Thinking About Another Pregnancy

[Healthy]

I was just diagnosed with a gluten intolerance 6 months ago. I've been slowly learning how to eat and feeling much better. I also have PCOS (Polycystic Ovary Syndrome) and leaky gut syndrome. I'm also concerned I may have an underactive thyroid, but have never been able to get doctors to confirm it.

I conceived my first child within the first cycle of trying. When trying for my second found out I had PCOS that was contributing to my infertility. Got pregnant on my own, but then miscarried. A year later with my first round of clomid, HCG trigger shot and progeterone shots was able to become pregnant and have a successful pregnancy.

With my second I developed GD and had to use insulin. I am on Metformin because of my PCOS and I'm IR.

With both pregnancies I had pre-eclampsia at 36 weeks. I delivered my first child at 38 weeks and my second at 37 weeks. I'm also overweight, used to be really thin. I'm 55 pounds over what used to be my normal weight.

I'm worried about losing weight before becoming pregnant again. But also wanting to find a doctor who can help me through another pregnancy. My OBGYN I went to knew nothing about PCOS and didn't handle my pre-eclampsia too well.

With my celiac diagnosis and having a leaky gut, which my functional medical doctor found and says is getting much better, just worried about the complications during pregnancy. And what I should be paying attention to in regards to getting ready for a pregnancy.

Also what kind of doctor would you suggest who could help with knowing what kinds of vitamins and minerals are safe for pregnancy. I'm on quite a few getting my levels back up to where they should be. My functional medical doctor can help with that, but I'd like an OB doctor that would support him.

My other OB said I didn't have a problem with my iron. But when becoming newly diagnosed with gluten intolerance he found out I was very iron deficient. So, I don't trust going back to that OB.

Thanks for any guidance!

[TrillumHunter]

Would you consider holding off trying for another year? I think you will find some of your issues may resolve as you heal. You need time to heal and continue with a strict gluten-free diet. Give yourself a chance to have a easier pregnancy.

HTH!

[Healthy]

Yes, I keep pushing when we'll start trying out further. Because I know if I can heal myself, the better off my pregnancy will be. It's also a balance of I'm 36 and don't want to be too much older when I have my last child

The good news is that my functional medicine doctor knows I want to start trying within 6 months or so. And said I'm getting better, but wants to do additional testing before I get pregnant to get me off on the right foot.

I just want to know if there is a doctor out there who could handle my pregnancy that is educated about gluten allergies and PCOS

[tarnalberry]

If you stay gluten free, and doing well maintaining a low-glycemic diet, I don't know that you need someone who can deal with the celiac aspect too much. Really, staying gluten free, and managing the insulin resistance that comes along with PCOS should take your risks way down. I think waiting six months is perfectly reasonable, and gives you time to interview potential providers (yes, you can set up a short interview without being a patient (or paying) with many, many OB's, CNM's, or LM's).

[Healthy]

Thanks for the advice, and it's good to know that because I have a gluten allergy it won't be an issue during pregnancy.

[brigala]

I just want to know if there is a doctor out there who could handle my pregnancy that is educated about gluten allergies and PCOS

Try looking into Naturopathic doctors who double as midwives.

You can still see an OB if you feel you need to, or if you must in order to deliver in a hospital (if that's what you want) but a ND who is also a midwife should be much more informed on nutrition and pregnancy, and NDs tend to be more understanding of food sensitivities and Celiac disease.

I am seeing both a ND who is a midwife and my Kaiser OBGYN department for this pregnancy. Kaiser covers for all the testing, blood work, ultrasounds, etc.. My ND gives me the actual care and advice I need to stay healthy. Kaiser frankly isn't very helpful.

If you could find a GI who is also an OB, that would work, too, but I think that's highly unlikely.

[tarnalberry]

It's worth noting that midwives are generally prohibited from caring for high-risk pregnancies by either state laws, insurance provisions, licensing standards, or some combination of the three. No reason that you can't see one *in addition* to an OB in that case, if you can find one who'll see you. And I don't know that you'd qualify as high risk - usually a midwife will evaluate that and determine how "risky" you are. You can, even outside of that, almost certainly see an ND (even one who isn't a midwife).

(It's a little frustrating what they won't allow midwives to treat. Breech, twin, and VBAC, for instance. Those tend to be for insurance purposes - and tend to be cases where OB's push c-sections because they don't have the training for vaginal delivery (particularly in the case of breech). ARGH!)

[Healthy]

It's worth noting that midwives are generally prohibited from caring for high-risk pregnancies by either state laws, insurance provisions, licensing standards, or some combination of the three. No reason that you can't see one *in addition* to an OB in that case, if you can find one who'll see you. And I don't know that you'd qualify as high risk - usually a midwife will evaluate that and determine how "risky" you are. You can, even outside of that, almost certainly see an ND (even one who isn't a midwife).

(It's a little frustrating what they won't allow midwives to treat. Breech, twin, and VBAC, for instance. Those tend to be for insurance purposes - and tend to be cases where OB's push c-sections because they don't have the training for vaginal delivery (particularly in the case of breech). ARGH!)

[Healthy]

Thanks for all the great advice! I will search out a ND or GI doctor in addition to an OB. I think with my pre-eclampsia and GD with my 2nd child a mid-wife wouldn't be able to take me.

