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All Posts in Category: Pregnancy

How Group B Strep Seriously Affects Pregnancy and Newborns

As part of July Group B Strep Awareness Month, Women’s Telehealth encourages all pregnant women to make sure they complete their Group B Strep testing as part of routine prenatal care.

Group B Streptococcus (GBS) lives in the body naturally and it is a bacteria normally found in 25% of health adult women’s rectum or vagina. Women who test positive for GBS are considered “colonized” or a “carrier.”

GBS is not normally harmful to the mother, but can be harmful to the newborn. A pregnant woman can pass on this infection to the baby during delivery. Not every mom will have symptoms of a GBS infection and not every baby born to a mom with a GBS infection will become ill. While GBS disease can be deadly, there are steps pregnant women can take to help protect their babies.

GBS Testing

The CDC recommends all pregnant women get tested for GBS between 35-37 weeks gestation. The most accurate results are within a 5 week period prior to delivery. The rectum and vagina are swabbed during the antepartum OB appointment and the sample is sent to the lab for processing. The results are usually available with a few days.

Rapid screen GBS tests are also available if a woman presents at a facility to deliver and has not had a GBS test completed. If a pregnant woman tests positive, treatment is considered.

Treatment

Intravenous antibiotics (usually Penicillin for non-allergic patients) are given to women who are at increased risk of having a baby who will develop GBS disease. The antibiotics help protect babies from infection, but only if given during labor. Antibiotics are administered from the onset of labor and continue every 4 hours through to delivery.

The following symptoms may indicate a higher risk of delivering a baby with GBS:

  • Labor or membrane rupture before 37 weeks gestation
  • Membrane rupture more than 18 hours prior to delivery
  • Fever during labor
  • Previous baby born with GBS
  • UTI as a result of GBS in pregnancy

If the baby is delivered via C-section and there is no labor or rupture of membranes, antibiotic treatment is not given. About 1 out of 200 babies of moms with GBS will contract the infection without IV antibiotic treatment. With IV antibiotic treatment, the incidence of babies contracting the infection is lowered to 1 in 4,000.

How GPS Affects Newborns

Early-onset GBS occurs when a baby is infected with GBS within the 1st week of life. Roughly half of babies born with GBS infection have early- onset symptoms including: sepsis, pneumonia, meningitis, breathing problems, heart rate and blood pressure instability and GI and kidney problems. In severe cases, stillbirth may result. Approximately 5% of babies with GBS infections at birth will die.

Late-onset GBS may occur after one week to several months of age. Signs of late-onset GBS include changes in your baby’s eating habits, such as feeding poorly, refusing to eat or not waking for feeding. Changes in baby’s skin, including blue, gray or pale skin due to lack of oxygen, or blotchy or red skin may also be signs of GBS. In the U.S., late-onset GBS has been the leading cause of meningitis in newborns in the first three months of life.

Prevention

Although research is continuing, there is currently no vaccine for Group B Strep infection. The best two ways to prevent GBS during the first week of a newborn’s life are:

  • Testing pregnant women for GBS bacteria
  • Giving antibiotics, during labor, to women at increased risk

For additional information, please visit: 

https://www.cdc.gov/groupbstrep/index.html or https://www.marchofdimes.org/complications/group-b-strep-infection.aspx

Don’t put your un-born baby at risk! Learn the facts and get tested!

~Tanya Mack, President

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Advisory Board Publication, Telehealth Primer: Pregnancy Care, Features Women’s Telehealth

Virtual pregnancy care spans from prenatal to postpartum care.  It incorporates a variety of telehealth modalities including audiovisual visits, remote patient monitoring and “live” and asynchronous store and forward imaging.

The Advisory Board is the best practice firm helping healthcare organizations worldwide improve their performance using a combination of research, technology and consulting. They have 12 offices on 3 continents and publish to over 9,000 healthcare organization outlets.

Recently, the Advisory Board published the piece, “Telehealth Primer: Pregnancy Care.” The publication features four innovative healthcare organizations using telehealth tools to deliver different aspects of pregnancy care and their business cases and results.

Women’s Telehealth is pleased to be featured in the primer for our work in providing maternal-fetal medicine services, delivered 100% via telemedicine, to help decrease preterm labor and improve access to maternal-fetal medicine providers.  

