Posted by My OB said WHAT?!?.
Nov
15
Posted by My OB said WHAT?!?.
“…Anything Over 8 Pounds Is Considered Macrosomia…”
“Well you definitely had Gestational Diabetes. We can tell by looking at your baby, anything over 8 pounds is considered macrosomia, and it’s caused by gestational diabetes.” – Nurse practitioner to mother at her 6 week postpartum checkup, when the nurse noticed that the mother had declined her glucose tolerance screening during her pregnancy.
There are 57 comments to this post.
Ummm right…. So I had gestational diabetes with all there of my kids? Even though I (unwillingly) took the test all three times and.passed with flying colors? Arte you.saying your tests are wrong? Guess I won’t bother next time cause you’ll assume I had it anyway when you see the size of my kids. It couldn’t possibly have smithing to do with the fact that my husband its a large.man and big babies run in his family…. Thanks nurse dumb dumb.
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road2vba2c had this to say,
Nov 15, 2011 @ 6:31 pm (Quote)
Since you don’t have proof you didn’t have it I’ll make up proof you did.
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Eight pounds isn’t the cutoff for macrosomia!
Not all macrosomia is caused by GD.
GD doesn’t always cause macrosomia.
I think at that point the mom would be justified in laughing and saying, “I didn’t realize it was Take Your Sister To Work Day. Can I speak to a real NP?”
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Heather Reply:
November 15th, 2011 at 6:56 pm (Quote)
Yup! 10lbs is the marker. I had GD with my first and not my second (or this one) and my first and second were BOTH 8lbs, 7oz.
I love that Take Your Sister To Work Day bit XD
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Jade Reply:
November 16th, 2011 at 3:29 am (Quote)
Fetal macrosomia has been defined in several different ways, including birth weight of 4000-4500 g (8 lb 13 oz to 9 lb 15 oz) or greater than 90% for gestational age after correcting for neonatal sex and ethnicity
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K Reply:
November 16th, 2011 at 2:06 pm (Quote)
That would make all three of my children macrosomic.
My husband is small in his family at 6’2″, and I am a shrimp in mine at 5’8″. My husband was a skinny 6 lb twin (twin B was also 6lb), in a pregnancy where his mother gained only 14 pounds and lost nearly 20 at the birth.
My mom, similarly, had me back when pregnant women “weren’t” supposed to gain weight… I was her smallest at 7 even (she left the hospital in regular clothes).
This notion that everyone has kids the same size is absurd. Once all people are the same size, we can be expected to have children of the same size.
My first two were 9 even (a forced c-section for asynclitism) and 8lb 14oz (precipitous homebirth). My last child was a CPD busting 10lb 12oz and came out posterior – just fine. Why was he so big? His malpositioning put off my labor – I was in prodromal labor for 10 days.
Did I have GD? I don’t think so. Perhaps the child that will grow to 6’6″ if he keeps the pace was just a big baby?
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Jade Reply:
November 16th, 2011 at 2:32 pm (Quote)
I don’t necessarily agree with that definition, but that is the definition, pulled straight from medical and nursing texts.
It would more than likely make both of my children macrosomic as well, DD was 9lb3oz and DS was 7lb at 36 weeks
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Jade Reply:
November 16th, 2011 at 2:39 pm (Quote)
I am one of 5 kids and was the smallest at 8lb 4 oz so I never expected to have small babies. Now I jsut wish I had stayed at the top of the growth charts, instead I am only 5’1 
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Lisa Reply:
November 17th, 2011 at 12:34 pm (Quote)
I’m 5’1 also, and I’d rather be short than tall. I have several uncles over 6 feet, and it’s rather nice to be able to walk under stuff without thinking about it rather than bonking my head all the time like they do. 
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Nnnnnnnnnnnnnnope! Macrosomia is, to quote the AAFP directly, “arbitrarily defined as a birth weight of more than 4,000 g (8 lb, 13 oz).” http://www.aafp.org/afp/2001/0115/p302.html
But I suppose if it’s arbitrary, we can pull any ‘ol number outta thin air, can’t we?
