Editing Pregnancy (section)

== Second Consultation ==

About a month later, after we'd traveled to France, Greece, the UK, and back we went to our next appointment. At every visit to Dr. Neiman, they run a quick urine test. At this appointment, we learned that Julie might be at risk for gestational diabetes.

By this time, the gestational age was about 16 weeks.

=== Gestational Diabetes - Screening ===

This is a straightforward test. They give you a glucose drink and then test you an hour later. We did this at our usual Sutter Health Lab.

=== Gestational Diabetes - Confirmation ===

If you test positive on the former, they give you this. This is a 3 hr effort so it's important to arrive early enough to do it. We arrived at 11 AM on a Saturday and they could not accommodate us, but were fortunately first in the Wednesday after.

=== Dealing With Gestational Diabetes ===

Annoyed by the wait for the confirmation test, I thought I'd do it myself. The test kit I constructed from Amazon was:

# A blood glucose monitor: I picked a cheap one, a [https://www.amazon.com/gp/product/B08LYC288R/ Metene TD-4116 BG03]
# The smallest container of Glucose for both of us to test: [https://www.amazon.com/gp/product/B079NQ8F98/ two ''pounds'' of dextrose]

This whole exercise ended up being a farce, however, when Julie refused to use my meter or my test and insisted on waiting to be tested by the lab. I enjoyed measuring myself and plugging the data into Apple Health so it wasn't a complete loss in the end. The dextrose remains unused.

Dealing with the actual condition is pretty much like dealing with Type II Diabetes: you manage your diet and exercise and prick yourself after every meal and in the morning to see how your blood glucose fares. This matters because gestational diabetes can lead to extra-large babies which has all sorts of problems. Since our test was done so early, it could be that Julie had Type II diabetes which is sometimes associated with low birth weight if unmanaged. Anyway, all said: you're gonna be pricking yourself every day and measuring.

==== Devices ====

The ob/gyn provider set us up with a counselor who set us up with a similar device: the [https://shop.onetouch.com/verio-flex-meter/product/OTSUS05_0004 Verio Flex OneTouch]. Both these devices are inexpensive, but Julie has the Verio Flex device reporting to her phone.

I just tested both devices simultaneously to compare accuracy and received the following from the same finger: (mg/dL of glucose in blood)<ref>I did all on the ring finger of my left hand at slightly different spots (which has left it rather sore). For the 1st prick, I first touched to the Metene strip then to the VF strip. For the 2nd the other way around. For the 3rd only the Metene.</ref>

# First prick: 88 on Metene, 80 on Verio Flex
# Second prick: 101 on Metene (but I dropped the test strip on the floor first accidentally), 88 on Verio Flex
# Third prick: 89 on Metene

So these are roughly in the same range for diagnostic reasons when you aren't rubbing them on the floor. After all, if you're close enough to go over all the time, that's just as bad. The Metene comes in a nice bag that's handy to carry around and I find the spring-activated lancet launcher (that pricks your finger) easier to use.

Julie prefers to prick herself manually with the lancet, and prefers using the Verio Flex tools.

=== Foetal Echo Ultrasound ===

One of the things that Dr. Neiman recommended we do is a Foetal Echocardiogram which is an ultrasound scan that checks for any obvious heart errors. This is normal for IVF pregnancies because of the elevated risk (it isn't a big risk, just an elevated risk). We did this at the Stanford Childrens' Lab in the same building as the Sutter Health Lab. It's a fairly long process where the lab tech scans your baby's heart and then a paediatric cardiologist tells you if there's a problem detected.

Note: '''Try to eat around an hour before these ultrasounds'''. If the baby is quiescent, it'll sometimes be in a position that makes it impossible to measure its heart.

=== MSAFP Test ===

The Maternal Serum Alpha-Foetoprotein test tells you if there are certain kinds of birth defects. The protein is made by the baby's liver (and perhaps other organs) so presumably having too much or too little points to problems there. We made a mistake on our checklist and did not do this test in time. It has to be done between 16 and 20 weeks, with 21 weeks reducing its diagnostic efficacy.

This would let you know early if there's a problem and begin preparing for it (or presumably terminating). It appears that California has a data-collection regime around this and Non-Invasive Prenatal Screening (NIPS). In any case, the MSAFP test results are sent to the state and the state sends them to your ob/gyn. So what this means is that you have to allow for 10 days of delay to get the results. The results of this help search for problems on the anatomy ultrasound that follows.