Diabetes and pregnancy

Definition

Diabetes is a condition in which glucose (a blood sugar that supplies the body with energy) cannot work properly because of a problem with insulin production or use in the body. Insulin is a hormone produced by the pancreas to regulate blood glucose levels. It works like a key that opens the cells in our bodies to accept glucose, thus providing us with energy.

There are two types of diabetes: type 1 and type 2. With type 1, the pancreas produces either little or no insulin to meet the body's needs. With type 2, the body cannot properly use the insulin it produces or produces too little insulin. With both types, the sugar stays in the bloodstream rather than passing into the cells, causing hyperglycemia (high blood sugar), which can damage a variety of body systems.

Pregnancy and diabetes

If you have diabetes and become pregnant, you face a greater risk of developing serious complications during pregnancy. Prepregnancy planning and prenatal care are essential in reducing this risk.

During pregnancy, your body may not produce enough insulin to meet its needs as well as the additional needs of your growing baby. As the baby develops, it needs more energy. As a result, your body needs more insulin to transform sugar into energy. If your blood sugar is higher than normal when the baby is born, the excess sugar is passed on to your infant and may cause medical complications.

During pregnancy, a mother who has diabetes has an increased risk of:

• miscarriage
• pregnancy-induced high blood pressure
• urinary tract, kidney and vaginal yeast infections
• stillbirth, sometimes without an identifiable cause
• preterm birth
• cesarean delivery

The baby has an increased risk of:

• serious birth defects, such as heart, brain, spinal cord, kidney or intestinal malformations
• hydramnios (excessive amniotic fluid)
• macrosomia (excessive weight at birth that can increase the risk of birth injuries)
• insufficient weight at birth
• if born prematurely, breathing difficulty
• low blood sugar after birth
• newborn jaundice (yellowing of the skin or whites of the eyes)
• obesity in childhood and possibly during adult life
• diabetes later in life

Two major factors influence the development of these risk factors, including:

• your ability to control your blood sugar during the three to six months before pregnancy and during the pregnancy itself
• the severity of any blood vessel damage that may have been caused by your diabetes

To reduce the risk of complications, careful prepregnancy planning and prenatal care are essential when you have diabetes. It's important to keep your blood sugar levels normal for several months before pregnancy -- and to maintain this control until your child is born. With proper care, you have nearly the same chances of having a healthy baby as a woman without diabetes.

Signs/symptoms

If your blood sugar level is too high (hyperglycemia), you may experience:

• increased thirst
• frequent urination
• weight loss despite an increase in appetite
• extreme fatigue and lack of energy
• nausea and vomiting
• blurred vision

If your blood sugar level is too low (hypoglycemia), you may experience the following mild symptoms, often with little warning:

• shakiness
• dizziness
• sweating
• irritability
• hunger
• heart palpitations or rapid heartbeat

Moderate to severe symptoms may include:

• headache
• difficulty concentrating or confusion
• poor coordination
• unusual behavior patterns such as stubbornness or uncooperativeness (may resemble a state of intoxication)
• eventually, stupor or unconsciousness

Diagnosis

To help ensure a safe, healthy pregnancy, your doctor may do a number of diagnostic tests before and during your pregnancy. Before conception, you'll have an eye exam and urine studies. If your pregnancy is unplanned, these tests will be done as early in the pregnancy as possible. A blood test called hemoglobin A1C (HgbA1C) can help the doctor determine how well controlled your blood sugar was in the three to four months before conception. The goal for this test is a result less than 7 percent, with 4 to 6 percent considered optimal.

During pregnancy, other tests may include:

• home testing of blood sugar levels four or more times a day
• a maternal serum alpha fetoprotein test (a blood test) at 16 to 20 weeks after conception to indicate the risk of certain birth defects
• an ultrasound (using sound waves to create images of internal body parts) at 16 to 20 weeks to check for birth defects, as well as accurately date the pregnancy
• nonstress tests to monitor your baby's heart rate at least weekly during the third trimester
• HbA1C test at least monthly
• measuring urine ketones (the end product of fat metabolism) each morning
• other tests, depending on the needs of you and your baby

Treatment

Your diabetes may be managed by a team of health care specialists during your pregnancy, possibly including an obstetrician specializing in high-risk pregnancy, an endocrinologist (a doctor who specializes in treating disorders of the hormone-producing endocrine glands), a dietitian, a diabetic educator and a pediatrician specializing in high-risk newborns. Your health care team will design a treatment plan to fit your specific needs, including a combination of proper diet, regular exercise and insulin. The goal of treatment is to keep your blood sugar as close to normal as possible.

