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Gestational Diabetes

I'm a little late to the party, but November is American Diabetes Month. In case you missed it, I've covered the topic of diabetes a few times on the blog: Diabetes 101, Diabetes on the Rise, and Prediabetes and Cancer. But today I want to touch on the topic of gestational diabetes.

What is gestational diabetes?

Gestational diabetes is the form of diabetes that occurs in expecting mothers. The difference in these cases is that the women did not have diabetes before they got pregnant. According to a 2014 analysis by the Centers for Disease Control and Prevention, the prevalence of gestational diabetes is as high as 9.2%.

What causes it?

It's not 100% clear what causes gestational diabetes, but here are some risk factors to consider:

  • Excess weight. If your BMI is 30 or higher, your rate increases significantly.
  • Family or personal history. If you had gestational diabetes during other pregnancies, you had prediabetes prior to pregnancy, or a 1st degree family member has type 2 diabetes.
  • Giving birth to a baby over 9 lbs, or an unexpected stillbirth.
  • Being over 25. In an urban setting in 2015, that's most women. Don't stress about this.
  • Being non-white. Hispanic, American Indian and Asian women are at higher risk.

During the second trimester of pregnancy, mom's insulin needs increase dramatically. The increased need, along with hormonal and physical changes in mom can cause an inability to make enough insulin, or an inability for the body to use the insulin properly.

What are the health concerns?

Gestational diabetes doesn't have the same risk to the baby as if mom had diabetes prior to pregnancy. However, untreated or uncontrolled gestational diabetes can have a negative impact on your baby. Specifically, the extra glucose in the bloodstream can cause the baby to store energy as fat, leading to a large baby. While this has ramifications for delivery, it also can cause newborns to have very low blood sugar at birth, have higher risk for breathing problems, and higher risk for obesity and type 2 diabetes as they age.

How is it diagnosed?

Pregnant women must take a glucose tolerance test somewhere around 24-28 weeks of pregnancy. From what my friends have told me, this is not the greatest joy of pregnancy. It involves drinking about 8 ounces of a very sweet drink, and having your blood drawn hourly. The real fun comes in that you can't eat or drink anything else, you have to hang out at the doctor's office, and you'll probably be a little jittery from all that sugar!

Depending on risk factors, and specific doctor's recommendations, the test may be one hour or three hours. The exact amount of sugar that have to drink will match the length of the test. Basically, the test shows how quickly your body can process the sugar, and how quickly your body can return to "normal". This is an indicator of how much and how well your body is using insulin.

What happens after diagnosis?

Most women can manage gestational diabetes through diet and activity. The biggest lifestyle change will likely be having to test your blood sugars regularly. It can be intimidating to prick your finger at first, but in the grand scheme of life, it's not that big of a deal. However, some women will need to use medication to manage the disease. Not only are the drugs safe for use during pregnancy, using them properly will benefit the baby.

So what dietary changes are required? An overall reduction in concentrated sweets and a reduction in the number of carbohydrates per meal or snack. Also, most dietitians recommend avoiding juice or fruit with breakfast, as the body is a little more resistant to insulin in the morning.

Increasing physical activity during the day also makes a difference. Women should exercise as much as they can while pregnant, while continuing to be safe. Walking is great exercise, and still a viable option into the third trimester. It may be more feasible for moms to take multiple short walks during the day instead of one long one. A 10- to 15-minute walk after each meal can make dramatic improvements to blood sugar control.

Post-Partum

For most women with gestational diabetes, their body will return to normal after giving birth. However, it doesn't end there. There is an increased risk of developing type 2 diabetes later in life - anywhere from a three- to sevenfold higher risk within five to 10 years. Again, we don't know exactly why. What we do know if that mom should be much more mindful to maintain a healthy weight and to limit concentrated sweets for optimum health.

If you are diagnosed with gestational diabetes, you should definitely talk with a dietitian. I'd love to help you, or you can find a dietitian near you. Getting your blood sugars under control is one of the best things you can do for you baby.