Gestational Diabetes

What is gestational diabetes?                                                                    Recipes
Gestational diabetes is the development of diabetes during pregnancy. Although the symptoms disappear after the baby is born, according to the U.S. Centers for Disease Control, about half of all women diagnosed with gestational diabetes will develop type 2 diabetes later in life. Diabetes occurs when the body does not produce or properly use insulin, a hormone necessary to convert sugar, starches and other food into the energy needed for daily life. According to the National Institutes of Health, gestational diabetes occurs in about 5 percent of all pregnancies in the United States, resulting in about 200,000 cases a year.

What are the symptoms?
Most women have no symptoms at all, although in rare cases, excessive thirst and increased urination may occur. However, when gestational diabetes develops, women are at increased risk of high blood pressure throughout the pregnancy as well as at increased risk of having a large baby and needing a cesarean section at delivery.

What are the causes?
Hormones produced by the placenta to sustain pregnancy can make cells throughout the body more resistant to insulin. The placenta produces more and more of these hormones as pregnancy progresses making it harder for insulin to “unlock” cells so that glucose can enter. Gestational diabetes is most likely to develop during the last three months of pregnancy when hormone production by the placenta is at its highest.

Risk factors for gestational diabetes include being overweight (the more overweight you are, the higher your risk), a family history of diabetes, your age (women over 25 have a higher risk), having had gestational diabetes during a previous pregnancy, having had a stillbirth or a very large baby with a previous pregnancy, or a history of abnormal glucose tolerance.

To test or not to test?

Many midwives do not routinely test their clients for gestational diabetes. There are many reasons for this.

  • First, healthy women who exercise and who are not overweight and who eat a healthy whole food diet without a lot of processed food and simple sugars, rarely have problems with blood sugar.
  • Second, the routine glucose tolerance test (GTT) is difficult for most pregnant women to do. It requires fasting the night before and then drinking a very sweet drink called “glucola.” The side effects of glucola are nausea, vomiting, bloating, and diarrhea, as well as other adverse reactions including headache, dizziness, and fatigue.

In addition to the fact that the glucola causes discomfort for many women it also contains ingredients that may not be good for your baby.

  • Ingredients in Oral Glucose Tolerance Beverage: Water, Dextrose, citric acid, natural flavoring, food starch modified, glycerol ester of wood rosin, brominated vegetable oil, FD&C yellow #6, Sodium hexametaphosphate, BHA and 0,10% Sodium Benzoate.
  • Brominated vegetable oil (BVO) BVO contains bromine, which is known to interfere with thyroid function. Even more frightening, it is found in the brominated flame retardants

As a midwife, I’ve always felt like the GTT didn’t make a lot of sense because it tested a pregnant woman’s blood glucose under artificial conditions. It makes more sense to me to have her eat a large meal of the food she normally would eat and then to test her after that. Don’t we want to know how her body is handling the food she eats every day during her pregnancy?

Instead of the GTT you can do what is called a 2 hour postprandial glucose test.

How is this test done?

A blood sample is taken before you eat, to provide a baseline, and then again two hours after you’ve eaten.

The American Diabetes Association recommends a postprandial glucose level under 140 mg/dl and a preprandial (before a meal) plasma glucose between 90-130 mg/dl. High values may indicate diabetes.

Other tests that can be done with the 2 hour pp are:

  • Fasting blood glucose test. Usually done after fasting all night and before eating in the morning. Afasting blood sugar level less than 100 mg/dL is normal. A fasting blood sugar level from 100 to 125 mg/dL is considered prediabetes. If it’s 126 mg/dL or higher on two separate tests, you have diabetes.
  • A1C (glycosylated hemoglobin) test. This measures your average blood sugar level over the last two to three months. The normal range for the hemoglobin A1c test is between 4% and 5.6%. Hemoglobin A1clevels between 5.7% and 6.4% indicate increased risk of diabetes, and levels of 6.5% or higher indicate diabetes
  • Radom blood glucose. Done randomly, no fasting or ingesting of a special drink is required. The reference values for a “normal”random glucose test in an average adult are 79 – 140 mg/dl, between 140 – 200 mg/dl is considered pre-diabetes, and > 200 mg/dl is considered diabetes

At the first prenatal, the midwife should ask about risk factors for Gestations Diabetes and if you have risk factors, then checking your hemoglobin A1c would be a good thing to do. A first trimester hemoglobin A1c reading of 5.9% or greater accurately predicted the development of GD 98.4% of the time

Routine GTT is usually done between 24 and 28 weeks, by checking your A1c early in pregnancy, if it is elevated then you have some time to make dietary and lifestyle changes and try to get your blood glucose under control before getting to 24 – 28 weeks.

