When It Comes To Gestational Diabetes, Management Is Key
Gestational diabetes mellitus (GDM) affects nearly 10% of women in the United States. While a positive diagnosis is concerning, it’s usually treatable through diet and exercise. Learn more about GDM, ways to manage it, and how to ensure a healthy pregnancy.
Somewhere between 24 and 28 weeks of pregnancy, your obstetrician will screen you for gestational diabetes mellitus (GDM). And while being diagnosed with gestational diabetes might sound alarming, you can still go on to have a healthy pregnancy.
What is gestational diabetes?
Insulin is a hormone produced by the pancreas that is crucial to moving glucose, or sugar, out of the bloodstream and into cells, where it is used as energy. During pregnancy, hormones made by the growing placenta, including estrogen and cortisol, make it more difficult for the body to use insulin effectively. A pregnant woman’s pancreas is normally able to compensate, secreting additional insulin after meals, but when it can’t produce enough of the hormone, glucose builds up in the blood, and GDM is diagnosed.
While there are factors that can increase the risk of GDM, including a family history of type 2 diabetes, advanced maternal age and obesity, they aren’t always reliable predictors. It’s important to remember that GDM isn’t necessarily preventable and for most women, GDM doesn’t cause noticeable symptoms. Any woman can be diagnosed.
Gabriele Famous, a mother of three, was diagnosed with GDM in her first pregnancy. “For me, it was very much a surprise,” she says. “I think it was a surprise even for my doctor because I’m a pretty fit person. I didn’t have any of the factors that [doctors] look for, general speaking.”
How is gestational diabetes diagnosed?
At the beginning of the third trimester, women can look forward to the oft-dreaded glucose challenge screening, also called the one-hour glucose tolerance test. First, you drink an ultra-sweet sugary solution disguised as a flavored drink. Lemon-lime! Orange! After an hour, blood is drawn and your blood sugar level is measured. If your result is outside the standard range, your doctor will do further testing using a three-hour glucose challenge test. This time, your blood glucose is tested one, two and three hours after you drink the solution to determine if you do, indeed, have GDM.
If you have a hard time getting the drink down at your screening without gagging, you may want to ask your doctor about substituting jelly beans for the drink. Yes, jelly beans. No promises your doctor will go for it, but there is a well-known study that determined that eating the candy is a reasonable alternative for women unable to successfully ingest the glucose drink. Don’ t try this without your doctor’s approval!
How to manage gestational diabetes
According to the Centers for Disease Control and Prevention, up to 10% of women in the United States alone are diagnosed with GDM every year. If you are one of these women, bear in mind that serious complications can be avoided with careful management of glucose levels throughout the pregnancy.
A woman diagnosed with GDM is taught how to use a glucometer, a device that monitors sugar levels by pricking the finger and drawing a tiny bead of blood, and depending on her medical professional’s protocol, is referred to a diabetes center and/or a nutritionist.
Karen Sumner, M.D., an attending physician and ob-gyn at Kaiser Permanente, says that at first, “there’s a lot of adjusting, figuring out which foods are going to spike your sugars and discussion of diet and exercise.” While the American Diabetes Association recommends aiming for a ratio of 25% protein, 25% grains and starchy foods, and 50% non-starchy vegetables, keep in mind that each body is different and it takes time to figure out what works best; there isn’t a one-size-fits-all diet. If after a while these measures don’t work, taking insulin is the next step.
What worked for Gabriele was an increase in physical activity and change in her diet. She followed a strict eating plan that balanced the right amount of proteins with the right amount of carbohydrates and fats. She learned to watch portions and read labels. When she ate mattered, too. A lot of women find that eating an approved late-night snack before bed helps with sugar levels.
“The only treat I could have was a piece of 80% dark chocolate. And when you’re pregnant, you just want a bowl of ice cream,” says Gabriele. She was surprised to learn that even fruit and yogurt, foods she thought were healthy, raised her blood sugar. She is now able to look back and be thankful that having GDM taught her to eat better in the last weeks of her pregnancy.
Implications for delivery, postpartum and future pregnancies
With careful management, most women with GDM go on to deliver healthy babies. Complications can arise, though. For example, babies born to mothers who do not carefully monitor their blood sugar, says Dr. Sumner, stand the chance of being larger around the abdomen and shoulders, which then means they can be too big to fit through the birth canal, prompting the need for C-section delivery. “If sugars are high, they can cross the placenta and stimulate growth hormone in the baby,” explains Dr. Sumner.
Once women with GDM give birth, Dr. Sumner says, they do need to test their sugar levels at around six weeks postpartum to make sure they’ve returned to pre-pregnancy levels. And for most women, they do. Dr. Sumner says that yearly testing after this is a good idea, since up to 40% of these women could go on to develop type 2 diabetes in their lifetime.
Because women with GDM in first pregnancies do have a higher likelihood of being diagnosed in subsequent pregnancies, doctors will screen these women earlier than the third trimester. For Gabriele, her first pregnancy was a one-off – she wasn’t diagnosed with GDM in either of her following two pregnancies.
So, what’s the takeaway when dealing with a GDM diagnosis? If you listen to your medical provider(s), eat right, exercise and monitor your blood sugar, both you and your baby have the best chance of a healthy outcome.