Episode 53: Pregnancy: Gestational diabetes & understanding baby’s movements

Dr. Sophia:
Hello everyone. Welcome to the Dr. Sophia ObGyn podcast. I'm an obgyn practicing for over 15 years in my native New York City, and I love to help women learn about their bodies, empower them, and embrace themselves. On this podcast, we talk openly and with heart about all things affecting women from pregnancy, menopause periods, sexual health, fertility, and so much more. Disclaimer, this is general medical information based on my professional opinion and experience. For specific medical advice, please refer to your physician. Hello everyone, and welcome to the Dr. Sophia OB GYN podcast. Today we're gonna kind of dive into what a day in the life of Dr. Sophia is. And of course, this all started from a conversation with my good friend and co-host Touseef Mirza.

Touseef Mirza:
Hi everybody.

Dr. Sophia:
So, you know, Touseef and I, we talk all the time, and often what we talk about, she asks me, oh, so how was your day? Or what was happening in the hospital today? I was telling her how my day was a little bit, just frustrating, and she was like, really? Well, what happened? You're usually so happy go lucky. And though I am, I'm usually very, very happy when it comes to seeing patients and I'm taking accountability that maybe I'm, you know, approaching my cycle. I'm a little bit moody.

Touseef Mirza:
Yes. We didn't realize that yesterday when we were talking-

Dr. Sophia:
When we were talking yesterday.

Touseef Mirza:
And today we've come to realize that there's a reason for that.

Dr. Sophia:
I woke up with cramps and I was like, oh, again, it gets me again. So it

Touseef Mirza:
Cramps even in the body of an obgyn, because you are a woman after all.

Dr. Sophia:
But anyway, today's podcast is not about my period.

Touseef Mirza:
We can go there if we want to. For me, what's interesting is, you know, I'm not a healthcare professional and I go see doctors, I go see different healthcare professionals. And so it's also to understand that sometimes when we go as patients, sometimes we have all of these expectations of what a doctor can do for us. And actually they can do a lot, but it's not like they're, you know, know absolute gods. And I think that's part of the problem of how doctors have been portrayed.

Dr. Sophia:
I work as a generalist, obgyn, I deliver babies, I cover the labor floor. And as part of that, I also work with other colleagues. And sometimes that means that I also have to cover or see their patients. For example, if a doctor has a patient that's coming into the labor floor, but that particular doctor is not present, I would see that patient. And when I see the patient, I would then report back my findings, and then that kind of will determine whether or not that doctor needs to come in. So what would happen is I would evaluate the patient and then kind of give them recommendations or something like that. But ultimately it's not my patient, it's their patient.

And so yesterday, this wasn't actually the patient who was kind of a little frustrating for me, but more so the how I would have dealt with the situation with the case versus totally complete normal patient care. But you know, the way the doctor chose to deal with the case. So I have a patient who comes in and she's complaining of something called decreased fetal movement. So she's pregnant, she's pregnant, she's at term being anywhere between 37 and 42 weeks. And she's actually more like maybe around 38 weeks. And her pregnancy happens to be complicated by something called gestational diabetes.

And so she's coming in with a complaint of decreased fetal movement. Now, when a woman comes in with decreased fetal movement, we are very concerned, especially at term, because here we have a baby who's fully able to survive outside of the womb.

Touseef Mirza:
So she's seven months pregnant at this point?

Dr. Sophia:
No, she's nine months pregnant.

Touseef Mirza:
Oh, okay. I'm sorry. It's early in the morning. I'm not fully awake. I have been thinking in months. I find it's easier when we talk about pregnancy, but

Dr. Sophia:
Yes. Oh, you, it's, you know, the problem is that obgyns, we think in weeks. That's so true.

Touseef Mirza:
The rest of the population is months.

Dr. Sophia:
So true.

Touseef Mirza:
Okay. We're always like, she's nine months, she's nine months. She, what does that mean?