The Mayo Clinic’s OB Nest program and the University of Utah were also featured in the Primer for their work in delivering antepartum visits virtually vs. in-person visits, to improve patient satisfaction with the same clinical outcomes.

The Primer also featured the University of Pennsylvania for delivering postpartum visits via remote patient monitoring to ease post-delivery care and outcomes for new moms.

For a copy of this informative primer, visit: https://www.advisory.com/research/service-line-strategy-advisor/resources/2018/telehealth-primer-pregnancy-care

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Newborn Umbilical Cord Blood Banking: The Basics

Umbilical cord blood (UCB) is rich in stem cells, which have the potential to be used to improve and save lives once they are collected and preserved for future medical use.

Over the past 30 years, since the first cord blood transplant was performed in Paris, France, the industry has continued to evolve in clinical applications. UCB is primarily banked and then available for treatment potential and compatibility. UBC can be legitimately used for treatment of over 80 diseases including:                                                       

  • Certain blood disorders (leukemia, lymphoma, anemia)    
  • Immune disorders
  • Genetic disorders
  • Inherited metabolic disorders
  • Possible transplant matches

Cord Blood Collection

Obstetricians have a key role in UCB as they spread awareness, counsel expectant parents about their options and also serve as the UCB collectors.  It is wise not to wait until delivery to make the decision to bank cord blood as arrangements must be made with the hospital and cord blood bank in advance. UCB collection is performed immediately after birth and is safe, painless and voluntary. The delivering physician clamps and cuts the cord, collects the blood in the umbilical cord and the cord itself in a sterile, protective cup. Then, a pre-arranged courier picks it up for processing in the lab. Once it is prepared and the stem cells have been extracted, it is cryopreserved and stored or “banked” for future medical use.  Recently, experts estimated there are almost 6 million cord blood units “banked.”

Public or Private Banking?

In the U.S., health insurance does not cover cord blood collection, processing or banking fees.  Patients collecting UCB can choose to donate cord blood and have it stored in a public cord blood bank and the costs are free. Donated cord blood could help save the life of someone in need or be used for valuable medical research. Patients can also choose and pay for private UCB banking. Privately banked cord blood is stored just for the family’s future use. It may help treat a family member who is sick and needs a stem cell transplant.

Upfront costs can vary from $500 to $2,500, plus an annual storage fee of around $300-500. Recently, private UCB has sharply increased and public UCB is going down.

There is no current, scientific data how long stem cells may be “banked,” although experts have stated that preserved stem cells have no expiration date and frozen stem cells may remain so indefinitely without losing their properties once thawed.

Cord Blood Banking and the Future

Although many view UCB as “biological insurance,” advanced cell therapies, especially in the areas of regenerative applications such as cerebral palsy and autism, are being studied intently. In tracking “released” UCB, 50% of clinical uses have been for brain injury patients and about 26% for congenital anomalies. 

Today, approximately 1:1,000 is the ratio of “used” UCB to “banked” UBC.  Although there is much promise and great potential with the current and future uses of UCB, there is no guarantee on the return of banked UCB.  We do know that research drives medical progress and numerous patients have achieved the benefits of banked cord blood.

For more information and to spread the news about UCB Banking during National Cord Blood Awareness Month, visit:   www.parentsguidecordblood.org

~Tanya Mack, President

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High Trisomy 18 Risk: Concerns Relieved Story

Unborn baby’s high birth defect risk is the focus of this Women’s Telehealth patient story.

This Pregnancy’s Challenge: In a prior pregnancy, prenatal tests indicated positive results for Downs Syndrome for this mom-to-be. Fortunately, this proved not to be the case and her baby was indeed born healthy.  However, with the next/current pregnancy, the patient was extremely worried when “Quad Test” results [deleted: during her current pregnancy] reflected a 1:56 risk for Trisomy 18 and the ultrasound conducted at the local hospital was inconclusive.

Trisomy 18, also known as Edwards Syndrome, is similar to Downs Syndrome, as they are both caused by a chromosome abnormality. Unlike Downs Syndrome however, Edwards Syndrome is potentially more life-threatening during the neonatal period and early life. It was very important that the mother and unborn child receive high-risk OB Specialist care. 

