Pregnancy is a period of nine months when every day and every week there is something new and exciting happening. Your body goes through so many physical and hormonal changes. There can be lots of anxiety especially if it is your first pregnancy. You usually visit your OB/GYN every 4 weeks starting your 10th or 12th week depending on your doctor. Usually they do an ultrasound around 12th week of pregnancy and then again around 20th week of pregnancy. The ultrasound done around 20th week of pregnancy is important as that is the time when they check each and every organs of the baby to see if they are developing well. They check baby’s heart, brain, limbs, stomach, bladder, length of the bones of upper and lower extremity, face and also the sex of the baby. So if you want to know if it is a boy or a girl this is the time. Another important visit is your visit to your OB/GYN at 28 weeks of pregnancy.

During this visit, the doctor check the baby’s heart beat, measures the size of your belly to see if the baby’s growth corresponds with gestational age. The doctor also gives you a Kick count card. You will be asked to monitor the movements of your baby everyday. The doctor will ask you to count 10 movements. It should not take more than 2 hours for the baby to do 10 movements. If you are unable to feel 10 movements in 2 hours, call your doctor. The movement count should be done preferably around the same time everyday. Count each and every small movement except for the hiccups of the baby. Mostly babies are more active after meals.

Before the visit to your OB/GYN, you are told to get a blood test which includes your complete blood count including your hemoglobin and a random glucose test. These tests should be done anytime between 24 to 28 weeks of pregnancy. The reason for these tests is that during your second trimester, there is an increase in your blood volume and also the baby’s requirements increase so there can be anemia (Decreased hemoglobin). This can be due to increased needs of the growing fetus or it can be something called Dilution Anemia, which is just because of increase in fluid volume in your body. The second test is a random glucose screening test which is done to check the sugar levels in your blood and rule out Gestational diabetes or Gestational Glucose Intolerance. If you have a strong family history of diabetes or gestational diabetes then you might undergo this test in first trimester of your pregnancy. Without any such history the test is conducted in the second trimester of pregnancy. You are allowed to eat your regular meals, no fasting required. You can go to the lab anytime convenient to you. For this test you will be asked to drink an orange colored drink ( it contains about 50 gm sugar, very sweet and tastes like an orange soda) and then wait in the lab for an hour. You are not allowed to eat or drink anything or chew a gum during that one hour. You may be allowed to drink some water. After one hour the lab technician will draw your blood. The results are usually available the next day or your doctor may discuss the results with you on your next visit. If your hemoglobin is low then the doctor may prescribe iron pills that you need to take until the baby is born. It is very common to have anemia in second trimester due to the reasons I mentioned earlier.

If the results of this Random Glucose test are normal then you will be told to carry out your routine and diet as usual. But, if the results of this test are a little abnormal and it shows levels slightly higher than normal, then in that case your doctor will ask you to undergo another test. This test is called 3 hour Glucose Tolerance Test. For this test, you will have to fast for 10 hours. You are allowed to eat a regular meal the previous night and then may be have a glass of milk a couple hours after dinner. Then you have to fast for 10 hours and go for the blood test to the lab the next day. They will draw your blood and then give you a sugar drink ( it contains about 100 gm sugar, may taste like sweet lemonade). After consuming the drink you will be asked to wait in the lab for 3 hours. Make sure you have books to read or your lap top to work on during this visit as you will be spending 3 hours at the lab. They will draw a blood sample every hour for 3 consecutive hours. The results will be ready by next day. You can discuss these results with your doctor over the phone or via email. If the results of 3 hour Glucose Tolerance Test show that out of the four blood samples collected (One fasting and 3 after consuming sugar drink), if any one or two samples show higher glucose values than normal then it is considered as Pregnancy induced Glucose Intolerance. This is not Gestational Diabetes but it is just that due to pregnancy the insulin is not functioning as well and so there is mild glucose intolerance. If 2-3 values show blood sugar higher than normal, then it is considered Gestational Diabetes.

In case of Pregnancy induced Glucose Intolerance, you will be told to meet with a dietitian who will provide you with all the recommendations for diet control which will help to manage the glucose intolerance. The dietitian will ask you to take small frequent meals. You will be asked to take about 6 small meals a day instead of 3-4 big meals. You will be asked to not starve for more than 8-10 hours during the night. Your first meal of the day should not contain easily digestible carbohydrates like milk, cold cereal etc. You can take hot cereal (Oat meal) or bread, tortilla etc. The gap between your night snack and your first morning breakfast should not be more than 8-10 hours. You can take milk or cold cereal about 3 hours after your first morning snack. Then 3 hours after that you can eat your lunch, 3 hours after lunch have another snack, 3 hours after snack will be your dinner and then 2-3 hours after dinner should be your night snack ( may be fruits if you like). Your breakfast and other snacks should not exceed carbohydrates more than 30 gms. You will be allowed to take 45 gms of carbohydrates in your lunch and dinner. If you eat fruits for your snack make sure that you eat the whole fruit if it is about the size of a tennis ball. If the fruit is bigger than the size of a tennis ball, then you are allowed to eat only half of it. Initially, it is difficult to find options that are low in carbohydrates and sugar and that can satisfy your hunger. But eventually things get easier. You can eat a lot of green salad, green beans, eggs, cheese, etc. Along with these diet restrictions, you should walk at least 30 minutes every day preferably after meals. If sugar is not controlled, it can cause increased birth weight of the baby which can cause difficulty in vaginal delivery. If the baby’s weight increases a lot then your doctor may take the decision of a Caesarian delivery. But that is in extreme cases.

In case of Gestational diabetes, you will be following the same diet restrictions and exercise. In addition to that, your doctor may ask more blood tests in coming weeks to keep a check on your blood sugar. If your blood sugar doesn’t come under control with diet and exercise, then you may be asked to take Insulin Injections every day after lunch and dinner. Your doctor may ask you to check your blood sugar every day after lunch and dinner and according to the results take the amount of insulin. Here there can be chances of high birth weight of the baby. So the doctor will keep a close eye on your sugar levels, baby’s weight and growth. They may induce you early if they think that the baby is gaining too much weight. You may have to undergo Caesarian delivery if baby’s is overweight.