Dr. Sophia:
She's nine months old. Okay. She's nine months pregnant. Okay. And then, and, but that's the thing you see for us, we're like, yeah, but you're really pregnant for 10 months.

Touseef Mirza:
Okay.

Dr. Sophia:
You know, when you're at the end like that due date, you're actually 10 months pregnant. So that's why it's harder for me to function in that way, but it's okay. I can do it, because I want my audience to understand. Including you.

So if we function in months anyway, I'm gonna call her nine months pregnant because that's what everybody understands as once you're nine months, you're ready to go. So at nine months we want this baby to be good in and out. Let's just say it that way. But when a woman comes in for decreased fetal movement, it could be a number of reasons why she's having decreased fetal movement or why she senses that she's having what we call decreased fetal movement.

Touseef Mirza:
So this is not something that she was diagnosed with as she just started to feel in her belly that all of a sudden the movement that she was feeling before, she's not feeling as much now.

Dr. Sophia:
Right. It's a change, it's a change, a shift, a you know, and sometimes what really is happening is that a mom is like, you know, busy going about her day and what have you, and may not feel the movements that the baby's actually having because she herself is moving and busy and what have you. And so I usually tell women when they notice that they don't feel the baby moving to stop for a second and just maybe drink something cold, sweet and rest If they can lay to their left side so that they can improve the blood flow back to the placenta.

Touseef Mirza:
So I haven't had a baby. So does that mean that when you are around like seven to nine months that you you're basically almost feeling the baby all the time? And if you don't, then you should do something about it.

Dr. Sophia:
So babies move in their own patterns. Are they moving all the time? Yes, to some extent. I would say they are. However, they have sleep cycles, you know? They can rest too. So I like to tell women to understand and pay attention to what their baby's pattern is. And really it's when they see or feel a change in how their baby usually moves. A lot of babies tend to be a lot more active at night, or at least mothers perceive the activity more at nighttime, for example. And early mornings, I don't know why, but you know, this it seems like what happens oftentimes. And so, and whereas during the daytime though, they feel the baby moving, but maybe it's not the same intensity or, you know, punchy. And again, I think it's just because women are busy.

Dr. Sophia:
They are also going about their day going to work, doing things. And so it might be part of the reason why they don't feel the baby as much. Nonetheless, if they take a moment to rest, like I said, do something like, you know, sugar food, those things like to kind of trigger the baby a little bit. And then that's it, the baby gets moving again like normal. And if that happens, great. When you can pretty much feel rest assured that everything is just fine. However, in a situation where you feel like it's been a couple of hours, you notice that the baby hasn't been moving. First of all, certainly if you, once you think about it, don't wait hours. That's one of my first things that I like to tell patients. It's different. If you notice now it's been a couple of hours, that's different than if you notice it and then wait more time, not necessary. Okay. In the conditions of a woman who has this complaint, we would typically do an ultrasound and we would put them on something called an NST or non-stress test or monitoring. You'll, they'll often hear people say, oh, I have to be monitored. And that monitoring is fetal monitoring where we put some straps on your belly and it listens to the baby's heartbeat. And so the combination of the NST non-stress test or monitoring along with an ultrasound are the two things that can give us a lot of information and reassurance.

Touseef Mirza:
These are the usual tests that you do on a regular basis during pregnancy?

Dr. Sophia:
So it depends on what potential other issues may be happening with the pregnancy in terms of how often one would get, let's say a sonogram or monitoring under certain conditions, then yes, we would do, we do exactly that looking at what we call fetal wellbeing. But for sure we would do it in a case of what we call decreased fetal movement. So yesterday a patient complained of decreased fetal movement. She comes in, she gets her ultrasound, she gets her monitoring, everything looks great. And so we are reassured that I have a healthy mommy and a healthy baby today. So here's where perhaps I differed from my colleague. Ultimately the patient wasn't delivered yesterday, she'll be delivered tomorrow. Okay. So it's just two days. Okay. And the patient herself was very content with the fact that by the time she left the labor floor, she was herself feeling the baby moving like normal. We'd given her a lot of fluids and she was-

Touseef Mirza:
Feeling better about it?