This has been very helpful

[NicoleAJ]

Thanks for all the great advice! I will search out a ND or GI doctor in addition to an OB. I think with my pre-eclampsia and GD with my 2nd child a mid-wife wouldn't be able to take me.

This has been very helpful

In addition to the advice provided above, have particular nutrient levels checked. I knew I've had problems with low B12 in the past, so I asked my doctor to check it out before I got pregnant, so I knew I was fine there. Unfortunately, I didn't have my vitamin D levels checked until I was already 16 weeks pregnant and suffering from constant bacterial infections. It turns out that I was deficient in vitamin D, so now I'm loading up on it and going out unprotected in the sun to try and make up for the deficiency before this becomes a real problem with the baby's brain development, immunity, or my own health. I wish I had known this before I started trying to conceive because I would have gotten my levels up before becoming pregnant.

[brigala]

(It's a little frustrating what they won't allow midwives to treat. Breech, twin, and VBAC, for instance. Those tend to be for insurance purposes - and tend to be cases where OB's push c-sections because they don't have the training for vaginal delivery (particularly in the case of breech). ARGH!)

That varies a LOT by state. My VBAC was delivered by a midwife in a hospital. Kaiser hospital has me seeing a midwife also, and if I deliver in the hospital it will be with a midwife unless I have a complication and need another c-section for some reason. In Oregon, Breech, twins, or VBACs after 2 or more cesareans can't be delivered by midwives in out-of-hospital birth centers but they CAN be delivered either at home with licensed midwives or in a hospital by CNMs.

For the OP, the history of pre-E and diabetes may or may not exclude you from midwife care depending on your state regulations and the individual midwives' comfort levels. Many midwives recommend the Brewer's Diet to help ward off pre-E, especially in women with a history of it. The OB who originally came up with the diet claimed that it would eliminate pre-E entirely; my ND says this isn't true but it does reduce the risk quite a bit. It's also a relatively lower-carb high-protein diet, so it should be good for diabetes as well.

If Dr. Brewer was right, and Pre-E is caused entirely by nutritional deficiencies, it would make perfect sense that undiagnosed/untreated Celiac disease could also cause Pre-E even if the actual diet was perfect -- because Celiac would prevent essential nutrients from being absorbed. If this is the case, then you may simply not develop Pre-E this time because you've eliminated the root cause.

In any case, my suggestion wasn't really to transfer all prenatal care to a midwife (although depending on your state, again, that could be an option). I was just thinking that a ND/Midwife combo would be a great resource to advise the OP in proper pregnancy nutrition on a gluten-free diet. A midwife usually will know all about the pregnancy nutrition and a ND will know about Celiac and gluten-free living, so it seems like someone who does both would be ideal.

[Healthy]

In addition to the advice provided above, have particular nutrient levels checked. I knew I've had problems with low B12 in the past, so I asked my doctor to check it out before I got pregnant, so I knew I was fine there. Unfortunately, I didn't have my vitamin D levels checked until I was already 16 weeks pregnant and suffering from constant bacterial infections. It turns out that I was deficient in vitamin D, so now I'm loading up on it and going out unprotected in the sun to try and make up for the deficiency before this becomes a real problem with the baby's brain development, immunity, or my own health. I wish I had known this before I started trying to conceive because I would have gotten my levels up before becoming pregnant.

My Functional Medical doctor is watching my nutrient levels and I am deficient in vitamin D. He's having me take supplements of various vitamins/minerals and he's retesting my levels making sure they are getting back to normal levels. At my last appointment he said I was almost there. It almost sounds like I should just make sure this doctor is involved during my pregnancy to keep check on all my levels. Thank you!

[Healthy]

That varies a LOT by state. My VBAC was delivered by a midwife in a hospital. Kaiser hospital has me seeing a midwife also, and if I deliver in the hospital it will be with a midwife unless I have a complication and need another c-section for some reason. In Oregon, Breech, twins, or VBACs after 2 or more cesareans can't be delivered by midwives in out-of-hospital birth centers but they CAN be delivered either at home with licensed midwives or in a hospital by CNMs.

For the OP, the history of pre-E and diabetes may or may not exclude you from midwife care depending on your state regulations and the individual midwives' comfort levels. Many midwives recommend the Brewer's Diet to help ward off pre-E, especially in women with a history of it. The OB who originally came up with the diet claimed that it would eliminate pre-E entirely; my ND says this isn't true but it does reduce the risk quite a bit. It's also a relatively lower-carb high-protein diet, so it should be good for diabetes as well.

If Dr. Brewer was right, and Pre-E is caused entirely by nutritional deficiencies, it would make perfect sense that undiagnosed/untreated Celiac disease could also cause Pre-E even if the actual diet was perfect -- because Celiac would prevent essential nutrients from being absorbed. If this is the case, then you may simply not develop Pre-E this time because you've eliminated the root cause.

In any case, my suggestion wasn't really to transfer all prenatal care to a midwife (although depending on your state, again, that could be an option). I was just thinking that a ND/Midwife combo would be a great resource to advise the OP in proper pregnancy nutrition on a gluten-free diet. A midwife usually will know all about the pregnancy nutrition and a ND will know about Celiac and gluten-free living, so it seems like someone who does both would be ideal.

I had no idea that being a celiac or having nutritional deficiencies would cause Pre-E. That explains a lot. I'm learning so much. Hopefully with my next pregnancy living gluten-free and having my vitan levels checked I will be in better shape for a pregnancy. Thanks for the information!