Before we get going, I truly think that preeclampsia is one of the biggest things that can make a change to your birth plan. Knowing about unexpected or unplanned events is one of the things that can really make your birth better. Taking a class that reviews common things that happen in labor, but aren’t planned for is so smart. I recommend this one.

Ok, let’s get going.

Aspirin Can Decrease Your Risk

This one’s for my friends who are still early in your pregnancy. You want to start this prior to 20 weeks (but talk with your provider about you and your specific needs).

Low-dose aspirin is recommended to be given to pregnant woman who are at risk of preeclampsia. The list of who’s at risk is long, and is sometimes shifting, so I’ll leave that up to a discussion between you and your provider.

It is not recommend for EVERY pregnant patient, and in fact — some should NOT be taking it. BUT, your provider should go through some specifics to decide if it is right for you. If they haven’t please ask them about it. Some of it is based on your current medical history, as well as a family history — so they need to ask the questions.

Studies have proven that in those of risk of preeclampsia aspirin can decrease your chances of getting preeclampsia — meaning:

• You get it later in pregnancy (allowing baby to grow longer inside)
• You get it less bad (meaning we don’t have to treat you as vigorously)
• You don’t get it at all vs without aspirin.

Now, aspirin is something we USED To say was a big no-no during pregnancy, so I’m really grateful for the studies on it. I did a whole podcast episode on it if you want more info (it’s not long).

This is a big soapbox for me, because it’s SUCH a change from when our moms were pregnant. Just like how we started laying babies on their back it is something we all have to talk about and discuss with our pregnant friends until this is normal. Yes, your mom may freak out when you tell her you’re on aspirin, but let’s all work together to educate each other!

The crazy part about aspirin is that we really don’t monitor for preeclampsia until about after 20 weeks — while it’s always worthwhile to talk to your provider about the symptoms we’ll talk about in here, we generally don’t think preeclampsia until after 20 weeks (and honestly, usually later).

Want to know more early pregnancy tips — check out these posts:

• 5 Do’s and Don’ts of the First Trimestser
• When to Announce Your Pregnancy
• 10 Things to Do When You Find-Out You’re Pregnant
• The Fear of Miscarriage or Loss
• Should You Buy Your Own Fetal Doppler?

BTW want other awesome tips like this that can make pregnancy easier, come join my newsletter:

Want to know more about preeclampsia — the signs, symptoms and treatment << that post on my sister site has a ton more info! It goes a bit more in-depth as to what it DOES to your body.

It Is Easily Detected

Some providers act like it’s a huge deal to test for, but it’s not.

If you are having symptoms of preeclampsia which include:

• Blurry Vision
• Headaches that don’t go away with Tylenol, hydration and sleep
• Right sided pain under your ribs

Most often in the doctor’s office they find it with a blood pressure check which triggers us checking other things — it can be a symptom of preeclampsia (but not always) and we will talk more about that.

Fun Facts: Swelling used to be a symptom, but it’s not really anymore — however if you notice suddenly you are VERY swollen when you wake up, I’d definitely call your provider — especially facial swelling. Swelling up after a long day on your feet, or swelling that happens daily tends to just be a symptom of pregnancy, not so much preeclampsia.

If you’re in the second half of your pregnancy, and having symptoms — they should be willing to do some preeclampsia labs. Most places call this a PIH panel (PIH is an anacronym that we used to use for preeclampsia, not anymore). It includes (although every facility varies a bit by what they order):

• A urine test to check for protein in your urine (sometimes just a urine test, or sometimes it’s a protein creatinine ratio check)
• A CBC to check platelets and for anemia
• A CMP (complete metabolic panel) or something that checks for liver enzymes and uric acid.

If you’re in the hospital to get the check (along with an NST) we’ll do blood pressures every 15 minutes or so to check it a few times as you lay in different positions (we call these serial blood pressures).

It can be helpful to remember that these labs are looking for HELLP syndrome which stands for:

• Hemolysis — destruction of blood cells which can lead to anemia and organ damage if left unchecked
• EL — elevated liver enzymes — because your liver function is being effected
• LP – lowered platelets — which can cause bleeding issues

This always reminded me that the big things we look for in those labs are:

• Liver Enzymes –are they elevated? This shows your liver is being compromised by the condition (and may enlarge — which is why you get that right sided pain)
• Platelets — are they low?
• Uric acid — is it increased (it rises due to how your kidneys filter urine if you have preeclampsia)
• Are you spilling protein in you urine, and if you are what’s the protein creatinine ratio (some places still do a 24-hour urine but it’s SO inconvenient, I don’t know why they don’t use that protein/creatinine ratio) — this also increases as your kidneys change how they filter with preeclampsia

All of those lab tests can be done at most labs, they don’t have to be sent out and are ordered VERY frequently.