Dr. Sophia:
She was already feeling much better about it. She's like, oh, the baby's moving totally like it normally does now. Okay. And here's the thing, as an obgyn, we are always managing two patients at the same time. Like always, which is the mother and the fetus all the time.

Touseef Mirza:
You're thinking about the health of the mother and also the health of the baby, and figuring out what's the right balance.

Dr. Sophia:
Yeah. And I think, so this is where for me, because I'm, I always have that in the back of my mind. I'm taking care of two people and one of them can't talk to me.

Touseef Mirza:
Yes. It's deep inside, cannot sign language, no nothing.

Dr. Sophia:
Now, I have, yes, of course. I'm so thankful for technology. I have the monitoring, I have the ultrasound, I have ways of seeing how this baby is doing inside its little home, the womb. It's not giving me facial expressions. I don't have all of that to go with. And so though I'm not an alarmist by any means, I guess I could consider myself a little bit more on the er, on the side of caution or conservative perhaps. There was a part of me yesterday that felt uncomfortable letting that woman go home.

Touseef Mirza:
Even though she was coming back the next day.

Dr. Sophia:
Even though she was coming back in two days.

Touseef Mirza:
That's because she has just on top of that, has gestational diabetes?

Dr. Sophia:
So on top of that, yes. So on top of her complaint of decreased fetal movement, she also has gestational diabetes.

Touseef Mirza:
And so what is exactly gestational diabetes versus diabetes by itself?

Dr. Sophia:
So the thing is, is that diabetes, so if someone is pregnant but has diabetes before they become pregnant, they're just a diabetic. But someone who develops, has never had diabetes before and then develops diabetes in the pregnancy, is considered gestational diabetes. And one key difference is that someone who had diabetes before pregnancy has diabetes throughout pregnancy and is still a diabetic after pregnancy. So after they deliver, they're still a diabetic. Whereas someone who is a gestational diabetic has diabetes that's diagnosed only in the pregnancy, and it resolves with delivery.

Touseef Mirza:
Which means after you, you deliver the baby, you don't have the diabetes aspect in your body anymore.

Dr. Sophia:
Right. I mean, it's a little bit more nuanced than that. I mean, in the sense that we no longer consider you a diabetic. Let's just put it that way. Okay. And then we test you for diabetes because you're just at an increased risk of developing actual diabetes after you've had gestational diabetes. But the cause of gestational diabetes is the pregnancy itself. So it's the way that your body handles some of the hormones that are released during pregnancy that then can increase your insulin resistance. And so because the resistance for insulin is higher during pregnancy is what can cause you to have gestational diabetes.

Touseef Mirza:
So basically you're healthy, you don't have diabetes, you get pregnant, you have a chance of potentially have gestational diabetes that is basically just caused by your placenta.

Dr. Sophia:
Your hormones.

Touseef Mirza:
Some women go through that and some women don't.

Dr. Sophia:
Our body is meant to function in harmony. And so when we get pregnant and we release all of these extra hormones, and especially one specifically that comes from the placenta, your pancreas is like, okay, this is what we're doing. And it kind of tries to keep up with what's going on with this brand new organ that developed when you were pregnant called the placenta. And it, they're kind of playing this little dance, but for some people, the pancreas is just not able to keep up with how the-

Touseef Mirza:
The demands.

Dr. Sophia:
The demands of what's going on with the pregnancy. In terms of glucose load and hormones and how fascinating they are. It is, it's fascinating. It, actually, is very fascinating. So anyway, the problem with gestational type diabetes-

Touseef Mirza:
I love talking about this stuff. I love the science behind it. This is literally how we talk together. Like, okay, but what does this mean? Okay, well what does that mean? I said, let's do a podcast about this.

