manage it with diet & exercise; you don't gain as much weight during pregnancy because you're watching what you eat, and after they establish if you're having success at managing it, you don't have to stick your finger as many times (I went from 5-6 times daily to once every 2 days). In fact, the better you already eat, the easier it will be to comply with the recommendations.

There were few foods that I flat out had to avoid -- mostly rice(!) but I had Breyer's Lite ice cream EVERY NIGHT before bed (it helped prevent the heartburn) -- I just had to watch my serving size. I think I had to make sure I ate 3 meals plus 3 snacks daily -- keeping the blood sugar levels more constant rather than sharp highs & sharp lows.

Dr. Kathleen Dalke at East Interstate is also fantastic! Always feel free to call the clinic and set up an appointment or talk to the advice nurse. I think these are common enough issues they should be able to help set your mind at ease.

Don't start to freak out... as another mama already mentioned, the glucose often comes back abnormal b/c of something that was eaten just prior to the test. I too was anemic and took iron supplements with my first pregnancy. They helped with the anemia but NOT with constipation :( I never had a warning about that and found out later that taking a stool softener wasn't harmful. So, my advice: try to relax about the glucose test, follow up with your next test and if you are still feeling confused, switch doctors/midwife (there are so many wonderful people in PDX - you should find someone you love) - next, take your iron supplement as advised, in moderation, and with a safe stool softener and increase the greens and prunes in your diet to keep things moving (hope I'm not getting too personal here). I moved to Portland late in my pregnancy and was so worried about changing doctors. I had a fantastic experience though - with the midwives at Women's Healthcare Associates, PETERKORT SOUTH OFFICE,9555 SW Barnes Road, Suite 100,Ph: (503) 292-3577, if all else fails and you're still not feeling secure about all of this, go get a second opinion. Best of luck, congratulations and welcome to Portland!

It is hard not to worry when it is your first pregnancy. Most women are anemic during pregnancy as the amount of blood you make doubles during pregnancy to nourish the growing fetus and placenta. In addition it is common for the first glucose tolerance test to return abnormal. It does not define gestational diabetes. GD is defined by the 3 hour glucose tolerance. The one hour is not fasting and there is a debate about this. The 3 hour is fasting and much more accurate. Despite the results, having a healthy diet rich in vegetables, fruits, proteins, and complex carbohydrates is the most important. In addition having more small frequent meals thought the day is helpful to prevent spikes and drops in your blood sugar

I had to take iron supplements with both pregnancies. Not being anemic led to more energy and less shortness of breath for me as well. I also had to do the longer glucose test last time. No problem and I passed with flying colors. I think it was about 4 blood draws total, each 1 hour apart. There is probably no need to worry about either. Good luck!

i had anemia as well and actually got my iron up by eating what they recommended (red meat, dark, leafy greens, some other stuff, and cooking in a cast iron pan. I had the Providence midwives and when my iron test came back low, they said, let's do it again in a month and my iron had increased so much, they thought I had taken supplements even though they told me to wait. I recommend Tori Hudson's Iron Extra (I get it at Wild Oats.) Ironically, 6 years later I am again anemic and diet and cast iron pan haven't worked. The reason I recommend the above is that it already has Vit C in it (and Vit C helps body absorb iron) and it is the only iron supplement that has not had the side effect of consitpation...

I am not a Kaiser pt, but I have heard RAVES about Wendy Smith, too.

Thank you, thank you, thank YOU all you wonderful moms. I just finished reading the last post and I feel so much better. What a great resource. . .the urbanmamas website! Update on my situation: I did have the 4-hour glucola testing on Tuesday this week, 3 of the 4 results came back fine which means that I do not have GD, however, my ob did still want me to see a nutritionist. Which I did, today, and she said that due to my fitness level and my eating habits that I should have no problem controlling it. She (the nutritionist) did say that my age (39) also played a factor along with the hormones, simply a fact of life and my pregnancy.

Also, I appreciate the passing on of names at Kaiser -- I do have an ob who I really like and connect with and after I posted my concern, she actually called me to reassure me all was okay. I just wish she could also deliver my baby, but alas, at Kaiser it's the luck of the draw who you get on the day of delivery. SO, once again, I am appreciative of all your words, stories, and simply putting out some good wah for me!!

I have Kaiser and if you haven't taken the 3 hour test, take it! For some odd reason they told me I could skip the three hour test, but then they treated me for gest. diabetes anyways! So I had to stab myself 4 times a day for weeks. It sucked. I was bad and didn't watch my food intake like I should have. My little girl was born a healthy weight and she was tested for glucose after she was born and she was totally fine. And BTW, if you have a choice of hospitals, do Kaiser Sunnyside, the new labor wing and the nurses were awesome! Good Luck!

I switched to Kaiser after my baby was born. I saw Dr. Dalke once and left telling my hubby that it was the worst appt of my life. I was referred to her after some hormone issues and post-partum counseling (that's another story - Kaiser did a study on how prevalent Post Partum depression is, yet they don't have anyone on staff here to treat it!) and rather than reviewing my history or ordering tests, she sat me in a hot room and tried to convince me to take Prozac and then questioned me on when I would be stopping breastfeeding so I could start HRT.

My former OB from Women's Healthcare recommended Kevin Overbeck at Kaiser in Beaverton. He's ok. Nice, but kind of flaky and always seems to be on vacation. He works with his wife.

Glad you have a doctor you like. It's important to have an advocate on your side or to be your own.

PS - I was anemic and took a very small iron pill from Walgreens with no side effects.

I am just about to enter my 37th week of my first pregnancy and a few months ago my OB informed me that I was pretty anemic. It was recommended that I take 325mG of iron 3x a day, which I knew could really put some other things out of whack. My glucose levels were okay, but I wanted to share with you some of the things I discovered about iron and it's absorption that have helped me get my levels up without any negative side effects. I learned that calcium inhibits the absorption of iron, while Omega 3's encourage it. I also learned that liquid iron is more easily absorbed than when it is in pill form. That said, rather than taking the recommended 325mG 3X/day I took 16mG 1X/day in liquid form and at the same time took a fish oil supplement. I also tried to avoid having any dairy at that time (though the Calcium is really important to fit into your diet at other times of the day). In addition I made sure to take my daily prenatal vitamin and threw spinach into smoothies for breakfast and snacks. I also choose to inform my OB that I was uncomfortable with her recommendation and was going to try to get my levels up a bit more creatively. It was a slightly akward conversation (I did not want to disrespect or undermine her), but was glad to make that step in advocating for my care and communicating openly with my care provider. Both she and her assistant have been impressed with how my levels have improved. I've listed below the brands of supplements I have used, just in case you find that helpful.

1) NatureWorks European Liquid Formula Herbal Iron (in the refrigerated section)
2) Nordic Naturals Omega-3 Purified Fish Oil
3)Rainbow Light Just Once Prenatal One Vegan Guard Multivitamin

I wish you well in this journey of pregnancy and motherhood!

when you are pregnant, it is necessary to know that struggling from anemia throughout being pregnant is a comparatively frequent subject

In my own experience, I was so sick my first trimester that I couldn't keep my prenatal vitamins down.

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