Diet

Dietary counseling is an important part of your treatment plan. There are no universal dietary standards for pregnant women who have diabetes. Your doctor will help you plan a diet that takes both your pregnancy and diabetes into account. The required number of calories may need to be adjusted depending on your needs at particular points during the pregnancy. For example, you may need fewer calories during the first 12 weeks of pregnancy.

Starches (breads, grains and starchy vegetables)
Six to 11 servings per day
One serving:

• one slice of bread
• half bagel or English muffin
• one plain rice cake
• six crackers (such as rye crisps or saltines)
• 6-inch tortilla
• 3/4 cup dry cereal
• 1/3 cup rice
• 1/2 cup pasta or cooked cereal
• 1/2 cup corn, cooked beans, lentils or peas
• one small, plain baked potato
• 1 cup winter squash
• 1/2 cup sweet potato or yam

Fruits
Two to four servings per day
One serving:

• one small fruit (apple, orange, banana or peach)
• one melon wedge
• 1/2 cup chopped, cooked, frozen or unsweetened canned fruit
• 2 tablespoons dried fruit
• 1/2 cup fruit juice

Vegetables
Three to five or more servings per day
One serving:

• 1/2 cup cooked or chopped raw vegetables
• 1 cup leafy, raw vegetables
• 1/2 cup tomato or vegetable juice

Milk and yogurt
Two to three servings per day
One serving:

• 1 cup low-fat milk
• 1 cup soy milk
• 1 cup low-fat, unsweetened yogurt

Protein (meat and meat substitutes)
Two to three servings per day
One serving:

• 2 to 3 ounces cooked lean meat or poultry or fish
• 2 ounces cheese
• 1/2 cup tofu
• one egg or equivalent egg substitute
• 2 tablespoons peanut butter

Fats and oils
Fats and oils supply mostly calories and few nutrients, so use them sparingly. Foods in this group include salad dressing, oil, cream, butter, margarine, gravy and cream cheese. One serving is 1 tablespoon of regular salad dressing, 2 tablespoons of light salad dressing, 1 tablespoon of light mayonnaise, and 1 teaspoon of regular margarine or oil.

Sugary foods
Small amounts of sugary foods can be worked into a meal plan as carbohydrates. As with fats and oils, however, sugary foods are low in nutrients and high in fat. Use them sparingly.

Exercise
Exercise can help you stay healthy during pregnancy. Moderate aerobic exercise, such as walking or swimming for 20 to 30 minutes three times a week, can help control your blood sugar. Discuss any exercises with your doctor first, however, because some may not be safe in your situation.

Insulin
It's important to tightly control your blood sugar (keep it as close to normal as possible). Because insulin does not cross the placenta (the structure that develops in the uterus during pregnancy to nourish the fetus), it's safe to take insulin injections while you're pregnant. Oral diabetes medications have not been used during pregnancy due to possible harm to the fetus.

Blood glucose levels and the amount of required insulin tend to be unstable during the first trimester (first three months). The situation often stabilizes during the second trimester, but the need for insulin during the third trimester typically rises steadily. Sometimes, the need for insulin doubles or triples during the third trimester.

Because insulin requirements vary throughout pregnancy, you'll need close monitoring and follow-up. Your doctor will recommend the right amount of insulin to help control your blood sugar. You may need to have several insulin injections each day and measure your blood sugar at home several times a day, often upon awakening, and before or after meals. For some women whose blood sugar cannot be controlled with insulin injections, an insulin pump that delivers insulin automatically according to your changing needs may be recommended.

Labor and delivery

Most pregnant women who keep their blood sugar in the normal range and do not have medical complications can deliver at or near full term. During labor and delivery and in the early postpartum period (after the baby is born), the doctor will closely monitor your blood sugar levels and provide any needed insulin. After delivery, you may not need much insulin for the first days. Your baby will also be closely monitored for low blood sugar levels, jaundice and other possible health problems.

If your doctor recommends an early delivery because of the baby's large size or other complications, the baby's lung maturity will probably be tested. Labor is sometimes induced with medication. In some cases, cesarean delivery may be necessary.

