Up to 22 Weeks Pregnancy
Healthy babies start with healthy pregnancies.
STARTING TO SHOW A LITTLE BUMP!
WOW! 20 weeks means technically half way through your pregnancy, that's wonderful. Movements are being felt regularly by most women now and energy has returned. This is a great time in pregnancy- the early discomforts have mostly subsided and the end of pregnancy discomforts and several months away from starting. Enjoy this time! If you chose to have a 20 week anatomy scan then you will have seen some pretty amazing pictures of your little person. We have the 2nd routine antenatal blood test coming up & I will offer you screening for gestational diabetes.
Second antenatal blood test
This is a smaller version of your first pregnancy blood tests. This time we are looking at a full blood count (known as a CBC for short) & ferritin. The CBC test checks whether your body has enough circulating iron (haemoglobin or Hb) to manage the extra requirements of pregnancy.
If your iron levels are low, you will feel more tired and will be less able to manage the loss of blood that occurs during birth.
You will be offered advice about how to increase the iron in your diet and/or iron tablets.
The full blood count also checks your platelet levels. Platelets help your blood to clot. Ferritin is the bodies stored iron so we also look that that to see the total picture of how your body is managing iron levels. We will also check for the presence of antibodies (part of your immune system).
Diabetes is when you have too much sugar in your blood, and it can make you sick and affect your baby’s growth. Diabetes screening is to check whether you already have diabetes or if you are at risk of developing diabetes while you are pregnant (gestational diabetes).
Diabetes screening is offered twice:
as part of the first antenatal blood test as the HbA1c test (or any time up until you are 20 weeks pregnant)
again when you are 24–28 weeks pregnant
How do we screen for gestational diabetes in NZ?
At 24–28 weeks’ gestation, all women not previously diagnosed with diabetes who are at high risk of gestational diabetes should be offered the diagnostic two-hour, 75g GTT. All other low risk women should be offered screening for gestational diabetes using the one-hour, 50g oral glucose challenge test known as the polycose test.
Polycose or GTT? Pro’s and cons of each test?
Polycose test: For low risk women only. It is arguably the easiest to do. You do not need to restrict eating beforehand, can go any time of the day, is 1 blood test, 1 sweet 50g drink and you only need to wait at the lab for 1 hour.
The polycose test is highly sensitive at picking up women with GDM but it is a screening test only. The downfall is that the polycose test has a high (25%) false-positive rate. This means that up to 25% of women may get a high result, go on to have the GTT which then is negative and rules out GDM.
If the result from the polycose is ≥ 11.1 mmol/L, then we refer directly to services that specialise in diabetes in pregnancy without further testing; if the result is ≥ 7.8–11.0 mmol/L, then we arrange a GTT to diagnose (or not!) GDM.
GTT: A bit harder on pregnant people! You must fast for 12 hours before the test. This means nothing to eat from 8pm, nothing to drink except water. Then go to the lab at 8am (still nothing to eat), have a blood test, drink the 75g glucose test, wait 2 hours (still nothing to eat), and another blood test.
This is our gold standard test and is what is used to definitively diagnose GDM.
Significant risk factors that indicate it is sensible to offer 75g GTT as first option at 24-28 weeks:
BMI over 35 (increased risk of 20-27%)
Women over 40 years of age (20% risk of GDM)
Pacific, Indian and Asian women (16 - 22% risk of GDM)
Booking HbA1c 41-49
Previous baby over 4000gms
Polycystic ovary syndrome
Two 1st degree relatives with diabetes
Glycosuria (glucose showing on urine stick)
On antipsychotic medication
Declining screening: you absolutely have the right to informed choice and consent. This includes the right to decline screening for GDM. I am happy to support you if you choose to decline after reading further about GDM, risk factors, chances/risks of GDM, and the importance of healthy diet and lifestyle. Part of informed choice and consent and declining of recommendations is also to accept responsibility for your choices, health, and the outcomes of those choices (whatever they may be). My role in our partnership is to present to you information, recommendations, assess and share your risk factors with you and to document your choices. I will also revisit your choice for discussion if something changes your chances of having GDM.
If you do already have diabetes or you develop diabetes in pregnancy, you will be offered information, treatment and support, including help to eat well and stay active.
For more information about gestational diabetes click here...
One of my favourite things about pregnancy is the very unique sensation of feeling your baby move! As a midwife I will ask you about baby's movements each time we see each other, and this is for good reason! A baby's movements is a indicator of their well-being. The tricky part is that every baby is a unique individual and every mum is also a unique individual. The sensitivity or activity level felt is unique to each mum. Some babies are more active than others too. What is important is to get to know your baby and its pattern of movement so that you will recognise if you haven't felt baby move or if movements are reducing so that if you are concerned, you call me.
Movements are generally first felt around 18 to 21 weeks gestation (sometimes earlier if this is not your first baby). By 22 to 24 weeks, most women will be feeling many movements a day. From 28 weeks, movements are a significant and reliable marker of your baby’s well-being.
The number of movements will increase up until 32 weeks and from then, the amount should start about the same. The nature of movements may slowly change from then until birth. If you think about the big forward rolls and ninja kicks babies do around 30 weeks, they are less like to have the space to do those big movements by 38 weeks.... but it is vitally important that baby is doing regular movements. The commonly held belief that movements slow down in the last third of pregnancy is not true.
click here to read about your baby's movements from the Australian and New Zealand stillbirth alliance....
Pre-eclampsia (PET) affects 3-5% of all pregnancies and threatens the health and life of the mother and her baby. Characterised by high blood pressure and protein in the urine, pre-eclampsia is a syndrome which can affect many organs including the brain, liver, lungs and kidneys. Scientists have not yet identified the cause although there are many theories.
At each of our appointments I ask you to pee on a urine stick & if I can take your blood pressure (BP). Both of these actions are specifically screening for signs of PET. Some of the other things I may ask you as your pregnancy progresses is if you have & any issues with intense frontal headaches, visual disturbances, or swelling in the hands or face.
Some women are at a higher risk of developing PET than others & we will have discussed this if it is the case for you. Sometimes it just develops in otherwise lower risk women though so it is important to be aware of some of the signs & symptoms and contact your LMC if you are concerned.
In some women with severe pre-eclampsia, signs and symptoms may include:
ongoing, persistent or severe headache
changes in eyesight such as seeing spots, flashing lights or floaters, blurry vision
pain in your upper belly, tummy area or shoulder
sudden and new swelling in your face, hands, and eyes (some feet and ankle swelling is normal during pregnancy)
sudden weight gain (more than 1 kg in a week, or more than 3 kg in a month)
vomiting later in your pregnancy (not the morning sickness of early pregnancy)
Seek medical advice immediately if you develop any of these symptoms during your pregnancy.
All pregnant women in NZ are offered and eligible for a free Flu Vax. This is available through GP's, and some pharmacies & hospitals.
From MoH: "Influenza (the Flu) during pregnancy can harm you and your unborn baby. Women who catch influenza during pregnancy have higher rates of pregnancy complications, including premature birth, stillbirth, and babies who are small for gestational age. New Zealand research shows that healthy pregnant women are nearly five times more likely to be admitted to hospital when suffering from influenza complications than women who are not pregnant."