Diabetes is a health problem that results in too much sugar in the bloodstream and not enough in cells where it can be used properly for energy. The problem occurs when the body is not able to make the hormone insulin (type 1 diabetes) or the insulin that is made doesn’t work very well (type 2 diabetes). Gestational diabetes (GDM) is “temporary” type of diabetes that occurs during pregnancy.  

Women with GDM don’t make enough insulin or the pregnancy hormones interfere with the insulin that they do make during pregnancy. It also affects how the cells use the sugar. This results in high levels of sugar in the blood, which is transferred to the baby. The baby turns the extra sugar into fat which is mostly around his or her belly. These are often referred to by ladies in our community as “Sugar Babies”. This extra birth fat increases your baby’s chance of having obesity, high blood pressure, heart disease, and type 2 diabetes later in life. In addition, the baby may have difficulty being born if he or she is too big, and can have low blood sugars that require special care right after birth. Uncontrolled GDM can also lead to respiratory problems and stillbirth. This is why it’s so very important to know if you have developed GDM and to work diligently with your midwife to keep it under control. 

Risk factors for developing GDM during pregnancy can include things like:

·      Being over 25 years old

·      Obesity/Overweight prior to pregnancy

·      Prior pregnancy with GDM present

·      Having high blood pressure

·      History of a very large baby (9# or more)/or one that got “stuck” (Shoulder Dystocia) during delivery

·      History of several miscarriages, a stillborn baby, a baby with birth defects,

·      If your mother, father, sister, or brother has diabetes

·      Presence of sugar/glucose urine at the first prenatal visit

·      Having a condition called polycystic ovarian syndrome (PCOS) or exhibiting symptoms of PCOS without official diagnosis.

·      If prior to pregnancy you were diagnosed with Insulin Resistance and were taking medications such as Glucophage (Metformin) or Supplements such as Cinnamon/Chromium Blends or Glucofort to control excess sugar in the blood. 

·      Women who are Hispanic, African American, Native American, South or East Asian, or from the Pacific Islands are also at higher risk for developing GDM.

If you have any of the listed risk factors you have a higher chance of getting gestational diabetes. Screening for GDM typically occurs around the 28^th week of pregnancy, but may be done earlier if there is a high level of risk.

Testing for gestational diabetes is done by having the woman ingest a “load” of glucose/sugar. This is usually around 50 grams. After 1 hour the blood is then tested to check the level of blood sugar present. If it is elevated it means your body is having difficulty processing large amount of sugar/glucose and a diagnostic test is done to either confirm you have GDM or fully rule it out. Often what is ingested/drank is a sweet orange flavored drink similar to an extra sweet Sunkist Orange Soda Pop which is provided to you by your midwife. Some providers may offer to do a test called a Hemoglobin A1C which provides a snap shot of your average blood glucose level for the previous 3 months to assess for this. This method of testing does not necessarily pick up gestational or pregnancy related diabetes since it only looks at previous months’ blood sugar averages. If your preference is not to drink the sweet drink provided to you, I suggest discussing alternative testing methods with your midwife. There are other options/alternatives to still get us the information.

If after the testing is completed you find that you do have Gestational Diabetes you will be asked to test your blood sugar at home. I like to meet with patients 1:1 to show them how to test their blood sugar level and explain how through diet and exercise they can keep their blood sugars well controlled throughout their pregnancy. Often I have found that women feel they can’t eat anything once diagnosed with GDM. On the contrary! You can eat, in fact I want you to eat, it’s what you eat and quantity that matters most. Occasionally diet and exercise isn’t able to keep blood sugars within optimal range and they may require oral medication or insulin to control blood sugar. 

Women who have GDM have an increased risk of developing Type 2 Diabetes later in life. Adopting the health eating habits and regular exercise they committed to during pregnancy will help decrease this risk long term. Women are usually checked again at the 6 week postpartum appointment to ensure the diabetes has cleared their body after birth, as occasionally it doesn’t. 

Another fun fact is that breastfeeding is very important if you have had GDM.  It will help you lose weight and will help your baby maintain a healthy weight too. Believe in yourself and your ability to have a healthy baby.



Sources:

American College of Nurse Midwives Share with Women patient handout titled: “Gestational Diabetes”

Centers for Disease Control patient handout titled “Gestational Diabetes”