The Team’s Actions: Because there were no MFM Specialists in the patient’s community and it was over an hour drive to the closest one in Albany, GA, the patient opted for MFM care via telemedicine through Women’s Telehealth based in Atlanta.  WT was able to offer the patient in-depth evaluation and consultations via telemedicine directly from her local OB physician’s office.

  • The patient declined amniocentesis, a procedure whereby amniotic fluid is collected for     detailed diagnostic testing and at the time, free cell DNA testing via maternal blood was not available. 
  • Advanced, serial “live” ultrasound imaging for fetal growth and well-being was performed.  
  • WT conducted regular MFM physician consultations to monitor the baby’s development.           
  • A co-management plan was developed between the WT MFM specialist and local OB/GYN.

The Results:

  • High risk monitoring continued to show no abnormalities and a healthy baby was born!
  • The family saved an est. $500 in travel expenses, not going to and from the home to Atlanta, $2000 out of pocket hospital facility fees, and over 28 hrs of commuting time.

WT’s progressive telemedicine capability, providing the right specialist at the right time, supported the patient safely through an uncertain, emotional journey. In this case, the WT team was able to allay the patient’s concerns and celebrate a positive outcome!

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Birth defects are a common, critical and costly condition affecting 1 in every 33 babies born in the U.S. each year.* For more information about birth defect stats, prevention, diagnosis and aftercare, visit: https://www.cdc.gov/ncbddd/birthdefects/facts.html

*Centers for Disease Control and Prevention. Update on Overall Prevalence of Major Birth Defects–Atlanta, Georgia, 1978-2005. MMWR Morb Mortal Wkly Rep. 2008;57(1):1-5.

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Our goal in sharing patient stories is to show the role and possibilities Women’s Telehealth plays in accessing and intervening in high risk pregnancies. We help turn patient and OB provider concern into the best possible care plans and outcomes for mom and their babies.
For more information, call our office at: 404.478.3017

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Preventing HIV Transmission to Your Baby during Pregnancy

The US has estimated that 1 million Americans are living with HIV today – and 1 in 7 do not know they have HIV as they have no symptoms. June 27th is World HIV Testing Day and Women’s Telehealth is working to raise awareness about preventing HIV transmission during pregnancy. Prevention starts with HIV testing and knowing your status.

Since 1995, the CDC has recommended that all pregnant women be test for HIV and STD’s in their first and third trimesters and then receive treatment during pregnancy if they test positive for HIV. Yet, recent statistics estimate that in the US, 31% of pregnant women are still not tested for HIV. Concurrent testing for STD’s allows for specifically testing for syphilis (which is treatable) and the prevention of congenital syphilis in the newborn. HIV infection is more prevalent in Southern States, African Americans, and in young people. Testing can be completed in a doctor’s office, hospital, clinic or home.

If the mom’s HIV test is positive or the mom has known HIV infection, with treatment, the risk of transmitting the infection to the newborn can be reduced to approximately 1% through early testing and diagnosis and the use of anti-retroviral therapy (ART) with increasingly effective medicines. The sooner therapy is started the better. The medications work by preventing HIV from multiplying, keeping the viral load in the body low. This helps a pregnant mom stay healthier and significantly decreases the likelihood of transmission during pregnancy or birth. Some of these medications also pass through the placenta adding extra protection for the baby. Most of these ART meds are safe during pregnancy but the best treatment regimen should be determined by a high risk pregnancy specialist.

If pregnant women present to deliver and there are no records of HIV and STD testing, rapid testing prior to delivery can be done with the mother’s consent. If HIV positive moms have a high HIV viral load at the time of delivery, a C-section may be performed to decrease the chance of transmission during the birth process. Babies born to a mom with a known HIV infection will be treated for HIV for 4-6 weeks after birth. To further reduce risk of HIV transmission, HIV positive moms should not breastfeed their newborns.

