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Pregnant. Overweight, developed gestational diabetes and back pain. How to get relief?

Mar 2013
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I am 16 weeks pregnant with an ESR of 55 and CRP of 10, My Rheumatoid factors are normal. I am 42 an d obese but active. I have some lower left sided back pain which seems to be muscular and occurs mainly when I walk.
I am very tired at the moment and have developed gestational diabeties which is now well controlled with insulin.
I am worried about these results and the implications of them. I have mild asthma which is mainly seasonal and allergic. I do not feel like I have a chest infection and my MSU's have all been normal.
Three weeks ago I had terrible pain in my chest and shoulders after overdoing it spring cleaning the house. I took dihydrocodene for a week and the pain gradually subsided, althought remained in my arms and shoulders. After a physio massaged my back and arms , all the pain has subsided and the tension in my arms and shoulders is now gone too.
I still have the pain around my left side when I walk.
I had a slightly elevated ESR two weeks ago but CRP was not taken
Posted Tue, 5 Mar 2013 in Pregnancy
Answered by Dr. Aarti Abraham 36 minutes later
Thanks for your health query.
Your ESR and CRP in the absence of any signs of systemic infection / inflammation are normal, and nothing to worry about.
Age of 42, obesity and gestational diabetes are all risk factors for the pregnancy.
The pain seems to be muscular and not rheumatoid , as per your description.
Backache is common with the second trimester of pregnancy and due to your weight.
Also, do not attempt any activity in uncomfortable postures which might strain your muscles, as ligaments and muscles are very prone to injury and very sensitive in pregnancy.
As you are on insulin, be very careful to maintain your blood sugars in the normal range ( fasting ideally < 95 and postprandial < 145 mg/dl ).
Measure sugars daily ideally.
Be very particular with your diet, and have a proper diet chart formulated after consultation with a Dietician, who will duly consider your weight, calorie requirement and insulin requirement.
Take adequate rest, avoid fatigue, and have a lot of intake of fluids.
If the pain persists even after rest and physiotherapy, you can consult a Rheumatologist to rule out more serious causes of muscular pain like Rheumatoid arthritis or any autoimmune disorder, however that seems least likely.
Aim at ideal weight gain, as recommended below :

Experts recommend that women should aim for a weight gain related to their pre-pregnancy BMI:
If your BMI was less than 19.8, you should aim for a weight gain of between 12.5 and 18kg.
If your BMI was between 19.8 and 26, you should aim for a weight gain of 11.5 to 16kg.
If your BMI was above 26, you should aim for a weight gain of 7 to 11.5kg.

Take all prescribed supplements , specially calcium and vitamin D supplements as both obesity and gestational diabetes are linked to vitamin D deficiency.

Please take care, and feel free to ask for further clarifications.
Above answer was peer-reviewed by
Follow-up: Pregnant. Overweight, developed gestational diabetes and back pain. How to get relief? 47 minutes later
As I said in my initial query, I have been tested for rheumatoid factors and they were negative. It is really the ESR and CRP that worry me. I thought they were indicative of something serious and underlying like cancer. I understand that ESR reacts slowly and that it may be elevated due to the period of muscle inflammation two weeks ago or the subsequent diahhorea which followed for the next week... I also understand that from the start of the second trimester it can be elevated but I still think it is a bit higher that I would expect.
The CRP, as I understand it reacts very quickly to problems and in the absence of underlying factors should be negative. As the problem has been gone for a week, it should, in my understanding be back down again. CRP should not be affected by pregnancy at all, I understood that it generally indicates a seroius problem.
I guess I need you to tell me why it isnt a problem because i am disturbed by the results. I think the saying goes...'a little knowledge is worse than no knowledge!'

As for my weight.... I have lost over a kilo since going onto the insulin and switching to a lower carb and more protein diet. My portion sizes ar very small and the midwives and specialists have been really pleased with the level of control of the sugars. We measure blood sugar in different meter is in mmol/l, and i take my bloods every hour for three hours after ameal as well as before I eat. I have not had a reading above 8 for two months and my mean reading over the last 40 days is 5.7.They are surprised that i have managed to achieve the weight loss but it has been by increasing the amount I walk each day and decreasing the amount I eat.
I am a farmer/ smallholder so I am very active for my size. I no longer carry heavy things because of the increased likelyhood of damaging myself during pregnancy.
My current dose of insulin is 45 units in the morning and 35 in the evening. I am not sure what the units are but I am using a humulin quickpen pre mix which delivers a small percentage 30% of quick acting insulin along with a higher proportion 70% of long acting insulin.

generally I have been feeling really well my BMI is over 40 but it is my second pregnancy and I managed not to gain overall in the first one 8 years ago. I am trying to keep the gain minimal although I know it will be much more difficult as the third trimester gets underway.

I hope this clarifies things a bit. The ranges i was given for ESR and CRP are ESR should be less than 20 and CRP should be negative but that anything over 10 needs investigation. Is this wrong? does it change in pregnancy or is there something else that could explain the elevated CRP?

Answered by Dr. Aarti Abraham 12 hours later
Hi again,
Your CRP is just borderline ( 10 is the cut off ) , so in absence of any symptoms, both the ESR and CRP should not bother you.
CRP is indicative of something serious, ONLY if you have signs/symptoms/supporting investigations. Cancer and such serious diseases are NEVER diagnosed based on just a borderline CRP.
Also, CRP is also slightly affected in pregnancy, and your results are mostly due to the muscle inflammation you had.
It has been more than a week, but the body is not pure mathematics, and as you still have slight pain, it is possible that the values maybe borderline.
I repeat, please do not read much into these reports, because they are reports and meant to be taken as a whole in conjunction with your problems and other clinical findings.
Take care, and congratulations on your metabolic control and vigilance on the weight aspect.
Above answer was peer-reviewed by
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