Complications

Hypoglycemia (low blood sugar) is most common during the early weeks of pregnancy, especially between 10 and 15 weeks after conception. It's important for family members and other close contacts to be aware of the signs, symptoms and treatment of hypoglycemia. As listed above, mild symptoms of hypoglycemia -- which can occur with little warning -- include:

• shakiness
• dizziness
• sweating
• irritability
• hunger
• heart palpitations or rapid heartbeat

Moderate to severe symptoms may include:

• headache
• difficulty concentrating or confusion
• poor coordination
• unusual behavior patterns such as stubbornness or uncooperativeness (may resemble a state of intoxication)
• eventually, stupor or unconsciousness

To prevent hypoglycemia, do not miss or delay meals, and keep a source of sugar with you at all times.

In contrast to hypoglycemia, ketoacidosis is an emergency condition that develops when diabetes is uncontrolled. The blood sugar gets too high and there's not enough insulin to move the sugar into cells for energy. To get energy, the body breaks down its store of fat. This process, called ketosis, produces an excessive accumulation of ketones in the blood and tissues. As the level of ketones rises, other chemicals in the body become unbalanced and lead to ketoacidosis. The condition is most common in people who have type 1 diabetes. It's often due to missed doses of insulin, infection or serious illness. Ketoacidosis is associated with a significant infant death rate, but it rarely occurs when the mother's diabetes is controlled.

Prevention

Planning is the essential step to reduce the risk of birth defects and other pregnancy complications. If you're planning to get pregnant, tightly control your blood sugar for at least three to six months before conception -- as well as throughout your pregnancy. If you're taking oral diabetes medications, your doctor will help you replace them with insulin before you conceive. Preconception planning with your doctor and close follow-up throughout your pregnancy can help safeguard you and your baby against complications. Of course, discuss any changes to your diet, exercise or insulin plan in advance with your doctor.

Pregnancy and Asthma

During pregnancy, mothers-to-be may feel uneasy taking medications. However, if a pregnant woman has asthma, it is doubly important that her symptoms be well-managed to increase both her health and her baby's health. Uncontrolled asthma can be a threat to maternal well-being and fetal growth and survival. The goals of asthma management and treatment during pregnancy are the same as for other patients-to prevent hospitalization, emergency room visits, work loss and chronic disability.

Pregnant women, like others with asthma, should avoid asthma triggers, including specific allergens such as house dust mites and animal dander, and irritants such as cigarette smoke. After discovering you are pregnant, see your allergist/immunologist soon after to discuss the best way to manage your asthma and what medications to take. He or she will be able to prescribe effective asthma and allergy medications that are appropriate to use during pregnancy, and will continue to work with you throughout your pregnancy to ensure your treatment is effective, without side effects.

If you are pregnant and have asthma, you may have questions regarding the best care for both your asthma symptoms and your baby. Following are some common questions and answers to assist you.

Common questions

Can women with asthma have safe, full-term pregnancies?
Studies show maternal asthma that is well-managed during pregnancy does not increase the risk of maternal or infant complications. With appropriate asthma management, you can have a healthy baby. Conversely, there is a direct relationship between lower birth weight and uncontrolled asthma. So, it benefits you and your baby to control asthma symptoms.

Why would uncontrolled asthma affect the fetus?
Uncontrolled asthma causes a decrease in the amount of oxygen in the mother's blood. Since the fetus receives its oxygen from the mother's blood, decreased oxygen in her blood can lead to decreased oxygen in the fetal blood. This, in turn, can lead to impaired fetal growth and survival, since a fetus requires a constant supply of oxygen for normal growth and development.

How do asthma medications affect the fetus?
Studies and observations of hundreds of pregnant women with asthma have demonstrated that most inhaled asthma medications are appropriate for patients to use while pregnant. The risks of uncontrolled asthma appear to be greater than the risks of necessary asthma medications. However, oral medications (pills) should be avoided unless necessary to control symptoms.

What effect does pregnancy have on asthma?
Pregnancy may affect the severity of asthma. One study showed that asthma symptoms worsened in 35% of pregnant women, improved in 28% and remained the same in 33% of the pregnant women. These changes in severity are another reason to stay in close contact with your allergist/immunologist so he or she can monitor your condition and alter your medications or dosages if necessary.

During what part of pregnancy will asthma change?
Asthma has a tendency to worsen during pregnancy in the late second and early third trimesters; however, women may experience fewer symptoms during the last four weeks of pregnancy. Troublesome asthma during labor and delivery is extremely rare in women whose asthma has been adequately controlled during pregnancy.