Dr. Sophia:
This is always how it comes out . So when we have gestational diabetes, you are increasing the sugar that is in your bloodstream and sugar that's present around the baby. And unfortunately, diabetes is a risk factor for a lot of things. One of them being preeclampsia, for example.

Touseef Mirza:
Okay.

Dr. Sophia:
Okay. Also hyperglycemia. Or hypoglycemia, meaning that once your baby is born, that the baby, because it was used to this big sugar environment, and then once it's born it, that sugar drops pretty drastically. And when you have hypoglycemia, that is also very dangerous. You know, it can cause a baby to have jitters and you know, it has its own consequences. It can also increase like all cause mortality, just like in terms of for the baby, you know, like increases your risk of even having stillbirth.

Touseef Mirza:
There's all these things to consider. I dunno, when does gestational diabetes in pregnancy start to show up? Like in terms of the diagnosis?

Dr. Sophia:
We usually test women somewhere between 24 and 28 weeks. Okay. So like around six months. Okay. Is when we screen them to see if they developed diabetes. In the pregnancy. And we do that by giving them what we call a glucose load. So we give them a very sweet sugary drink, and then we wait an hour and then we test their sugar in their blood. And for most women, they're able to handle it. Okay. Right. That's your body's work working and functioning normally. And so to process it, to process right. That sugar load. And so that's around 24 to 28 weeks ideally.

Okay. And then in, in a woman who may have, let's say increased risk factors for developing diabetes, perhaps she had a condition before pregnancy called PCOS, which already increases what we call insulin resistance. Perhaps she was already pre-diabetic, which would increase her chances of being diabetic in pregnancy. Perhaps she's overweight or has is obese. That increases her chances of having diabetes and pregnancy. And so with all those things, we would test them even earlier. And really, as soon as we know that they're pregnant, typically in their first couple of weeks or first labs that we do, we check to see if they have diabetes even at that time. Okay. So way before the 24 week mark.

Touseef Mirza:
So then you have this woman, and now she's feeling fine, and she's like, okay, I can go back home now. But now you have this feeling in your gut where you're trying to like say, all right, do I have that gut feeling?

Dr. Sophia:
But she's not my patient. And we've done standard care. It's not like, it's not like we've done anything. We haven't deviated from it by any means. You know, and it's just the concept also of when you are personally taking care of a patient, when it's your patient, how you either develop the relationship and how relationship you can perhaps have more, whether it's tolerance or how else to call it, but like a connection with the, with the patient. With the patient. And by all means, I'm sure her doctor had all those things. Right. The stuff that I was missing at that moment was the connection.

So all I had to go with was, look who's in front of me right now. And I'm like, oh my God. But she's a gestational diabetic and she had decreased fetal movement and, and for me it was like the second time she'd made this complaint in maybe 72 hours or something like that. And so for me, I was like, what's gonna happen in three days? It's already been three days since she's here again, because of decreased fetal movement. I don't know. Why is the baby doing that, I don't know why the baby's doing that. Why is the baby not moving?

Touseef Mirza:
So then you're just like, all right, if that woman was your patient, then you might have said, you know, let's just keep you in the hospital.

Dr. Sophia:
She was a woman who was going to be induced. Yeah. And so it was gonna be probably if it were my personal patient, I probably would've been like, okay, today's the day,

Touseef Mirza:
Let's just do it. Yeah. Let's just do it. Yeah. And it's not to say that the other healthcare provider was wrong. No. It's just that different obgyns or different practitioners have their own way of assessing. So I think this is an important point for us in the lay public to understand also that it's not always an exact science.

Dr. Sophia:
Not just that it's not an exact science, but there's room. Right? Yeah. There's room in the care of what can be expected. Or what can happen. Right. You know what I'm saying? And so it was just a conflict for me. The patient was totally fine. My report back to that doctor is yes, everything is as it should be. And so they're making that decision based on what I'm saying. Right. And that's the truth.