I won’t even comment on this NP’s ignorance about GD, except to wonder whom she bribed to get her license…
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Yeah, hi. I failed my glucose test and my son was a whopping 6 lbs. 2 oz. So….. I didn’t have GD? I took meds for four months for no reason?
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Sonia Reply:
November 16th, 2011 at 7:08 pm (Quote)
My GD baby was a whopping 7lbs 2oz and he was my chunker, my oldest was 6lbs 13oz, both four days over due and I was apparently borderline with my oldest (6 pounder) and GD with my youngest….They even had me injecting insulin because I am allergic to whatever is in the glybride. Now they just say that I just took such good care of myself that is why he never had any issues…BS! I don’t believe now that I was ever GD, or if I was, then I was just that ONE day…ugh…OH yeah and I only gained 17lbs with both pregnancies, so yeah….
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Of my three kids the smallest was 9lbs 2oz and the biggest was 10lbs 6oz. I was told that I had to take the GD test with my second pregnancy at 12 weeks because obviously they “missed” my GD with my first pregnancy that resulted in the 9lber. I took that one and the 28 week one and passed with flying colors and still had my first 10lber!
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This is one of those things that makes me wonder whether the practitioner just isn’t used to seeing fullterm babies. Eight pounds is not unusual at all for full term average gestation time. It’s not pathological…. unless you are used to seeing 37-weekers who were forced out a month early and therefore are smaller.
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LOLOLOL…oh, wait, you weren’t trying to be funny?
‘Cause my first was 11 pounds 9 ounces, and I didn’t have GD, per both the GD test and a blood sugar screen after he was born.
Of course, it can’t be that large babies run in my father’s family and my husband’s mother’s family, now, can it? (My uncle was a 12-pounder.)
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Jespren had this to say,
Nov 16, 2011 @ 4:00 am (Quote)
Obviously, silly people, if you passed the test and then had a baby over 8lbs you developed GD *after* having past the test. Because, obviously, a pregnancy can only be ‘healthy’ and ‘normal’ after the fact, so if baby comes out less than 50% perfect, something happened between the last ‘passed’ test and the birth to make you abnormal and unhealthy!
/sarcasm off.
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Jespren had this to say,
Nov 16, 2011 @ 4:03 am (Quote)
Btw, 9lbs 1oz and 8lbs 13 oz. With the 1st I passed the stupid GD test on 3 separate occassions. With my second I failed the stupid test, but in 2 months of checking my blood sugar 5 times a day I didn’t have a single diabetes level blood sugar spike (although did have 1 that was higher than my normal range).
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I must have had it with all of my kids, even though I passed the test twice.
In fact I just had a 10lb 6oz baby and I didn’t have gestational diabetes and I’m a tiny person. They did make her do blood sugar tests and the ped said the cutoff was 8lbs 13oz. My midwife, with a quick wit, said “oh, is it that low now?!” Insert nasty look from ped and big smile from midwife! That was awesome.
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aussieannie Reply:
November 16th, 2011 at 5:23 am (Quote)
I must have had it with all my kids also, even though I passed the test with all of them. My smallest bub was 10lb 6oz and my biggest was 11lb 2oz. Nurse is either ignorant or stupid??????
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Passed the GD screen, had a 9 lb 9 oz baby. I was 9 lb 11 oz when I was born, so no big thing in our family. The midwife was startled by my son’s size though. Said, surprised, that he was LGA (large for gestational age) so they’d have to do blood sugar tests. Which were all fine.
He also apparently had a huge placenta.
So, it was a little odd to me that e midwife seemed perplexed about our son being LGA, but I’ve since heard that babies of mothers with GD have a sort of characteristic chubby appearance. Kiddo was lean, just big all over. I think it was clear to the nurses that he wasn’t the result of GD, as they didn’t even do all the blood sugar tests they said they we going to
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maggie had this to say,
Nov 16, 2011 @ 6:14 am (Quote)
I had GD while preggo with my daughter, I only gained 8lbs and she weighed 6lb 14oz and was 18″ . Her father is 6’1″ and I’m 5’10″. She was the smallest baby our family has had in 2 generations even though I was the only one who has had GD. My point? Every baby is unique, I hate hate hate when drs try to fit them into a box before spending time/testing them.
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Thought macrosomia was >5000g (11 lbs).
