That Thing Called GDM

The individual uniqueness of every child, starts with a unique pregnancy. I must say that all my 3 pregnancies went smooth. I never had morning sickness or episodes of severe vomiting. Yes, I'm blessed that way. The only thing I was battling was increased daytime sleepiness which is a major struggle for a resident doctor (and a mom, too) like me who is expected to be awake and active 24/7. But, there's a peculiarity in every pregnancy. My 1st one was totally unremarkable while I had UTI and fetal malpresentation with my 2nd pregnancy that I ended up undergoing elective cesarean section. This time, guess what I do have? At 24 weeks, I was diagnosed to have Gestational Diabetes Mellitus (GDM) which imposes a lot of risks for me and the baby! What is GDM and how did I unexpectedly acquired it?

Gestational diabetes is a form of diabetes that is developed during pregnancy. It is usually diagnosed at 24-28 weeks AOG after a 2-hour 75-g oral glucose tolerance test. You can read more about it here, but the gist is, GDM occurs because "the placenta, which connects your baby to your blood supply, produces high levels of various other hormones. Almost all of them impair the action of insulin in your cells, raising your blood sugar."

Meaning, there is insulin resistance so a little intake of sweets from all forms raise the blood sugar immediately in multiple folds. Prolonged exposure to high sugar level poses risks for both mother and child. The mother will have a 7x risk of developing overt diabetes after pregnancy and a chance to develop GDM in the succeeding pregnancies. The child on the other hand will be macrosomic (large for gestational age) which is a risk for preterm birth, difficult vaginal delivery and cesarean section. Upon delivery of the baby, he will also have hypoglycemia which may have detrimental effects. It's scary to have GDM, right????

I really thought I will NEVER have the diseases since NONE of my family members on both sides of my family has it. Yes, my family is a bunch of hypertensives but gladly, non-diabetics. So how did I get it? I'll enumerate the risk factors for you, which means, if you have any of the following, you have a chance to acquire gestational diabetes too! Here goes:

• Prior GDM
• Glucosuria (you'll know when you have your urine checked, aka urinalysis)
• Family history or first-degree relative with Type 2 Diabetes Mellitus
• Polycystic Ovary Syndrome (PCOS)
• Age >25 (this is one of the culprits!)
• Overweight or obesity (and this one, too!)
• Macrosomia in previous or current pregnancy (defined as baby born >8 lbs.)
• Polyhydramnios in current pregnancy (your OB will suspect if you have extraordinarily huge preggy belly and confirmed through an ultrasound scan)

From the list above, I only have two risk factors, one is modifiable and the other is non-modifiable. I cannot do anything with my age, I just turned 33 last month and I am nothing but grateful to have reached this age. The downside of ageing is that everything in the body goes downhill once you do not practice a healthy lifestyle---hence, I am overweight by more than 10kg. I eat a lot. As in, a lot. I do not exercise (excuse: residency!) and I am in a department where there is a daily feeding program. Lol! I know what we do is a major contradiction to what we tell our patients but we're all ranging from overweight to being obese here. Pharma companies love feeding us so as our consultants. We do not run out of food, all sort of sinful food, on the table. My biggest sin is indulging. I indulged. A lot. And now I am facing the consequence. 

When I saw the result of my OGTT, dang! It hit me. All the milk teas I drank and all the chocolates I ate came back to me in a flash. They're the sweet villains to my growing bump! They lured me into the depth of destruction! Ugh. 

My OB advised me to see an endocrinologist but that would take me time. Thanks to my Endo  Fellow friend, Racquel Bruno (Iligan peeps, abangan niyo siya once she starts her practice there, she'll be the BEST Endo in town!) who's just a private message away. She put me under a tight diet---no white rice, no white breads, strictly NO cakes, ice creams, milk tea, biscuits and ALL sort of sweets. Huhu. How do you think I will live without RICE and BREAD? They're my LIFE! 

The most painful part is monitoring my capillary blood glucose (CBG) twice a day (pre-meal must be <94 mg/dl and 1-hour post-meal must be <140 mg/dl). Physically and financially painful. Glucometer is quite costly and so are the glucose strips! 

Glucometer.