Why does asthma improve for some women during pregnancy?
The exact reason is unknown. Higher levels of cortisone in the body during pregnancy may be an important cause of this improvement.

Why does asthma worsen for some women during pregnancy?
Again, the exact reasons are not known. Because the stomach area is compacted during pregnancy, some women may experience gastroesophageal reflux, a condition that causes heartburn and other symptoms. This reflux can worsen asthma symptoms. Other conditions, such as sinus infections, viral respiratory infections and increased stress, may also aggravate asthma during pregnancy.

Can I continue to receive allergy shots during pregnancy?
Immunotherapy or "allergy shots," do not have an adverse effect on pregnancy, so they can be continued. As always, your allergist/immunologist will monitor your dose to reduce the risk of an allergic reaction to the shots. These reactions are rare; however, such a reaction could be harmful to the fetus. And, allergy shot treatments should not be started for the first time during pregnancy.

Can women with asthma perform Lamaze?
Most women with asthma are able to perform Lamaze breathing techniques without difficulty.

Can I breast feed if I have asthma?
Breast feeding is a good way to increase your child's immunity, and is encouraged. The transfer of most drugs into breast milk has not been precisely evaluated; however, there appears to be no evidence that asthma medications adversely affect nursing infants. (However, some infants may become irritable from theophylline transferred by breast milk.) Also, if you have allergy symptoms while nursing, it is appropriate to treat these as well. Again, make sure to see your allergist/immunologist for the best treatment of allergies and asthma while nursing.

Although these are common questions during pregnancy, each patient's individual treatment varies. Managing asthma and avoiding asthma flare-ups during pregnancy is important to the health of the mother and fetus. It is best if women see their allergist/immunologist regularly during pregnancy so that any worsening of asthma can be countered by appropriate changes in the management program. Make sure to discuss any specific concerns with your doctor to ensure the healthiest pregnancy-for your well-being and that of your baby.

More Pregnancy Tips

Tips to prevent nausea and morning sickness

Eat more often but smaller amounts. Try not to go more than four hours between eating.
Get out of bed slowly
Keep biscuits handy to eat before getting out of bed
Avoid large meals
Rest as much as you can as feeling tiredness makes the feeling worse
Try to avoid smells and food that make you feel worse
Clean, lemony smells may make you feel better
Avoid eating spicy or fatty foods
Try to wear loose clothes that don't put pressure on your stomach

Tips to prevent heartburn

Try putting a pillow between your knees to help ease the strain on hips and knees.
Decrease your fluid intake in the evenings (but not during the day) and avoid caffeine to avoid heartburn.
Eat little and often. Drink milk or herbal teas with chamomile or fennel after eating.
Also eat peppermints after eating.

Travel tips

The second trimester is the best time to travel. At this time, you are probably over the sick and nauseous feelings of the first trimester. The miscarriage risk is also minimum at this time.
On the road or in the air, avoid sitting for extended periods of time, try to walk around at least every hour or two. On a plane or train, even a trip up and down the aisles can help get your circulation going. Also make frequent trips to the toilet.
Carry light snacks so that you do not go without food for long periods of time. Keep munching a carrot, an apple or a sandwich every hour or so.
In the sultry heat of India, keep water handy all the time ot prevent dehydration and cramping.
Use travel sickness bands - these work by massaging your pressure points.

Miscellaneous

If you suffer with piles during pregnancy ice packs covered with a soft cloth on the area can provide relief.
To relieve backache, place a warm hot water bottle on the relevant area. Press your spine against a wall and keep in that position for a few seconds.
For cramps, gentle exercise will help - swimming is particularly good. Raise your feet on a pillow when lying in bed.

Pain relief during labour

Having your back rubbed during labour helps with the pain.
When you are in labour, try and walk around or at least stay in an upright position for as long as possible. This speeds up the process.
Squatting, hands and knees or standing during delivery increases the pelvis size by over 30% giving you a faster, easier and safer delivery.
Eating and drinking fluids during labour is the best natural remedy for labour pain.
You can help your baby move into the optimal position for birth in your third trimester by making sure that your knees are lower than your hips when driving, sitting or relaxing.