We are moving in the right direction with preventing transmission during pregnancy through awareness, testing and treatment! From 2012-2016, diagnosed perinatal HIV infections have decrease by 41%! Many states have laws about HIV and STD testing in pregnancy and surveillance upon delivery. For example, Georgia has the HIV and Syphilis Screening Act that mandates all pregnant women be tested for HIV and STD’s in the 1st and 3rd trimester- unless the woman opts out. Also, the law states that if there is no evidence that testing was done prior to delivery when a woman presents for delivery that a rapid HIV screen be performed, unless the mother declines. Similarly, all babies born to an HIV positive mom are required to be reported to the health department within 7 days of birth in GA. Likewise, all babies born with congenital syphilis are to be reported within 24 hours of birth to the local health district officer in the state surveillance system.

HIV transmission to the baby during pregnancy, birth and breastfeeding can be greatly reduced through early testing, treatment and following some precautions. Women’s Telehealth provides high risk pregnancy care via telemedicine – including care of HIV positive moms and their babies – with great results!

Help us raise awareness on World HIV Testing Day by SHARING this blog or checking out further resources:
– For more info, call CDC 800-232-4636
– To schedule HIV testing in your local GA Health Dept., call 800-551-2728
– To find a testing provider nationally, visit: http://www.greaterthan.org or http://www.locator.hiv.gov

~Tanya Mack, President

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Twin to Twin Transfusion Syndrome: A Life-Saving Story

A twin pregnancy comes with risks for mother and babies and this Women’s Telehealth patient story presents one such serious complication.

This Pregnancy’s Challenge: The ultrasound conducted by the patient’s local OB physician revealed that one twin was growing and the other was not. Preliminary tests indicated a suspected “Twin to Twin Transfusion Syndrome,” caused by a blood vessel defect. Left untreated, the survival rate for both twins would be less than 15%.  The mom-to-be needed immediate high-risk OB care and intervention. Because the closest MFM Specialist was two hours away and the patient would require consistent monitoring, she was referred to the OB/GYN’s MFM telemedicine partner in Atlanta, GA, Women’s Telehealth.

The Team’s Actions:

  • The initial MFM telemed consult and specialized ultrasound confirmed the “Twin to Twin Transfusion Syndrome” and identified the problematic blood vessels causing it. 
  • The MFM physician forwarded all images and notes immediately to the closest  fetal surgeon to see if he would take the case as there was a critical time window.
  • The surgery was performed in FL and the patient stayed in the hospital for a few days to monitor mom and babies before they were released to home.
  • WT continued to remotely monitor growth of both twins regularly until the OB and MFM doctors decided to deliver a little early via C-Section, to prevent loss and trauma.

The Results:

  • Two healthy baby girls were delivered slightly early by C-Section with no residual health problems.          
  • Cost savings were estimated to be > $12,000 in expenses.                                                                  
  • Travel savings of 2700 miles and 40 commuting hours were realized.                                               

Early identification and treatment of this often-fatal condition in a rural area, where there was no MFM specialist, led to the successful birth of these babies. Women’s Telehealth is pleased to have played a key role in arranging life-saving surgery through their network of high risk OB specialists and the use of continued monitoring via telemedicine!

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Multiple births are much more common today than in the past. According to the U.S. Dept. of Health and Human Services, the twin birth rate has increased by over 75% since 1980, and triplet, quadruplet and high-order multiple births have increased at an even higher rate.  To learn more, visit:

https://www.reproductivefacts.org/news-and-publications/patient-fact-sheets-and-booklets/documents/fact-sheets-and-info-booklets/multiple-pregnancy-and-birth-twins-triplets-and-high-order-multiples-booklet/

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Our goal in sharing patient case stories is to show the role and possibilities Women’s Telehealth plays in accessing and intervening in high risk pregnancies. We help turn patient and OB provider concern into the best possible care plans and outcomes for moms and their babies.
For more information, call our office at: 404.478.3017

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Keeping Safe While Pregnant

The U.S. celebrates National Safety Month in June! Since Women’s Telehealth focuses on high risk pregnancy, we are motivated to pass along some tips to keep moms safe while pregnant from day one through delivery!

Injury is the leading cause of death in the US between the ages of 1 and 44, which includes those childbearing years. Research shows that most injuries are preventable and over half of falls occur in the home.

Pregnant women are bombarded with all kinds of do’s and don’ts during their pregnancy. Now that summer is here, there are some extra precautions for pregnant women during this season.