In fact, often at the Dr’s office they can at least spot check your urine for protein, and they check your blood pressure. That’s a start.

While you can have preeclampsia with “normal” blood pressure, most often you’ll see it rise from what your baseline is (so, if you started off low, and now it’s a bit above what’s “normal” — that’s an increase for you and should be noted).

It is also possible to have preeclampsia with a normal blood pressure (but you’d have other symptoms and the lab work will show it).

All of this to say that lab work can really give us the full picture of if or how it is affecting your body.

One thing I’ve heard a lot of experienced practitioners say is that if the patient is saying “this is the worst headache of my life” we really need to take it seriously and it is often due to preeclampsia — if your headache is that, PLEASE contact your provider right away.

It’s not JUST High Blood Pressure

If you have high blood pressure, but all your labs are normal — that’s gestational hypertension (hypertension is just a fancy word for high blood pressure). This can often be helped with medications like Labetalol or Hydralazine — both of which are blood pressure meds routinely given to people to lower their blood pressure.

While also not great, high blood pressure isn’t just a sign of preeclampsia.

Note: If your blood pressure is elevated, but your labs come back fine — your provider should be considering blood pressure medication for you. As you can imagine just having high blood pressure for days on end isn’t great for your system, especially when medications can be effective in lowering it. If they don’t, I think it’s worth asking about.

Sometimes this high blood pressure starts to resolve once baby is born, or you may end-up with longer term hypertension — so, that’s definitely something to keep an eye on. They should be checking it after baby is born as well.

ONE high blood pressure doesn’t mean that you have high blood pressure. Mine was always high first thing in the office. I think I just found being called back stressful (often with a child in tow) — but if they’d take it after I settled into the room for a bit it was fine. However, it’s always something to keep an eye on.

It Can Be a Reason to Deliver Early

Preeclampsia is one of the most frequent reasons that we induce people early.

It is believed the MOST often preeclampsia is resolved by removal of the placenta. That doesn’t mean it’s immediately resolved, but that is the best “cure” for it. It can still show-up later-on (keep reading for more info on that).

The other things we do are just to manage to keep you and baby healthy through the remains of your pregnancy.

Really quickly, I’m going to talk about how we treat preeclampsia, but this section may not be for everyone. Some of you may want to just skip to the next heading. If you have no signs of preeclampsia, I don’t think there’s any reason to dive into the treatments if it makes you worried.

In case you’re wondering, the main treatment of preeclampsia is magnesium sulfate via IV in the hospital. It’s definitely not my favorite drug. It can make you feel pretty hot and miserable, but it helps your blood vessels relax so we don’t head into eclampsia — which is when you start seizing. We are trying to avoid that at all cost.

Any Downton Abby fans out there? — that’s what Lady Sybil had.

They may also give you high blood pressure medications if your blood pressure is high.

And, they will induce you to get the baby out. If things are extreme enough they may recommend a cesarean section because they think getting baby out fast is the best thing for you and baby.

Want to know more about inductions — check out these posts:

• 5 Things NOT to do Before Your Induction
• Pitocin to Induce Labor
• 5 Reasons to NOT Get Induced
• What to Expect at A Foley Bulb Induction
• What Happens if Your Induction Doesn’t Work?

It Can Show-Up Postpartum Too!

One of the MOST annoying parts of preeclampsia is that even though we think it’s best treatment is to get the baby OUT — it can still show-up postpartum.

EVEN IF YOU DIDN’T HAVE ANY SIGNS OR SYMPTOMS OF IT DURING PREGNANCY.

Did you see I put that part big and in cap’s? Because I really mean it.

EVERYONE needs to watch out for it postpartum. The signs are the same as above.

• Blurry Vision
• Headaches that don’t go away with Tylenol, hydration and sleep (especially that “worst headache of my life part”)
• Right sided pain under your ribs

Too often moms ignore the signs in themselves because they’re so busy watching out for the baby.

I recommend that EVERY pregnant family know the signs and symptoms of problem signs postpartum so everyone can be watching out for them.