In any case, I tested negative for GD twice and still gave birth to a 9 lb, 12 oz baby at 39 wk, 5 days. I was a 9 lb baby, my husband was an 8.5 lb baby and we are both larger-sized people even now! It was not surprising to anyone that we had a large baby.
My sis DID have GD (controlled by diet), delivered at 41 weeks and had an 8 lb, 13 oz baby.
Hmmmmmmm….
Agree with prior poster. GD doesn’t always cause macrosomia and macrosomia isn’t always caused by GD.
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Me again!
My positively enormous, 8 pound 11 ounce baby was born at 40 weeks and 5 days gestation. I refused the glucose test because it made me feel sick and insane my first pregnancy, and I was avoiding induction at all costs. Even if I had it, I knew that treating it and being induced didn’t not improve outcomes, so I just wanted to avoid induction, because induction was very miserable. I was monitoring my sugar myself, because I knew how to do it, but that seemed to not be good enough for my very first NP. I switched to another one who was WONDERFUL, jus said okay when I told her I didn’t want it, and always asked before doing a VE, and didn’t sweep my membranes at all, though if she’d asked, I would have let her, lol. I never saw anything worrying in my sugars, so I just decided it was best not to do it. I’m the one whose doctor told me in my first pregnancy that my baby would definitely have a stroke and die if I went to my due date, btw. Nothing could scare me at this point. 
Of course, everyone lost their damned minds in the hospital. They stuck her for glucose tests without asking me, then when she wanted to sleep rather than nurse, they’d wake her and make me feed her every hour and a half. For real. I’d just lay her back to sleep cause she wouldn’t eat, just sleep under my shirt, which was cool with me, lol. By her check up at 4 days, she was down to 7 pounds, 2 ounces. It worried me, but then i read that babies born after full term often carry a lot of water weight and they shed that quickly after birth. She nursed fine and was in great shape, not even a touch of jaundice.
At my 6 week, this nurse looked at my papers and told me that it was careless of me not to take the glucose test, because she knew I had GD, that one easy way to tell was by looking atmy baby. anything over 8 pounds was considered macrosomia. I called her on the carpet, told her it was 9 pounds before term and 10 pounds at any time. She told me that it had changed. Idiot. I laughed at her and told her she ought to look at her nursing school notes again, because I’d checked my sugar throughout my 3rd trimester and everything was good, and babies are supposed to be over 8 pounds at 41 weeks.
You can’t win. At 40 weeks, if they’re 7 pounds, you have IUGR, and we must inuce immediately! But if they are 8 pounds, they’re OMGHUGE! and we must induce immediately!
thats assuming they even “let” you get that far. :-\
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My mom’s first 6 kids were all 10-11 lbs, except my sister who weighed in at a dainty 8 lbs 8 oz. When she was pregnant with me, the FP had a shiny new toy he wanted to try–the glucose test. Mom passed with perfect levels. My birth weight was 12 pounds 5 and a half ounces. That half ounce is very important to my mother, she doesn’t let me forget it.
Some people are just big. Of my 19 nieces and nephews, 17 would be considered macrosomic by any standard mentioned here. Only one was under 7 lbs and my immediate thought was “what’s wrong with him?” He was an iatrogenic 35 weeker due to due date miscalculation and the scheduled cs that was moved up 2 weeks for dr. convenience. He barely clung to life the first week and has lasting executive function problems.
After my nephew’s experience and with the changing perception of “appropriate” birth weight, I was terrified that they would force me to induce early with my son. My GD test was 2 points under the high normal range and the OB browbeat me into doing the 4 hr test. Three days later my son was born. I often wonder if the shocky ill feeling I had after the 4 hr test caused his premature birth, but the medicos all claim it didn’t.
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karen had this to say,
Nov 16, 2011 @ 9:58 am (Quote)
Ever here of genetics?
A woman who was a big baby married to a man who was a big baby will likely have…..big babies regardless of golden blood sugars. I’m a big girl (5’9″ and 200 lbs). Folks assume I have big babies. Nope all 7lbs give or take a few ounces regardless of gestation (37-42 weeks). I was 7-4, dh was 7-0.
