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More Articles on A Healthy Pregnancy

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Congratulations on Your Pregnancy! (for those who are newly pregnant)
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Can I continue to eat a vegetarian diet during pregnancy?
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What to Do About The Flu
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Faith Bontrager, RN, BSN

Faith Bontrager, RN, BSNFaith's passion in nursing is to help people find the options they need to discover their personal path to optimum health. Ask her friends and they will tell you that their appreciation of nutritious food has grown through Faith. About Faith Bontrager, RN, BSN



 

A Healthy Pregnancy
Gestational Diabetes



About halfway through your pregnancy, you are likely to have a "glucose tolerance test" to test for gestational diabetes. What is this condition and why do we test for it?

Insulin is a hormone that helps break down carbohydrates into energy that the cells can use. If there is not enough of this hormone, the level of glucose (sugar) in the blood becomes too high. This can cause serious health problems.

Diabetes is a disease where there is inadequate insulin to meet the person's needs. Gestational Diabetes is a form of diabetes that appears during pregnancy. It has similarities and differences from other types of diabetes.

Gestational diabetes is diagnosed when a woman who previously showed no sign of diabetes has either a high fasting blood sugar or (more commonly) a normal fasting blood sugar but a higher than expected blood sugar reading after being given a high sugar drink. This test is called a glucose tolerance test.

Is "gestational diabetes" the same as other kinds of diabetes?

The term "diabetes" or "diabetes mellitus" is used to refer to 3 separate conditions. In all three conditions there is inadequate insulin. All of the conditions can cause high blood sugar. All of them, if left untreated, can have serious implication for future health.

Type 1 Diabetes (previously called juvenile diabetes). This disease occurs when the pancreas stops producing insulin. A person with type 1 diabetes needs to take insulin daily (or several times daily) but diet and exercise are still very important.

Type 2 Diabetes (previously called adult onset diabetes). The pancreas does not produce enough insulin to meet the body's needs with this disease. This may be a problem with the pancreas or the person with type 2 diabetes may develop a resistance to insulin which increases the body's needs. Some type 2 diabetics can control their disease with diet and exercise alone. Others will need to take medication. Usually oral medication is enough but sometimes type 2 diabetics need insulin injections. Diet and exercise are extremely important. Exercise is known to decrease insulin resistance.

Gestational Diabetes is an insufficiency of insulin (like type 2 diabetes) that is discovered during pregnancy. The diabetes usually disappears quickly after the baby is born but women who have gestational diabetes are more likely to develop type 2 diabetes later in life. Gestational diabetics need to modify their diet and exercise habits. Some may need to take insulin as well. Untreated gestational diabetes can cause problems for both mother and baby.

Researchers debate the underlying cause of gestational diabetes but our best current understanding it that it is a combination of the pancreas not producing enough insulin and an increased insulin resistance. (Chen p 2240 Pre-gravid sugar sweetened beverage)

About half way through a normal pregnancy, a woman's resistance to insulin begins to rise. This may be because of increased fat storage during pregnancy but is likely related to the hormones produced by the placenta. Most women have the capacity to produce more insulin so blood sugar levels remain normal. However some women can not produce enough extra insulin so their blood sugar rises. This is gestational diabetes. Gestational diabetes occurs in between 1 and 14% of pregnancies. [http://www.nih.gov/news/health/sep2009/nichd-30.htm]

Women are more likely to develop gestational diabetes if they have an immediate family member who is diabetic, if they were overweight before becoming pregnant, if they had gestational diabetes in a previous pregnancy, or if they had previously given birth to a baby that weighed more than 9 pounds. Gestational diabetes is higher in certain ethnic groups than in others. African American, American Indian, Asian American, Hispanic/Latino, or Pacific Islander women are more likely to develop gestational diabetes than other groups. [http://diabetes.niddk.nih.gov/dm/pubs/gestational/#1]

Until recently there has been controversy over when to treat gestational diabetes. Original treatment guidelines were developed to treat the women who were most likely to develop type 2 diabetes after pregnancy. We knew that severe gestational diabetes, left untreated, could cause serious complications for both mother and baby but there wasn't evidence to show if treating mild gestational diabetes would help, hurt, or be neutral.

Complications

Untreated gestational diabetes poses risks for both mother and baby.

Risks to baby include:

Growing to abnormally large size: This happens in about 20-30% of babies born to women with GDM. Baby's larger size can lead to an increased likelihood of cesarean birth, an increased likelihood of shoulder dystocia, and other complications.

Low blood sugar in the immediate post partum period: This happens because baby's pancreas produced insulin at a higher rate because of mother's high blood sugars.

Babies have a higher chance of having high bilirubin levels. They may have more problems breathing immediately after birth and may have abnormal blood levels.

Babies born to women with GDM have an increased risk of being obese or developing diabetes later in life.

Before GDM was treated, there was a higher incidence of stillbirths. Since we have begun monitoring and treating for this condition, there does not seem to be a significantly increased risk of stillbirth.

Birth defects – women who have diabetes before pregnancy have an increased risk of birth defects. Women who have severe GDM also have an increased risk. Mild GDM does not seem to increase the risk of birth defects.

Risks to mother include:

  • High blood pressure
  • Preeclampsia
  • An increased risk of cesarean delivery
  • An increased risk of later developing type 2 diabetes (Setji TL, Brown AJ, Feinglos M. Gestational diabetes mellitus. Clinical Diabetes January 2005 vol. 23 no. 1 17-24)

A recent study by the National Institute for Health showed significant benefit to treating even mild gestational diabetes. Women who had normal fasting blood sugars but higher than expected blood sugars after drinking a sugary drink were classified as mild gestational diabetics in this study (Landon p 1340). Half of these women were given standard prenatal care, the other half were treated.

There was no difference in the number of severe neonatal complications between the two groups but women with mild gestational diabetes who were treated had better outcomes in a number of ways:

  • Their babies were less likely to be abnormally large
  • They were less likely to have shoulder dystocia (a condition where the baby's shoulders get "stuck" as he is being born)
  • They were less likely to have a cesarean birth
  • They were less likely to have high blood pressure or preeclampsia (Landon p 1339)

Because gestational diabetes influences the risk of childhood obesity, it is possible that treating women with mild gestational diabetes might decrease the child's risk of being obese and the child's likelihood of developing diabetes in the future but this study did not follow the children long enough to show those outcomes.

This is an important study and it does seem likely that treatment of mild gestational diabetes can make a difference. However, I would have liked to see a one difference. "Treatment" for the treatment group consisted of dietary counseling and, if blood sugars remained high, treatment with insulin. However many normal healthy pregnant women are not given significant "dietary counseling."

The dietary counseling was specific for gestational diabetes, but some of the suggested dietary changes would be beneficial for all pregnant women. Could adequate instruction about a healthy diet for ALL pregnant women make a difference in the health of women and babies? At Dr. Gourmet we certainly believe it can – which is why we bring evidence-based nutrition straight to your email box or web browser.

Nourish yourself and your child!