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Pregnancy tips

Before Getting Pregnant:

• Get checked to see if you are immune to German Measles. Sometimes vaccinations don't "take". If you're not immune, they can re-vaccinate you and then you wait 3 months to become pregnant, so that the vaccination won't harm the baby.
• If you or your partner is Jewish, get checked to see if you are a Tay-Sachs disease carrier. Testing for this is less accurate once you're pregnant. 1 in 25 American Jews is a carrier; 1 in 250 non-Jewish Americans is a carrier. Tay-Sachs is a tragic genetic disease; you don't want to go through having a Tay-Sachs baby.
• Your sleep needs may increase when you are pregnant. If you can arrange your life to allow you to get more sleep once you are pregnant, go for it. This doesn't mean dropping all activities!! It does mean setting up your schedule so you can take a nap once in a while, or so you can go to bed early enough to get 10 hours of sleep if you feel like it.
• Go to the dentist for a full checkup and cleaning.
• Avoid potatoes for a month or two before conception. There's some crazy researcher who thinks potato consumption may be associated with a higher risk of certain birth defects. She's mostly a nut, but I think she has a decent case for this, and in any case it surely can't hurt. The time to avoid potatoes would be from a month or two before conception until maybe 2 months into the first trimester, when the baby's neural tube is formed.

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First Trimester:

• Keep some reading material in the bathroom. Something you can read in small bits, like a magazine, is ideal.
• Possibly of interest: go to www.pregnancytoday.com and join an e-mail list of women who are due in the same month as you. The December list is wonderful!
• Tips for swallowing pills when you are nauseous:
  • If your nausea comes and goes, wait half an hour to see if you feel more like swallowing a pill then.
  • After putting pills in your mouth, have water ready to swallow really fast. The worst moments for me are while the pills are sitting in my mouth.
  • Showers make me queasy for some reason, possibly because I'm a very energetic shampooer. I used to shower and then take my daily pills right afterward. It's better to take the pills first.
• Flossing tip: I used to gag on the last two teeth. At first I thought that the top left section of my mouth was more gag-prone, but eventually I realized that it was always the last two teeth. By flossing my teeth in a different sequence each day, I could vary which teeth got less flossing.
• My theory of how to answer when people ask if you prefer a girl or a boy: Even if you have a preference, don't let on. If you get the other type of kid from what you asked for, word may one day get back to your kid that you would have prefered the other kind -- and that hurts!
• Crackers are the conventional wisdom antidote for morning sickness. I personally liked bread better than crackers when I was queasy. I've heard other people swear by matzoh, so that may be worth a try too, although it didn't seem to do much for me. My favorite bread for this purpose was a Farmer's Bread that tasted very slightly sour (sourdough?) and had a visible dusting of flour on the outside of the crust.
• Remember that your body is still the same body you've always had. I spent a lot of first trimester treating myself as if my body had been taken over by space aliens. Eventually I realized that the same things that had always been true of me were still true, for example I *still* didn't like the idea of food first thing in the morning, not even crackers.
• Don't forget to drink lots of water. I tend to forget, or not want any, especially if I'm feeling yucky. By "yucky" I mean something more like "heartburn" or a "heavy full-feeling stomach" or "itchy and jumpy", but not "queasy". Even though I don't usually want water when I feel yucky, that is when I need water most. And, surprisingly, water often makes it feel better.
• Experienced moms keep saying that the place to get baby clothes is at garage sales. You can spend $100 at a store for 3 items, or you can spend $100 at a garage sale for 3 grocery bags of stuff. One lady on my December e-mail list says to go to garage sales in rich neighborhoods for the best baby clothes. We went to a garage sale and spent $35 for four bags of great baby clothes! Yell if you'd like a list of excellent list of garage sale tips.
• Don't stress out about food information sheets that tell you to eat jillions of servings of a zillion specific foods each day. These are for later in pregnancy when you're hungry enough to eat that much food in a day. Until you reach that point, don't stress about eating all those servings of food in a day; just try to make sure that what you do eat is healthy (not too many gumi worms). :)
• I found I was more energetic when I took multivitamins. I took those instead of prenatal vitamins. I've read a lot about vitamins and concluded that I haven't yet found the perfect option. I ended up taking my same old multivitamin from before pregnancy, rather than prenatal vitamins, for a variety of reasons.