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Kristy Reply:
November 16th, 2011 at 10:20 am (Quote)
I personally have small children that were *big* babies… I get asked all the time if my tiny 4yr old was a preemie. He was 8-3! My husband’s family has some very small people on his mother’s side and my son is taking after them. Unless you ask WIC… if you ask them I’m starving this kid and simply don’t have a clue how to raise kids at all. They really seem to believe this even though they have known me since my 14 yr old was 2yrs and can see he is now taller than me and my hubby… he just happens to take after hubby’s *dad’s* side.
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Huh..l’m on pregnancy #3 (due literally any day now). First baby was 8 lbs. 11 oz., second was 9 lbs 5.5 oz. this one is not looking or feeling to be any smaller. And out of 4 glucose tests I’ve taken, I have only not passed one 1-hour test. And that was due more to a ridiculously low cut-off. Passed the 3-hour with flying colors.
In fact, when I talked to my awesome doctor about it after failing the 1-hour, and commented on my daughter’s previous large size, his response: “I really don’t think you have gestational diabetes. I think that, most of the time, women have big babies because their bodies can have big babies.”
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I am against intervention but had never considered skipping the glucose test because it just never occured to me. Is there any risks or is it just discomfort? If you have GD can they actually do anything? I have a family history of diabeties, does that put me at risk? Thanks to anyone who answers!
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Jade Reply:
November 16th, 2011 at 2:37 pm (Quote)
For me, the reason for skipping the test when pregnant with # 2 was that I did do it with #1, it was horrible, I vomited over a dowzen times in the first hour, I passed out at least half a dowzen times, I couldn’t easily walk straight or upright when I arrived because I had been fasting, I was even worse by the time we left.
If you have GD it can be controlled with either diet modifications or insulin medication.
I am not sure if you are at an increased rick for GD but I am inclined to say yes.
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Kit Reply:
November 16th, 2011 at 2:54 pm (Quote)
I just took my GD test for this pregnancy. They told me that if I vomitted they would toss the results. I’m surprised they let you continue the test with that many issues! So sorry.
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Jade Reply:
November 16th, 2011 at 2:57 pm (Quote)
If they had told me they would toss my results I would have had to laugh at them, I had hyperemesis so the chances of me vomiting were nearly 100% at the best of times, let alone restricting my food then giving me that stupid disgusting drink.
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Melissa Reply:
November 16th, 2011 at 4:46 pm (Quote)
The problem I have with the GD test is twofold:
1. It’s highly inaccurate. “Non-repeatable results”…not good enough for me.
2. The evidence is that being diagnosed with GD doesn’t improve outcomes for either mom or baby, statistically speaking.
So…while I do think that uncontrolled sugars are a real problem for both mom and baby and should be taken seriously, I choose to do things differently.
1.I offer to test my blood sugar levels according to whatever schedule my provider thinks is reasonable, instead of taking the glucola. This gives the most accurate picture of whether or not someone is, in fact, having issues with sugar. It even points out specific “trouble” times, and how bad the problem is, and can be matched with a record of one’s eating habits to find out what triggered any “bad” readings. Very accurate, quite helpful, and minimally problematic for a pregnant woman (no fasting, no throwing up after a horrible sugar drink).
2.Since the “treatment” for mild GD is simply restricted sugars and mild exercise, and since a healthy diet and exercise are good for you anyway, especially while pregnant, I just make sure that I eat well and exercise. Ta da! It’s a win-win.
More severe GD can need medication, but again, that would become abundantly clear with even a few glucometer readings.
And for the record, I’ve never had GD, and I had a 9lb 5 oz son at 41w2days. I was tested (standard glucola) and passed, during that pregnancy. It’s something I’m aware of for this pregnancy, though, since a larger baby like that is unusual, but I was a big baby, too, and both my mom and I tend more towards hypoglycemia rather than hyperglycemia (diabetes).
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jaed Reply:
November 16th, 2011 at 5:04 pm (Quote)
I’m not sure whether there are statistically confirmed risks. In the absence of studies that test this question, I would be inclined not to do glucose challenge when pregnant – especially if you are at risk – simply because putting one’s blood sugar on a roller coaster doesn’t seem as though it would be healthy for the baby, and when in doubt I think doing potentially unhealthy things is something to avoid.