Touseef Mirza:
The lead. Yeah. Right. Yeah. And that person said, yes, she's good. You can send her home.

Dr. Sophia:
I felt like there was another way of handling the situation. And at the end of the day, it wasn't my call to make. And I got frustrated by that.

Touseef Mirza:
I mean, I think from my perspective or, or from a lay person perspective, I think this is not something that we think about when we interact with healthcare healthcare professionals that they also have like, yes, there's like the science, but then there's also that room that you talked about, right. Of, like how to take care of patients, that you have more flexibility of making the call and that that's something that you have to deal with and sort of consolidate within yourself. It's not black and white.

Dr. Sophia:
It's not black and white. That is so true. It's not a, there's definitely a gray zone, you know? There's a gray zone in how we can care for our patients. And moreover, there are differences between one provider and the next, and that's totally okay. But the conflict within me at that moment is what was frustrating.

Touseef Mirza:
And then you have to let go

Dr. Sophia:
And then I have to let it go. Yeah. For sure. I have to let it go. I have to let it go.

Touseef Mirza:
So to let it, that, that's like, that's part of like dealing with work. Any topic that we're involved in, there's all these different variables, right? It's so rare that it's on the straight and narrow on one line, and you have to figure out how to navigate that.

Dr. Sophia:
For sure. Medicine is not on one line. There's no question about that. And I feel like if there's anything that has a lot of zigzags, it's obgyn. So, you know, that was one patient. I'm happy to bring these types of stories because I think that it's important for our audience to see what it's like both on the patient side as well as from a provider standpoint. And so, I just hope you are all enjoying listening to us here on the Dr. Sophia OB GYN podcast and the different perspectives that we share.

Touseef Mirza:
And also just to view different people and their lived experiences and what other women go through. Because for us, it's not just about giving medical information, but it's really about exploring what women are actually going through as they're going through pregnancy or going through whatever it is. But it's to really look at the evolution of that and how people are feeling and what they're going through.

Dr. Sophia:
And how I'm feeling and what I'm going through.

Touseef Mirza:
Your lived experience as well.

Dr. Sophia:
Yes. Well, I mean, at least what my colleagues and I, you know, some of the things that happened to us, and I, and I do think that it's important to bring that little tidbit. Or that part of it.

Touseef Mirza:
I mean, let's just be clear. If for any reason you thought that something was really wrong, even if it wasn't your patient, you would've called that out.

Dr. Sophia:
A hundred percent. 100%. Right.

Touseef Mirza:
So let's just be clear about that.

Dr. Sophia:
Oh, yeah. Oh yeah. Let's be very clear. I mean, like I said, the standard of care was definitely met . With this patient. And she is excited, she's expecting her baby. She gets to go home and plan. Right. As opposed to me being like, well, could you just stay? No. You know, and, and then have to like rearrange her whole day. She's got her and her provider made a decision, and that was fine. That was, that was totally fine. And yes, had it, had she been in a danger zone for whatever reason, I would have had a conversation with the provider in terms of why I feel like they're in danger. And then of course, that dialogue would've happened. But definitely that's not what was going on. And I'm happy that we talked about this. It's actually making me feel so much lighter.

Touseef Mirza:
This is your therapy right now. This is, you know, how you always say at the end, embrace your body, embrace yourself. I will say that to you today. Embrace your body, Dr. Sophia, and embrace yourself.

Dr. Sophia:
Okay. I'll take it.

Touseef Mirza:
Take it for the whole day. Just, just love yourself today. Thank you.

Dr. Sophia:
You're welcome. Thank you Touseef. I appreciate you. To our listeners, thank you so much for listening to the Dr. Sophia ObGyn podcast. We really appreciate you. And as always, embrace your body, embrace yourself. Thanks for listening. Bye

This is General Medical information based on my professional opinion and experience. For specific medical advice, please refer to your physician. Until next time, embrace your body. Embrace yourself.