The good news? You don’t have to wait to be discharged from the hospital to learn them. I go through them in Postpartum Care Made Easy. I think pregnant patients, partners and even grandparents or other support people should run through the symptoms so they know them. I’ll send them all right to you (it’s free):

I really do believe that preeclampsia is something that catches a LOT of people off-guard. It is most often found in generally healthy individuals who haven’t had serious health problems prior to pregnancy — so it really catches you unaware it can be as big of an issue as it can be.

Honestly, there’s a lot in pregnancy, and third trimester testing (like PIH labs) that catches people off-guard — but it doesn’t need to.

You have the time to get prepared and I 100% recommend you do so in this class. It isn’t going to take over your life, it encourages partners to come learn too and it’s taught by an expert you can trust to get you prepared.

Oh, and it includes three whole sections on both what to expect postpartum and staying vigilant for problem signs, because far too many moms are dying from things we can prevent. I’m here to help those, one pregnant couple at a time.

Ok, those are the 5 things. I wanted to keep it simple so you knew what to keep an eye on. These will help you watch out for them, and know a bit more as you talk with your provider if you see any problem signs.

Did YOU have issues with preeclampsia? Tell us in the comments!

The post 5 Things You Need to Know About Preeclampsia appeared first on The Pregnancy Nurse®.

As a note: I failed the glucose test a number of times.  It absolutely sucked.  So I get. you!

Pro Tip: if you’re looking at your third trimester, now is also the time to get one of these!

What happens if/when you fail your 1-hour glucose screening?

There are two options.

For most people, they will recommend the 3-hour oral glucose tolerance test (sometimes called glucose screening test, or a glucose challenge test or OGTT).  We’ll talk more about that in a bit.

For some people, who fail it by a lot they will just diagnose you with gestational diabetes mellitus (GDM).  That means you’ll then visit a dietician and come up with a way to control this with diet.  If that doesn’t work they will then work on medications (most often oral, although some people will need insulin now and then) to help control it.  You’re just basically skipping the 3-hour test because you will most likely fail it.

Pro Tip:  most of this info is from the United States.  I have heard of other countries that just start with a 2-hour test, but in the US the standard of care is to offer the 1- hour test and then if you fail that, do the 3-hour test.

What’s the Three-Hour Glucose Test?

It’s a lot like the first test, but it’s 3 hours (2 hours longer)

I believe all providers want a fasting glucose, which means you’ll want to do this test early in the morning as you won’t be able to eat until you’re done.

They will take your blood glucose upon arrival (checking your fasting blood glucose level), and then will have you drink a more sugary glucose solution than last time (it has more sugar in it than before).  You’ll then have a blood draw a one hour, two hours and a final one at 3 hours. 

Then you’ll want a nice snack that balance carbs and proteins.  I always did a PB&J sandwich as it had some proein with the peanut butter, and lots of carbs to help carry you through until you get home and have an actual meal.

It is REALLY important that you not eat or drink anything during the test.  Some places will allow small sips of water, but if you were to eat during the test it will nullify the results and you’ll have to start over.

The lab will test these blood samples for the glucose level in your blood as insulin kicks in.  The hope is that your blood glucose levels go down nicely as time goes by.  The test result is normally reported by the next day (although it varies on when you will get the information).

Fun fact: You can fail one of the 3-hour tests and still not be diagnosed with GDM, just failing one in the 3-hour glucose challenge test isn’t enough to diagnose you.

You may be thinking this is just ONE MORE THING. I get that. I think there’s so much to do and think about in pregnancy. However, I think every pregnant couple needs a birth class to have the best hospital birth they can. I recommend this one. Here’s why:

• It can be done in just a few hours because I know you’re busy
• Created for couples because I know you want a teammate, not just a cheerleader
• Created by an expert you’ll be prepared for most hospital scenarios (because I know you LOVE feeling prepared — that’s why you’re here).

What if I fail the 3-hour glucose test?

Valid question, but I want to be really clear that just because you failed the 1-hour does NOT mean you’ll likely fail the 3-hour.  

As far as I can tell, about 25% of the people fail the 1-hour glucose test, and only 2-10% of people are ultimately diagnosed with gestational diabetes.  So this isn’t a time to catastrophize and worry about what life will be like diabetic.  Let’s just take each step at a time.

BUT, if you ultimately fail the 3-hour test you’ll be diagnosed with gestational diabetes.