That being said, I don’t know of any specific risk to the glucose challenge test, other than that it’s unpleasant.
However, given that you have family history of diabetes, you might want to look into having your A1c checked (this is a longer-term measurement that tests, more or less, how high your average blood sugar has been over the last six weeks or so). This is a simple blood draw, no glucose challenge involved. You can also buy a glucometer in order to check your blood sugar at home occasionally. Checking fasting and post-meal blood glucose occasionally is something that I think gives a better clinical picture anyway – you are measuring it in the normal situation, instead of the very artificial swill-a-buncha-pure-glucose situation in a lab.
If you do have blood-sugar abnormalities, the best course will be to limit carbs (sugar and starch-rich foods) somewhat, emphasize veggies and protein, eat carbs with a meal when you have them, do some exercise, and keep monitoring to make sure your blood glucose doesn’t get too high. Much of this is what you’d be advised to do anyway in pregnancy and most of the time it’s enough to get blood sugar to stay in the normal range.
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Ellen Reply:
November 18th, 2011 at 12:16 am (Quote)
Fasting itself is a risk of the GTT, as you point out in your own first paragraph.
http://www.kristycolley.com/2011/08/26/the-inaccuracy-of-the-1-hour-glucose-tolerance-test/
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Uh… I was tested, came back negative, and my son was 9lbs 8oz. I gained 30lbs.
BIG WHOOP!
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Jade Reply:
November 16th, 2011 at 3:01 pm (Quote)
According to the definitions of macrosomia, both of my kids were macrosomic. I passed the test once (didn’t do it 2nd time around), gained absolutely nothing ans still had babies that weighed 9lb 3 oz and 6lb 9oz at 36 weeks
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Cattaca Reply:
November 17th, 2011 at 8:48 am (Quote)
I gave birth to a 8.5 lb 21″ long baby girl with a 14″ head. Long and lean. The nurse freaked out because she thought she was so big she must be a “blood sugar baby” and waaaay over nine lbs. She didn’t calm down until the weigh-in an hour later. I’m 5’7″ and run 150 lbs and gained 40 for the pregnancy and lost 20 the day of the birth. My 5 month old is wearing 9 month clothes because she is so long, but even though she eats as much breast milk as she wants she can’t even fill out the girth of a 3-month old outfit.
Bottom line, every baby is different. The OB profession is just so bored they need to invent medical emergencies so that they can have something to do between the relatively rare REAL medical emergencies.
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Sara Mitchell had this to say,
Nov 16, 2011 @ 6:38 pm (Quote)
Funny, cuz I had an 8+ lb baby and I did not have GD….
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Jenny Islander had this to say,
Nov 16, 2011 @ 8:05 pm (Quote)
My midwife counseled me to skip the test because of the discomfort and especially because of the high incidence of false positives, leading to interventions, leading to further discomfort and possibly iatrogenic complications. I finally did skip the thing with my third pregnancy. They freaked out about my great big fatty fat fatness and hinted around about firing me–this was the only practice in my insurance network and they knew it–so I borrowed a glucometer from the midwife and, what do you know, solidly in midrange every single morning.
And also–they said firmly, “You MUST use a glucometer and you MUST report at all times (so we can be sure you didn’t explode and die),” but when I didn’t buy a glucometer through their office, oddly enough, nobody seemed to care about the results. Gee. I guess my fatty fat butt is only in danger if it’s billable.
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Considering the pregnancies I DID allow for the GTT and they came back NEGATIVE and I STILL had baby’s over 9lbs . . . that is the biggest BS line Ihave ever heard of.
When I started doing UP/UC I got my own glucose tester and I was still normal all the time. My biggest baby was 10lbs 9oz and I only L&D’d for 45mins.
I grow my kids fast and big. My smallest was 7lbs 3oz and my biggest 10lbs 9oz, with a LOT of 9 pounders in there. (I have 8 kids) Still no diabetes and never ONCE GD.
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Add Your Comment.
That’s nifty.
I was 8lbs 4oz and my mother did not have gestational diabetes. A friend of mine had a 9lb 9oz boy and also did not have gestational diabetes.
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