By Jennifer Steffen, NP – InterMed Women’s Health
Gestational diabetes is a type of diabetes specific to pregnancy. Between the 24th – 28th weeks of pregnancy, all women are screened for this condition with a one-hour glucose tolerance test. If results are abnormal, a three-hour glucose tolerance test is completed. If this is also abnormal, a woman is diagnosed with gestational diabetes.
What Causes Gestational Diabetes?
Normally, when you eat, your body breaks food down into glucose. In the bloodstream, insulin moves glucose into the cells to be used as fuel. Excess glucose is stored for later needs. According to the American Diabetes Association,
“During pregnancy, an expecting mother’s placenta makes lots of hormones. Some of these hormones block insulin from moving glucose in to the cells. This is called insulin resistance. All pregnant women, with or without gestational diabetes, have some insulin resistance. To overcome this “resistance,” the body makes more insulin. However, if you have gestational diabetes, your body cannot make enough insulin to keep up. Without enough insulin, the glucose in your blood rises higher than normal. This is called high blood glucose or hyperglycemia. The higher blood glucose levels can cause the fetus to gain too much weight during pregnancy.”
This can lead to increased risk of C section, birth trauma for mother and baby, hypertension disorders, polyhydramnios (too much amniotic fluid), and stillbirth. The newborn can develop respiratory problems and unstable glucose levels.
Managing Gestational Diabetes
Keeping glucose levels within a normal range is key to preventing complications. This is done through glucose monitoring, carbohydrate balance, and exercise. Occasionally, medications are necessary to maintain normal glucose levels. For most women, delivery and the return of pre-pregnancy hormone levels lead to the reestablishment of normal insulin function.
Research is revealing long-term risks associated with gestational diabetes.
- Children born to mothers with gestational diabetes have a higher risk of developing obesity and impaired glucose tolerance.
- Women who have a personal history of gestational diabetes are at an increased risk for developing type 2 diabetes and associated cardiovascular disease. For this reason, a follow up glucose tolerance test is performed at 6-12 weeks postpartum. Breastfeeding also helps to improve glucose metabolism.
Maintaining a normal weight, exercise and healthy eating can help reduce the long term risks.
Angela Tillotson, a Family Nurse Practitioner and Diabetes Specialist at InterMed, finds that the diagnosis of gestational diabetes is blindsiding for most people. Angela relates that many women express anger, feeling that they should be able to eat what they want to during pregnancy and not worry too much about their weight. They also wonder, “What did I do wrong?”
Angela states, “It’s important that women don’t blame themselves. This is truly a case where your pregnancy hormones affect your ability to use insulin.”
A woman newly-diagnosed with gestational diabetes meets with Angela for 90 minutes for the first appointment. Individual history and risk factors are reviewed and the woman learns realistic ways to manage her blood sugars. Shorter, follow-up appointments are scheduled every two weeks until delivery.
In addition to teaching her how to use a home glucometer, “We review label reading, carbohydrate counting, and meal planning. It is important to understand — especially in light of nutritional demands in pregnancy — that it’s about the right carbohydrate balance, not restriction.” Women will ask, “What about Thanksgiving?” or, “Can I eat cake at my baby shower?”
Angela counsels that a little meal planning and an extra walk around the block can usually accommodate a small indulgence on a special occasion. “It’s about monitoring the patterns and adjusting the carbohydrates.”
Less than 50 percent of the time insulin injections or oral agents, such as glyburide or metformin, are necessary to keep blood sugars in check. Angela recognizes that managing gestational diabetes effectively involves hard work and commitment. She reminds women, “The goal is a healthy baby. You will be rewarded for your efforts!”