Around 26 to 28 weeks
We will screen you for gestational diabetes. This is a condition that can arise in the latter half of the pregnancy so we don't routinely screen until this gestational age. (If you have a strong family history of diabetes we may screen you earlier and again at 26 to 28 weeks.) You will swallow a predetermined amount of sugar (in the form of a sweet drink) and we will check your blood exactly one hour later to see how your body handled this sugar. You can eat before this visit but you should avoid sweets the hour before the test (avoid fruit juices and simple carbohydrates). If you pass this test you do not have gestational diabetes at this time. If you have sugar in your urine at future routine visits we may repeat the test. If this test is positive (higher than 140) we will schedule you to come back for a more detailed test. This test is a 3 hour glucose challenge test. You will be given more details if this test is necessary but basically you come back to the office one morning without eating anything and we give you another predetermined sugar load and check your blood sugar every hour for 3 hours. If you fail the 3 hour test, you are then diagnosed as having gestational diabetes. In this case we will schedule a consult with a nutritionist because most gestational diabetic patients can be treated with a low carbohydrate diet. Rarely women will have to take insulin. It is important that we follow this process because gestational diabetes can be associated with very large babies and complications that can go along with large babies. If insulin is required then we will also be monitoring your pregnancy to prevent more serious complications such as stillbirths. Remember that the complications of diabetes are much less common than in previous years because our interventions have been very successful at preventing the problems associated with diabetes. This is not something to worry about but something that must be done along with other good prenatal care. If you are diagnosed with gestational diabetes one of the doctors will give you a lot more detailed explanation.
A hemoglobin is repeated at this point because many women develop anemia during pregnancy. You will be notified if your levels are low. If they are it is important that you get more iron in your diet and we will often recommend a supplement. This is very important because it will help prevent you from feeling the symptoms of anemia (fatigue, dizziness, headaches, tiredness, shortness of breath) when you have a new born child at home. It will also lessen the chances that we will have to give you a blood transfusion after your delivery.
At 36 weeks
We will test you for Group B Strep (GBS) colonization. If you had this bacteria in your urine earlier you will not need this test. To do the test we will use a Q tip like swab to take a sample from your vagina and rectum (it only takes a few seconds and is not painful). Many women (1 out of 5) will have this bacteria as part of their normal body. Because it is one bacteria that babies have trouble keeping in check when they are born, we will give you an antibiotic during labor if you have GBS. We will not give you an antibiotic now because it is not an infection that we can "get rid of" in you and we will only build resistant bacteria if we keep you on an antibiotic until you deliver. We will give you the results of this test in one week. If you have the bacteria we will also give you a pamphlet explaining this in further detail. Please ask us for a pamphlet if we forget to offer it to you.
STD testing in pregnancy:
Many STD tests are recommended during pregnancy. Many are now required by law which means that the hospital will test you or the baby when you deliver if we haven't done it during the pregnancy. Gonorrhea and Chlamydia may be done at the visit when you confirmed the pregnancy or any visit after that. HIV, syphilis, hepatitis B will be done early in the pregnancy. HIV, syphilis, GC and Chlamydia will also be offered in the third trimester. Herpes testing is not routinely done but is important to do if you have not had herpes but your partner has. Please let your doctor know about this situation.
If you have had a new sexual partner or your partner has had a new sexual partner it is very important that we test for all STDs again during the third trimester. Your 36 week visit is the ideal time to do this.
If you have had all of the STD tests done during the early pregnancy and have NO new risk factors, it is ok to decline the tests that are offered later in pregnancy. If you have any concerns about your risk factors, please ask any of the doctors. Please do not be embarrassed - we want to discuss this with you to protect your child.