Here are our “Top 10 Tips” for Keeping Safe While Pregnant:

  1. Wear a seat belt (We are frequently sent pregnant women who have been in motor accidents.)
  2. Don’t text and drive (In some states, it’s the law!)
  3. Avoid falls, trips and slips (The body’s center of gravity changes during the 2nd and 3rd trimester.)
  4. Mind your food safety (Learn about diet during pregnancy. Steer clear of mercury-laden fish.)
  5. Learn first aid and CPR (You can save another or help them save you!)
  6. Avoid overheating in the summer (Drink fluids and avoid dehydration.)
  7. Skip the amusement park rides that jolt suddenly and have high impact (can tear the placenta).
  8. Add the Poison Control number to your phone for an emergency: 1-800-222-1222
  9. Wear sunblock
  10. Most importantly – KEEP all your prenatal care appointments!  That’s the best prevention! Follow doctor’s guidelines on no smoking, drugs, alcohol, CBD use and caffeine during pregnancy.

To help us raise awareness for Pregnant Women and Family Safety, check your local neighborhood resources for local events on Family Safety Day, June 8th. Visit your local parks, get out and take a safe walk! Keep your safety awareness keen and teach your family to do the same!

~ Tanya Mack, President

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Mom’s Rare Birth Defect – An Unchartered Pregnancy Story

This Women’s Telehealth patient story is a twist on a birth defect – the mother’s rare birth defect, a diaphragmatic hernia at birth, now posed a pregnancy management challenge to mom and potentially baby.

The Pregnancy Challenge: A mom-to-be from middle Georgia was 26 weeks pregnant when she visited her local OB physician for the first time.  When her initial OB assessment revealed that she had been treated for a Bochdelek Hernia at birth, her doctor promptly referred her to Women’s Telehealth for high-risk MFM Specialist care.

A Bochdelek Hernia is a rare, life-threatening congenital birth defect in which an opening in the diaphragm allows the baby’s abdominal organs to shift into the chest.  The patient required surgery at birth to place the organs in the proper position and repair the opening in the diaphragm, and, a tissue graft was placed surgically during childhood.  Rarely does a woman who has had this condition become pregnant herself later in life.                          

Of primary concern was:  Would the growing baby in utero cause the graft to stretch or possibly break? How would the growing baby affect the patient’s health? Would she be able to push during delivery or would a C-section be required? These were the serious questions facing the patient and her obstetric team.

The Team’s Actions:

  • The initial, advanced MFM ultrasound via telemedicine revealed that the tissue graft was intact and functioning well.                
  • The fetus was found to have a two vessel umbilical cord with low blood flow and was in the 9th percentile for its gestational age, indicating Intrauterine Growth Retardation (IUGR).                 
  • An extensive literature search revealed no documented, similar cases.                                                    
  • WT collaborated with other MFM’s and a graft surgeon in San Francisco who places grafts in children, to discuss the situation and graft function with a pregnancy stress.
  • The patient was educated about immediate reasons to present to the ER.                               
  • Diagnostic genetic lab tests revealed the baby did not have any genetic or neural tube defects.
  • WT is now in the process of writing this case study for publication in a professional peer reviewed journal, with the family’s cooperation, so there will be a future resource for others.          

The Results: A healthy, > 5-pound baby girl was successfully delivered via C-Section at 35 weeks gestation!  WT is happy to report that the mom’s diaphragmatic graft functioned well throughout the pregnancy and required no medical or surgical intervention. 

Women’s Telehealth was pleased to be called on to help solve this rare pregnancy dilemma. It’s another example of how the advanced MFM technological services can be provided via telemedicine to treat complicated, high-risk prenatal cases often saving time and money as well.

Our goal in sharing patient stories is to show the role and possibilities Women’s Telehealth plays in accessing and intervening in high risk pregnancies. We help turn patient and OB provider concern into the best possible care plans and outcomes for moms and their babies.
For more information, call our office at: 404.478.3017

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Addiction and Babies? Help Us Raise Awareness!

April is Alcohol Awareness Month in the U.S. and a perfect time to raise awareness around prenatal substance abuse and how this affects both the fetus and the newborn. The U.S. has seen a dramatic increase in the past ten years in babies exposed to drugs and alcohol in the womb before birth.  Babies that are born to an addicted mother can suffer from withdrawal once born. Babies can’t consciously abstain. We know this and see stories about this in the news every day. 