How do I cope up with this? My motivation to force myself into following a low carbs, low sugar diet is my plan of undergoing a normal delivery and of course, for my baby. Aaaand I DO NOT WANT TO INJECT INSULIN ON MY BODY! (Insulin is the only medication for GDM, according to guidelines) So I shifted to eating brown rice and cutting my rice intake to 1/2 half cup a day. Yes, a day. No more breads too. I researched on the different kinds of food with low glycemic index which brought me to this meal plan:

• Breakfast: 1-2 pcs of boiled saba banana and 1 cup of milk (boiled banana is being sold outside the hospital), sometimes I opt to eat yellow corn for a change.
• Lunch: 1/2 cup brown rice and any viand available (I'm on brown rice for two months now and I'm loving it!). Fruits for dessert, usually banana or apple. 
• Dinner: salad or a piece of fruit and lots of water. 
• Snacks: peanuts or any nuts, and/or fruits

To be honest, I am inclined to eating healthy naman talaga, it's not as if eating more veggies and fruits are new to me. It's just that I got swayed to eating more of the non-healthy side and I indulged for quite some time (culprit: Family Medicine Department). Alhamdulillah I got back on track. I lost 3 kg on my first 3 weeks of dieting which, according to my OB, is okay since my baseline weight is overweight. Ouch. Lol! Also, I really feel much better now that I am eating healthy again.  

Having GDM reminds me that, one, I AM NOT EFFING INVINCIBLE! I may be a doctor and I know how to prevent the diseases and treat them, but temptations are always lurking around. We are human beings too and we are not exempted from any kind of diseases. Ironically, we, doctors, are among the most unhealthiest of people. We do not exercise, we do not eat healthy and we do not rest/sleep well. Second, having no family member who has diabetes does not mean I will not have it too. Diabetes Mellitus is not mainly hereditary, it can be acquired too, same with the rest of non-communicable diseases we are seeing such as hypertension and the metabolic syndrome. These diseases are siblings and they're born to an unhealthy lifestyle. #lamonpamore Third, I need to seriously think of my health now if I want to live longer for my kids. I don't want to be under maintenance medications in the future so I need to keep my body in top shape. 

Grabbed from the internet

Now if you're pregnant and reading this, THINK A MILLION TIMES before you get that slice of cupcake into your mouth. Wait for a few months before you indulge in milk tea and your favorite donuts. Those chocolate bars and chocolate cakes? They can wait in the fridge! 

I'll be giving birth in few weeks, in shaa Allah, and I have already talked to the husband to have a box of J. Co donuts and Gong Cha Milk Tea Cream Cheese with pearls right when I get wheeled out of the delivery room. Don't I deserve such sweet treats after months of deprivation? But I promise to cut down on sweets after delivery for my own sake. 

How's my sugar doing so far? Well, I got used to the routine of CBG monitoring showing that my sugar level is controlled. Alhamdulillah. I had my third trimester scan yesterday and the baby is appropriate for her gestational age and I have an adequate amniotic fluid. In other words, the baby is healthy, in shaa Allah. Please pray for me, guys, as I am determined to push myself for a VBAC (vaginal birth after cesarean section)! We can do this, baby! Bismillahir rahmaanir raheem.

G3P2

Assalamu'alaikom! I know I blocked the lighting in this photo (husband didn' tell me so! tsk tsk, poor photog skills) but Baby #3 says hi!

Maternity Shoot

Last Sunday, my husband Jabar gave in to one of my wishes---an outdoors maternity shoot. It was very amateur as we had his sister who's temporarily staying with us to get behind the camera while Jab and I did the directing and, of course, acting! It was also very awkward as it is our first time to do something like this (we previously didn't have a prenup or postnup photo shoots). Hahaha! I'm sharing with you the best shots that we were able to muster. 

I searched the internet for some posing ideas as well as the best location here in Bangkok which turned out to be at the King Rama IX Park,  the largest green space in the city. 

That ring I was wearing was from my Mom, her own wedding ring that she handed down to me. It used to be very loose on my finger but now, it fits snugly! 

One thing I realized, we should have done this at around 30-33ish weeks AOG when the baby bump is evident but not too huge and the body swelling has not yet materialized. I'm on my 38th week now so aside from the discomfort arising from the heavy bulging of my entire body, there's a threat that I might just contract anytime. Haha! 

