The 411 on Gestational Diabetes

For an expectant mother, terms like gestational diabetes, hyperglycemia, insulin resistance, and macrosomia can be just as frightening as they are confusing.  But those terms don’t have to raise the alarm if you understand their meaning and know how your body is affected by gestational diabetes.  This guide will help you understand.

WHAT IS GESTATIONAL DIABETES?

Glucose and insulin work hand in hand to regulate the sugar levels in the blood stream.  An imbalance either way can lead to challenges.

When you are pregnant, and your body fails to produce enough insulin, or if the insulin isn’t working as it should, to transition glucose out of the blood stream allowing it to be converted to energy, it builds up in the blood stream causing a condition called gestational diabetes. Elevated levels of blood sugar are called hyperglycemia.

Insulin resistance is when the body makes insulin, but it isn’t working as it should. In pregnancy, hormones from the placenta can make it more difficult for the mother’s insulin to work properly.

HOW COMMON IS IT?

Though the root causes are still unclear, gestational diabetes affects as many as 18% of all pregnancies.

WHAT ARE THE RISKS TO ME AND MY UNBORN CHILD?

In pregnancy, it is important to have controlled blood sugars. If blood sugars remain too high over a long period of time, it can cause the baby to get too big. This condition is called macrosomia.

Macrosomia increases the risk of complications at delivery. One of these complications is called shoulder dystocia. Shoulder dystocia is an obstetric emergency that occurs when the baby’s shoulder gets “stuck” during delivery.

Macrosomia also has shown to increase the risk of the baby developing childhood obesity.

HOW DO I KNOW IF I HAVE GESTATIONAL DIABETES?

Your doctor will have you complete an Oral Glucose Tolerance test (OGTT) at 24-28 weeks of your pregnancy. This test challenges your body’s ability to manage a controlled amount of glucose. You will need to drink the glucose beverage within 5 minutes. You will not be able to eat or drink anything or leave the lab during the testing period.

There are a few different OGTT tests used by physicians:

• 1 hour glucose maternal screen: You will drink a beverage containing 50g glucose and then have your blood drawn 1 hour later.
• If you have an elevated result, your doctor will then order a 3 hour OGTT. You will fast overnight prior to completing this test and then you will have a fasting blood glucose drawn. Then, you will drink a 100g glucose beverage and have your blood drawn again at 1 hour, 2 hours, and 3 hours after completing the beverage. Gestational diabetes is diagnosed when 2 out of the 4 blood values are elevated.
• Some physicians screen for gestational diabetes using a 2 hour OGTT at 24-28 weeks of your pregnancy. You will fast overnight and then you will have a fasting blood glucose drawn. Then, you will drink a 75g glucose beverage and have your blood drawn again at 1 hour and 2 hours after completing the beverage. Gestational diabetes is diagnosed when 1 out of the 3 blood values are elevated.

Many women who develop gestational diabetes will have no known risk factors. For others, some risk factors have been shown to correlate with gestational diabetes. These include:

• Having a family history of diabetes
• Being at least 20% over the ideal body weight prior to getting pregnant
• Previous pregnancies with gestational diabetes
• Some ethnic backgrounds have a higher prevalence of gestational diabetes. These include Hispanic, Black, Asian, and Native American ethnicities.
• Personal history with abnormal blood glucose testing

HOW IS GESTATIONAL DIABETES TREATED DURING PREGNANCY?

When you are diagnosed with gestational diabetes, you will usually be referred to a Certified Diabetes Educator (CDE). You will work closely with the CDE throughout the pregnancy. The CDE works collectively with your physicians to create a plan that is individualized for your needs.

The CDE will teach you how and when to monitor your blood sugar using a glucometer. You will also be taught diet strategies that will help promote optimal glucose control. This usually includes being given a meal plan that is specialized for pregnancy.

As directed by your physician, light exercise, such as walking, after meals is often recommended to promote glucose control.

Sometimes, exercise and a gestational diabetes diet are not enough to control the blood sugars in pregnancy. Your physician will determine if medication will be required. Be sure to take all medications as prescribed.

6 WAYS TO FIGHT GESTATIONAL DIABETES AT HOME

1. Stay active. Light walking is a great exercise. Be sure to carry water with you at all times. Please check with your physician before starting any exercise program.
2. Don’t skip out on breakfast. Whole wheat toast and 1-2 scrambled eggs is an example of a great breakfast.
3. Fiber is key – high fiber foods typically have a lower Glycemic Index and therefore are absorbed more slowly.
4. Cut out the sugary drinks and foods – processed foods with added sugar can cause quick spikes in blood sugar.
5. Eat  three regular meals, watching the portions, and add a few healthy low sugar snacks in between to regulate your blood sugar throughout the day.
6. Drink lots of water! Aim for 1 gallon/day (128 ounces), unless otherwise instructed by your physician.