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Second Trimester:

• If you haven't started already, the beginning of second trimester is a really good time to start doing Kegel exercises. I took a "wait and see" approach to doing Kegels, figuring that at some point I'd have some kind of signal that it was time to start. It turned out that at about 4 or 5 months pregnant, standing became painful. The solution was to do lots of Kegel exercises. If I'd started sooner, I'd've prevented the problem.
• Lots of women report "not feeling pregnant" early in second trimester and feeling worried about the baby because of this. It's okay to feel okay!
• The rumor mill says that baby furniture tends to be severely back-ordered, so now may be the time to go shopping. Dunno about this, though.
• I normally eat 2 meals in a day. Some days in second trimester I'd eat like that. Other days I'd eat six and go to bed kind of hungry. A widely varying appetite seems to be normal.
• I didn't start putting on weight beyond my pre-pregnancy weight until around 18-19 weeks -- almost half-way through pregnancy.
• Lots of women with children have a box of maternity clothes they're keeping for "just in case" they have another child. If you keep your ears open, you may find one or two people like this who are willing to loan these clothes to you. This very unexpectedly happened to me, and the clothes turned out to be wonderful!
• I dunno why maternity clothes so rarely have pockets. Sometimes I prefer my big non-maternity clothes just because then I can have pockets.
• You can rent maternity formal attire, rather than spending lots of money on something you'll only wear once or twice.
• Before investing in 17 identical maternity items, buy only one or two to be sure you like that style. For example, I really liked pants with an elastic belly-panel when I first tried them on, but later on I decided that I prefer things that don't stretch tightly over my belly.
• In general I was happier wearing my same old clothes (well, the baggier ones) as much as I could, rather than my maternity clothes. My favorite outfit turns out to be a big t-shirt plus underwear, no pants -- not very suitable for wearing in public!
• The maternity clothes I did end up wearing a lot are maternity leggings, a maternity slip, and a maternity turtleneck. (My pre-pregnancy slips and turtlenecks fit okay too, but they tended to slide upward to above the bulge). I got some big amorphous dresses at a store that sells clothes that are made by exploited women from third world countries, and wore those over a turtleneck and leggings almost all the time. Also, even though I didn't use it much, I was very glad to have a maternity swimsuit.
• At the end of second trimester I found I'd get out of breath and tired very easily. This seems to be very common. Exercise seems to help. So does increasing the amount of iron in your diet.
• If your obstetrician is the kind who always runs late, it might be worth calling ahead before going to appointments. If you find out that there's a huge delay, you might be able to arrange to spend the time elsewhere instead of sitting in a waiting room.
• Morning sickness does NOT just disappear after the first trimester ends! I was sick until about 20 weeks or so, had 3 good weeks, then broke my ankle... But, that's just me! :-) The sad thing about it was, I was counting down to pass that 12th week, then I wouldn't be sick anymore!!! HA!!! Now I know better!
• if you like wearing jeans, invest in maternity jeans. I didn't for a long time, trying to tell myself (sternly) that I had enough things I COULD wear. But, when I found a pair at a maternity outlet while traveling, I gave in -- and have not been happier. I feel so much more normal wearing them than leggings (which I don't wear much when not pregnant). I also found a pair that have an adjustable elastic waist so you can wear them while you shrink. The elastic has button holes in it, and as you shrink, you just keep tightening it further down.
• My clothing suggestion is a Mama Coat. They're a little expensive, but you can wear them while you're pregnant; after the baby's born you can keep the baby tucked inside the front of the coat; finally, the front panel zips out, and it's just a lovely, lined coat. I love mine.

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Third Trimester:

• My bikini underwear all still fits fine. If you already wear bikini underwear you'll probably need no new maternity underwear.
• If the doctors or nurses sit you down and tell you about the signs of, say, pre-term labor, it is worth paying attention. The doctor talked to me about it before I had had any contractions at all, so I didn't pay a lot of attention to what the warning signs to watch for are. Then, a few days later, boom! -- contractions! At that point I wished I'd paid better attention.
• By third trimester, I was amazed at how unproductive I was at doing my work. It took a long time for me to realize that this was pregnancy related. Between eating extra meals each day and constantly running off on one baby-related errand or another, baby production gets to be time consuming!
• If your partner is out of reach of the telephone for any length of time (eg. a camping trip) it may be worth exploring getting a pager. Your hospital may offer these free with a deposit for couples that are getting close to their due date.... Also, you can rent cellular phones pretty inexpensively for a short period of time.
• Keep detailed notes on exactly what people gave you get at baby showers. I want to re-thank the person who gave us the great white socks for our baby, but I have no idea which of the 12 pairs of socks we were given came from which person. I wish my shower notes said.

courtesy http://www.valeriemates.com