The effects are far reaching and for the baby in utero, may result in low birth weight, slow growth, altered development and in some, lifelong health problems.  After the baby is born, Fetal Alcohol Spectrum Disorder (FASD) and Neonatal Abstinence Syndrome (NAS) may require intense intervention in a hospital, perhaps even NICU setting.

Neonates may be exposed to a wide range of substances and it’s hard to know what they may be exposed to due to self-reporting, not knowing the exact components of illicit drugs and wide range of prescription drugs the mother may be taking during pregnancy. All babies do not have withdrawal depending on the length of exposure, the cumulative dose and the baby’s gestational age at birth. Full term babies are more likely to experience withdrawal than preemies.

Symptoms for babies who are experiencing withdrawal often show up within 72 hours of birth, but may not become apparent until a few weeks after delivery. Specific symptoms may vary but include:

  • Irritability 
  • Poor Feeding    
  • High Pitched Crying
  • Fever  
  • Diarrhea 
  • Vomiting
  • Seizures  
  • Chronic pain

Most babies get better initially in 5-30 days and treatments for these conditions include:

  • Environmental manipulation (swaddling, holding, low lighting, mother-baby bonding
  • Pharmacologic therapy to wean them off of the  addictive substance
  • Social service intervention as family situations may be complex
  • Providing empathy and support  
  • Close follow up post hospitalization and these substances may affect their development

As with many health care issues, prevention is preferred over later intervention. Early intervention is a critical path to mitigating problems.  Consider:

  • If you are pregnant and on prescriptive drugs that may affect the fetus, notify your provider.
  • If you are pregnant and using, do not quit cold turkey without the direction of your provider, as it may negatively affect the baby.  Ask about medically-assisted treatment.                                           

To help us raise awareness, SHARE THIS MESSAGE to get information into the hands of people dealing with pregnancy and substance abuse.
~Tanya Mack, President
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“March” with Us Toward Greater Gestational Diabetes Awareness!

March 26 is Diabetes Alert Day! It’s a one-day wake-up call reminding everyone to find out you are at risk for developing Type 2 diabetes.

It’s especially important for women who are pregnant to be checked for Gestational Diabetes. It’s a growing epidemic spurred on by increasing obesity in pregnant women.  Gestational Diabetes is caused by an insulin blocking hormone produced by the placenta, which in turn causes high blood sugar during pregnancy.

Here are key takeaways to increase awareness for all pregnant women and their families:

Testing: Gestational Diabetes is detected by an oral glucose tolerance test between 24-28 weeks gestation.

Symptoms:  Pregnant women may have no symptoms or may experience thirst and frequent urination.

Risk Factors:  Being overweight, history of gestational diabetes during a past pregnancy, delivery of a baby weighing over 9 lbs., PCOS (hormonal disorder), family history of Type 2 Diabetes

Potential Complications:  Mom – pre-eclampsia, Type 2 diabetes later in life; Baby premature birth, stillbirth, jaundice, higher than normal weight

Treatment: Treating gestational diabetes comes down to one key factor: controlling your blood sugar. It is very important to monitor your blood glucose level closely throughout pregnancy to ensure that your blood sugar remains in your target range. This is accomplished by:

  • Eating wisely. Pay attention to what you eat, how much you eat and when you eat. Seek professional help to develop a meal plan that’s full of good-for-you and good-for-the-baby foods.
  • Physical Activity. When you’re active, your body uses more glucose, doesn’t need as much insulin to transport the glucose, and your body becomes less insulin resistant. Since your body isn’t using insulin well when you have gestational diabetes, a lower insulin resistance is a very good thing. Physical activity also helps control your weight during pregnancy, keep your heart healthy, improve your sleep and even reduce stress and lighten your mood. After checking with your doctor about what’s safe to do while you’re pregnant, try to get at least 30 minutes of activity every day… anything that gets you moving rather than sitting.
  • Insulin/Medications. Most people are able to control blood glucose levels through adjustments in diet and exercise. However, 10-20% of women with gestational diabetes may require insulin or another medication to assist your body in regulating your blood glucose level. These medications are safe for your baby.

Don’t be anxious!  Be informed!  Contact your OB provider to get tested!

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