I'm really glad that we were able to pull it off even though 1.) we're not still very familiar with our EOS-M Canon (yan na nga lang hirap na ako ano na lang 'pag yung mga highly professional cams? tamad lang talaga akong aralin ang specs nya. lol!) 2.) it was soooo hot! 3.) worst case that can happen in a photo shoot? Run out of battery and having no extra to use!! It happened! So we had very limited shots plus we were in a hurry as the red warning sign blinks. Kaloka! But it was a fun day and I'm grateful that Jabar was cool about it! 

Preggo Woes

Working my butt off in the gym at 27 weeks AOG.

                           

This pregnancy brought out the paranoid person in me. Since this is a planned pregnancy, I took all the necessary precautions as I was anticipating for a possible conception. I was taking folic acid as early as 2 months before I got married (and stopping every time I found out I'm not yet pregnant, haha), got rid of all whitening lotions and creams, finding my way to eat healthily and I took yoga classes when I got here in Bangkok. I was ready to do anything just to have this little muffin. 

One year and nine months of marriage and four unsuccessful attempts later, my pregnancy sets in however it is accompanied by a hullabaloo of negative scenarios such as abortion. As much as we want to share the good news to everyone, I asked the husband to keep it to ourselves for the mean time as I was afraid I might only disappoint our loved ones if I lost the embryo. But our little secret didn't last a week as he was super excited to break it to our immediate family members. We implore them to pray for a successful and healthy pregnancy and baby.

At 27 weeks as of writing, the last week of my second trimester, I am beyond grateful that everything went smoothly since day one. I suffered the usual 1st-tri distress of headache, nausea and fatigue on an almost daily basis for almost three months. Adding to that is the contrasting hunger pangs and lack of appetite. I mainly craved for Maranao food particularly my Mom's cooking but since it's out of my reach, I can only be patient with whatever in store for me here. I didn't want to make my pregnancy a burden to my husband, I am lucky enough that he frequently brings me anything I might want to eat but my taste buds seemed to have been numb during those days. So unlikely of me. I am quite lucky to be not working while pregnant because I can just lie down at home whenever I feel nauseous (I haven't experienced vomiting, lucky me), I can only imagine those mothers or mothers-to-be who are enduring all the discomfort in the middle of work.  

My baby bump says hello! :)

On the second trimester, the discomfort gradually disappeared but my appetite came back not without a fierce revenge! I eat almost every 2-hours that my taste buds seem to be very accommodating to whatever you shove in my mouth! Consequently, I gained quite a lot of weight, some few pounds in excess of what I am supposed to gain at this stage of pregnancy. I try to eat healthily, meaning totally cutting out caffeine and soda drinks, more on dairy products, fresh vegetable and fruits, fish and meat, rice and bread. I try to strike a balance with the nutrients that my baby and I need without gaining too much weight, but I guess I can't help to eat more than what is required. Well, I'll deal with that post-delivery. Haha!

As I am gearing towards the third and final trimester, some of the physical discomforts are slowly coming back. I suffer from pregnancy insomnia, difficulty of breathing when lying flat on my back, allergic rhinitis attacks, the creepy-crawly sensation on my legs whenever I lie down to relax which urges me to frequently move my legs (restless leg syndrome), and my appetite is no way going downhill. My baby kicks very strongly and frequently nowadays that sometimes she's giving me a hard time to sleep. With all of these, never did I complain. I embrace all these distress and consider it as a blessing. With all the pessimistic scenarios brewing in my head during the first trimester, I am so grateful that my baby and I have reached this far. In few months' time, I will cradle my beautiful daughter in my arms and shower her with all the love in this world, in shaa Allah. I always caught myself daydreaming about her and our future conversations. The husband and I are so blessed beyond words.  

Confirming the truth of what other mothers say, it is during one's pregnancy that one realizes to appreciate our very own mothers. Being a firstborn, I constantly think that all the excitement stirring inside me must be the exact same feeling that my Mom had when she was pregnant of me. My Mom was even working so I can only imagine what she went through for the six of us, most especially when she was pregnant with my triplet siblings! OMG. True enough, no matter what we do for them, we cannot repay all the hardships that our mothers have endured to bring us out into this world and eventually in raising us to be morally upright people.

My parents are coming over here in Bangkok in two days' time, I am so excited to tell them my pregnancy story.  I cannot wait to hug my Mom so tightly and THANK her for everything she's done for me and my siblings. Friends, while we still have our mothers with us in this world, let us not waste a single opportunity to give them joy and happiness. In shaa Allah. :)