Friday, 20 May 2011

30w3d: Gestational diabetes

The good news is that the little guy is doing well. He is moving a lot, the placenta is moving away from my cervix, and my fundal height is on track.

The bad news is that I have gestational diabetes. I am diabetic. I rang my doctor to confirm my "no news is good news" theory, and she told me that I had failed the one hour test. Then I failed the fasting two hour test. They took another 7 vials of blood from me this morning, and I have my first meeting with an endocrinologist on Monday.

As soon as I got my diagnosis I went to the shop and bought three books on diabetes, and I have spent this morning reading the literature on randomized trials of diet and diabetes.

From the studies that I have read, it seems that the quickest way to get my diabetes under control is to follow a low-fat low-GI vegan diet. What is the evidence for this?
  • After adjustment for age, sex, ethnicity, education, income, physical activity, television watching, sleep habits, alcohol use, and BMI, an observational study found that vegans (OR 0.51 [95% CI 0.40–0.66]), lacto-ovo vegetarians (0.54 [0.49–0.60]), pesco-vegetarians (0.70 [0.61–0.80]), and semi-vegetarians (0.76 [0.65–0.90]) had a lower risk of type 2 diabetes than nonvegetarians. N = 60,903 1

  • A prospective cohort study (N = 3,158) and a case-control study (N = 596) found that compared to no egg consumption, adjusted relative risks for gestational diabetes were 0.94, 1.01, 1.12, 1.54, and 2.52 for consumption of ≤1, 2–3, 4–6, 7–9, and ≥10 eggs/week, respectively (P for trend = 0.008) 2

  • A randomised trial (N = 99) found that type 2 diabetics allocated to a low-fat low-GI vegan diet (rather than the 2003 American Diabetes Association diet) had significantly lower HbA1c and cholesterol levels 3

I had always thought that the vegan diet was only suitable for self-righteous stinky hippies, but it looks like this is what my plate will look like for the next ten weeks:

1. Tonstad S, et al. Type of Vegetarian Diet, Body Weight, and Prevalence of Type 2 Diabetes. Diabetes Care May 2009 vol. 32 no. 5 791-796
2. Qui, et al.
Risk of Gestational Diabetes Mellitus in Relation to Maternal Egg and Cholesterol Intake. Am. J. Epidemiol. (2011) 173 (6): 649-658.
3. Bardard, ND, et al.
A low-fat vegan diet and a conventional diabetes diet in the treatment
of type 2 diabetes: a randomized, controlled, 74-wk clinical trial
. Am J Clin Nutr 2009;89(suppl):1588S–96S

Sunday, 8 May 2011

28w5d: Third Trimester

I have finally arrived in the third trimester, and things are still going well. I have puffy ankles and constant heartburn, and the occasional backache, but no major problems.

Last week I had my glucose test. I know that a lot of women complain about it, but for me it felt like a right of passage. It's an experience that I had read about so many times, it seemed surreal to be sitting there with all the other pregnant ladies, drinking my sugar drink and waiting the hour for my test. I haven't heard back from my doctor, so I'm figuring that no news is good news.

The little guy is wriggling all around, so reassuring to get a little poke every hour or so to let me know that he's doing okay. I love sitting on the couch with my hand on my belly, feeling him press against my skin. It is so difficult to refrain from doing so while in business meetings when I can feel him bouncing around in there.

The nursery is finished - cot, rocking bassinet, changing table. Some friends are throwing me a small baby shower next month, which is very unusual in Europe - many people consider it bad luck to give gifts before a birth. Sometimes I feel a little presumptuous too, decorating a room for a person who has yet to arrive in this world, and it's hard to believe that in less than three months we could be parents.

Ye every day his chances of survival increase if he were born prematurely, every day his kicks feel stronger, ad every day I can feel my womb expand as he grows.

Eleven weeks to go.