You could also get your Vitamin D3 level tested. Two recent systematic reviews concluded that vitamin D deficiency is associated with a higher risk of GD.

During pregnancy it is normal for you to have a little bit of glucose intolerance. This is a normal condition that helps to “push” nutrients to your baby. Some women will become more glucose intolerant than others and this is what we are looking for. If your blood sugar is too high during pregnancy that can cause serious medical problems for you and your baby. This is very real and for this reason it is important to pay attention. Problems such as:

  • High blood pressure, pre-eclampsia, and preterm birth.
  • Babies born to overweight or diabetic moms have a much higher lifetime likelihood of developing chronic health problems associated with obesity and diabetes.
  • Women who develop GD have at least a 50% chance of becoming diabetic later in life.
  • Babies born to overweight or diabetic moms are more likely to be large for gestational age which might lead to a cesarean delivery and admission to a NICU after birth

Since 93% of pregnant women test negative for gestational diabetes, it is questionable that we need to test everyone. You also have the right to refuse testing, but I think it is good to use good judgment, if there is a possibility that a glucose problem does exist, then it would be wise to make dietary changes and to do some testing.

Alternatives to glucola, some people have consumed things like:

  • 6 ounces organic grape juice + a banana
  • 1 cup milk + 1.5 cups cereal
  • Pancakes with 1/4 cup maple syrup
  • 28 dye-free jelly beans
  • Natural soda with 50 grams total sugar
  • 16-ounces orange juice

Jelly beans may be used as an alternative to the 50-g glucose beverage as a sugar source for gestational diabetes  screening. In studies women had similar serum glucose responses and fewer side effects after a jelly bean challenge than after a 50-g glucose beverage challenge. Also you can use jelly beans that do not contain artificial colors.

Can Gestational Diabetes be Prevented?

  • The risk of gestational diabetes is five times greater in women with a body mass index (BMI) greater than 35, than a woman at a healthy weight.
  • Adequate protein consumption during the first trimester may also protect against the later development of gestational diabetes.
  • One study showed that women who exercised 150 minutes or more per week prior to conception and through 20 weeks gestation had a 49-78% reduced risk of developing gestational diabetes.
  • Many women with GD were also deficient in magnesium.  Magnesium helps promote healthy insulin production, take equal amounts of calcium and magnesium. Magnesium glycinate is a good form with less of a laxative effect than other forms of magnesium.
  • Another study found that the combination of not smoking, exercising, and healthy eating reduced the risk of gestational diabetes.

What if I test positive, what can I do?

When women test their own blood sugar at home with a glucometer, they are able to see how various foods are affecting their blood sugar. This is what one woman did:

  • Taking a reading as soon as I woke up
  • 1-hour after each meal
  • 2-hours after each meal if reading was not below 120 at 1-hour
  • Several times after purposefully consuming a really high-carb meal
  • At other times just out of curiosity, including a few times after purposefully eating about 50g sugar just to see how I would have done on the GTT

At my doctor’s recommendation, these were the ranges I was looking for to make sure my blood glucose was in a healthy range:

  • Fasting blood glucose (first thing in the morning) of 86 or lower (Mine ranged from 81-85)
  • 1 hour after eating= 140 or lower (mine was always below 120)
  • 2 hours after eating= 120 or lower (mine was usually around 100)
  • 3 hours after eating= back to fasting level (yep)

What is the conventional treatment?
Treatment involves dietary measures, exercise and, in some cases, insulin injections. Your doctor may refer you to a dietitian or diabetes educator who will design a meal plan to help keep blood sugar in your target range. This may involve:

  • limiting sweets and other carbohydrate-rich foods.
  • eating three small meals and one to three snacks daily.
  • making sure that you get fiber with your meals in the form of fruits, vegetables and whole-grain cereals, crackers and breads.

Your doctor may also recommend walking, swimming or other form of aerobic activity to help bring maintain glucose levels within your goal range. You may also have to give yourself insulin injections and to monitor and record your blood glucose levels four or five times a day with the aid of device called a blood glucose meter.

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