They will encourage you to check your blood sugar in the mornings and after every meal.  If those numbers continue to be high, even when you’re eating the proper diet, they may recommend medication like metformin or possibly insulin depending on how off the numbers are. If your blood sugar are in the in the normal range, they will encourage you to continue the diet they recommended (usually a certain # of grams of carbs in each meal, balanced with protein).

The VAST majority of people who have gestational diabetes control it with diet alone, and don’t need insulin shots or even oral meds.

Pro Tip: SO many people think they were mis-diagnosed with GDM because their levels remain very stable on the diet.  But GDM could progress quickly as you progress in your pregnancy so it’s really important you keep an eye on it.  The glucose test are just our best way to check for who’s at risk.

I would give a plug here to see a dietician to learn about how to best eat if you are diagnosed with gestational diabetes.  Many providers try to handle it on their own, but a dietician visit would be the gold standard of care.  Often these can even be done remotely.  Even if your doctor wants to “handle” it on their own, you could ask them if there’s someone you could see to really dial in your diet.

OR you could just use the glucose monitor, and see how your sugars are.  The big hope is that your sugars will remain in the suggested guidelines and with small modifications you’ll have a term, healthy pregnancy.

I recommend a dietician because they can really help you with some life-long guidelines to help your eating habits. Dieticians are an under-used resource!

I think diet is so important, I actually have a dietician teach a bonus video in here to talk about balancing carbs and proteins for ALL pregnant people! So helpful!

Is there an alternate test?

Man, I wish. There are various reasons why they have to do this test this way…. which really stinks because I agree it’s HORRIBLE. I FEEL horrible after it and it frankly isn’t awesome for our bodies. But, because it’s a one-time test and it can tell if we’re going to have issues further down the road.

If you absolutely don’t want to take the 3-hour test talk with your provider. Some recommend taking your blood sugar a few times/day for a few weeks to see what the results are. Many people would prefer that to the 3-hour test, so see what works for you after discussing it with your provider.

Unfortunately, the only one studied well is doing the 3-hour test as it is now.

Want to know more about the glucose test — check out these posts:

• Avoid Failing the Glucose Test During Pregnancy
• What to Eat Before Your Pregnancy Glucose Test
• Your Glucose Test During Pregnancy: How to pass it.
• Signs You Passed Your Glucose Screening Test During Pregnancy
• The WORST Parts of Pregnancy

What else happens?

You may have an extra anatomy ultrasound, BPP’s and NST’s. 

Understanding your third trimester testing is SO important. It is often where interventions start, and understanding the ROOT of them, will help you make better choices.

If you’re diabetic there are good chances of more interventions with your pregnancy, or at least being offered them (like being induced early).  It’s really important you know how to talk with your team to get the information you need to make choices as you head towards to your due date.  The Online Prenatal Class for Couples is the easy way to get prepared for all of that.  You’ll feel so much more prepared and confident for what you might face (it includes that information on testing you might have done too).

I know a lot of people take a diagnosis of gestational diabetes as a death sentence, but the vast majority of people resume their regular eating patterns after they have the baby.  It doesn’t mean that you shouldn’t watch your blood sugars and how you eat afterwards. 

If you have gestational diabetes you do have a higher risk of having diabetes as you get older.  Being pregnant puts similar strain on your cells as getting older, and this can be a map of what to expect as you age.  So, take it seriously, but also be aware that life is going to go on.

Some people may be diagnosed with type 2 diabetes after pregnancy if sugar levels continue to be abnormal.  Most often they recommend a 2-hour glucose tolerance test 6-12 weeks after delivery to see if you have lingering blood sugar level issues.

I really did want to give you a pat on the back for taking this test during pregnancy.  SO many people just stick their head in the sand or say the test has too many preservatives so they don’t want to take it.  but undiagnosed diabetes in pregnant women does puts you at risk for severe complications for you and baby including stillbirth.  So I’m so glad you’re taking your recommend tests between 24 and 28 weeks of pregnancy.

And, like I said — if you’re at the point where you’re taking these tests you’re at the PERFECT spot to get your prenatal class in.  Studies show it reduces your chance of a C-section or other interventions at birth so come join me in here.

And, if you’re not quite sure you’re ready for that whole thing, check out my free lesson for you. It’s your first step toward getting in the driver’s seat of your birth.

This is just a part of my series on The Pregnancy Glucose Test For Gestational Diabetes << be sure to read that post for ALL the info on that important test!

The post You Failed Your 1-hour Glucose Test – What’s Next? appeared first on The Pregnancy Nurse®.