There is no shortage of unsolicited advice given by family members and complete strangers to women who are trying to become pregnant or expecting their first children. However, there are many proactive women who are trying to alleviate worry and risk by seeking wise counsel on pregnancy concerns early in the process.
Technology, social media and the abundant available information make having a healthy pregnancy and preparing a mother’s body for the rigorous road ahead seem easier. However, a lingering concern for some women is whether or not they will develop gestational diabetes.
Diabetes is a condition in which the body does not properly process food for use as energy. Most of the food we eat is turned into glucose, or sugar, for our bodies to use as energy. The insulin-producing pancreas makes the hormone to help glucose penetrate the cells of the body; it also helps manage blood sugar levels. When a person has diabetes, the body either doesn’t produce enough insulin or cannot use its own effectively, causing a sugar buildup in the blood.
There are two types of diabetes, type 1 and type 2. Type 1 diabetes is caused by genetics and other unknown factors; type 2 is caused by genetics and lifestyle.
Pregnant women who have never had diabetes before, but who have high blood glucose (sugar) levels during pregnancy due to not producing enough insulin, are said to have gestational diabetes mellitus, also known as GDM.
During pregnancy, a woman’s body not only makes more hormones – her existing hormone levels change. These changes, in addition to other changes such as weight gain, cause her body to use insulin less effectively, thus increasing the need for more insulin.
According to the American Pregnancy Association, “Approximately 2-5 percent of pregnant women develop gestational diabetes; this number may increase to 7-9 percent of mothers who are more likely to have risk factors. The screening for this disease usually takes place between the 24th and 28th week of pregnancy. Doctors test for gestational diabetes during this time because the placenta is producing large amounts of hormones that may cause insulin resistance. If the results indicate elevated levels, further testing would be done to confirm a gestational diabetes diagnosis.”
William A. Cook III, MD, FACOG of Johnson Health Center in Lynchburg explains, “Most patients are asymptomatic, but some experience excessive thirst, frequent urination, and food cravings (especially sweets).”
Other symptoms of GDM may include:
- Sugar in urine (revealed in a doctor’s office check-up)
- Fatigue or nausea (common with many pregnancies)
- Frequent bladder or vaginal infections
- Blurred vision
Dr. Cook continues, “All patients are screened with an initial serum glucose at the onset of pregnancy care and then a one-hour glucose screen at about 28 weeks of pregnancy. If the one-hour glucose screen is abnormal, then a three-hour GTT is done to obtain the diagnosis.”
Although the American Diabetes Association confirms that professionals do not know the exact cause of gestational diabetes, they do offer suggestions to lower the risks for mothers of developing the condition during pregnancy.
Women at risk of developing GDM are those who:
- Are overweight,
- Have high blood pressure,
- Have unhealthy cholesterol levels,
- Are physically inactive, and/or
- Have unhealthy eating habits.
Women can greatly reduce their risk of developing GDM by improving their daily habits prior to becoming pregnant. Being more active and quitting smoking are two low-cost initiatives that not only improve a woman’s own health, but also the health of her unborn baby.
Simply shedding a few pounds (if a woman is over 20% her ideal body weight) prior to becoming pregnant can increase her self-esteem, lower her blood pressure and stress, and decrease her likelihood of developing GDM.
In terms of developing gestational diabetes, “The biggest risks are large babies (fetal macrosomia) and hypoglycemia in the baby after birth. If GDM is severe or poorly controlled, then risk of small babies and an association with stillbirths exists. We monitor our patients very closely with antenatal testing and try to deliver them early (39 weeks) if possible,” explains Dr. Cook.
Larger birth weights may also lead to delivery risks, such as injures to the infant’s shoulders and arms. Additionally, women who develop gestational diabetes have an increased risk of developing type 2 diabetes later in life, as do their children.
“We treat patients with gestational diabetes first through education and diet modification. Patients are given a glucometer to check their blood sugars. If after diet changes the blood sugars are still elevated, then oral hypoglycemic agents and/or insulin are used to gain blood sugar control. There is no real way other than trying to be weight conscious to prevent GDM,” says William A. Cook III, MD, FACOG of Johnson Health Center.
The treatment for patients with gestational diabetes is a collaborative effort between the patient, the obstetrician, possibly a nurse practitioner or midwife, and a dietician. An effective treatment plan always includes a strategic meal plan and routine physical activity.
According to the American Diabetic Association, a healthy meal plan for people with diabetes (or gestational diabetes) is generally the same as a healthy diet for anyone – one that is low in saturated and trans-fat, moderate in salt and sugar, and includes meals based on lean protein, non-starchy vegetables, whole grains, healthy fats and fruit.
Diabetic and "dietetic" foods generally offer no special benefit. Most of them still raise blood glucose levels, are usually more expensive, and can also have a laxative effect if they contain sugar alcohols.
“Most patients return to normal after they deliver, but some may have been diabetic prior to their pregnancy, so all should be checked at their postpartum visit to make sure the concern is resolved. There is definitely a higher risk of developing GDM later in life, which may not be preventable. However, good exercise, maintaining a healthy weight, and proper diet can all help keep it from occurring,” reminds Dr. Cook.
A well-balanced diet that includes plenty of fruits and vegetables and lean proteins (such a chicken or fish) combined with moderate exercise will help improve the overall health of any individual. A woman who is looking to improve her own health as well as that of her unborn child should consult her doctor for the steps to implement a safe plan that achieves long-term results. Women going into pregnancy with a healthy lifestyle are more likely to return to a healthy weight after delivery in addition to reducing their risk of developing gestational diabetes.
A pregnant woman’s growing belly is a beautiful gift, but it can also lead to increased worries and concern. By working together with her healthcare team before, during, and after pregnancy, a woman can successfully manage complications that occur during pregnancy, resulting in the birth of a healthy baby.
William A. Cook III, MD, FACOG with Johnson Health Center in Lynchburg
1 Center for Disease Control and Prevention, www.cdc.gov
2 American Diabetes Association, www.diabetes.org
3 American Pregnancy Association, americanpregnancy.org