Gestational Diabetes
You found out you are pregnant. This is such a special time in your life. Everything is progressing along just fine and then you find out you have Gestational Diabetes, specifically, Gestational Diabetes Mellitus (GDM). Suddenly things become more intense. What does this mean? What did I do? How can I control it? First of all you CAN control GDM. There wasn’t anything you did or didn’t do that caused this to happen.
What is GDM?
GDM is defined as glucose intolerance during pregnancy. The food you eat
breaks down into sugar. Your body isn’t able to use the sugar (glucose)
in your blood as well as it should. So your blood sugar level becomes
higher than normal. GDM occurs in about 4-8% of all pregnancies. (Blame
it on your hormones!!) This condition often goes away after the baby is
born. GDM can affect almost any woman of any age or race, and its occurrence
is on the rise. There are several risk factors, which may increase a woman’s
risk of developing GDM.
Risk factors:
These include: advanced maternal age, previous history of macrosomic baby
(greater than 9 lbs at birth), previously unexplained stillbirth, family
history of diabetes, and/or maternal obesity.
Screening:
All women are screened for diabetes between 24-28 wks of gestation. If
this initial screen is positive, a three-hour glucose tolerance test (GTT)
is performed. This test measures blood sugar levels at fasting and then
hourly for the next 3 hours following consumption of glucose. If two of
the four readings are abnormal, GDM is diagnosed.
Treatment:
Nutrition therapy is the primary treatment for the management of GDM.
Exercise, home blood glucose monitoring, and stress management are the
other key components. In some cases, insulin may be added to the treatment
plan.
Here is a list of frequently asked questions regarding GDM.
1. How does too much glucose affect my baby and me?
If the mother does not maintain good blood glucose levels, then excess
sugar goes to the baby, and the baby stores this sugar, thus accelerating
the baby’s weight. These babies are usually poor feeders after they
are born, may develop jaundice, may have low blood sugar, and some may
have breathing problems. If your baby is too big, you may have a more
difficult delivery or need a cesarean section.
2. Can I have a normal pregnancy with GDM?
Your chances of having a healthy baby are good if you follow the advice
of your diabetes team. Your doctor, the diabetes nurse, and the dietitian
will work with you to help you control your diabetes during pregnancy.
3. What can I eat?
A registered dietitian will work with you to develop a meal plan that
will allow you to have a wide variety of foods, and still maintain your
blood sugars within a normal range. Small frequent meals are best if distributed
throughout the day. There are many new items on the market, which make
meal planning easier and tastier! There is nothing you can’t eat.
Most foods can be worked into the meal plan. If you are unwilling or unable
to follow your prescribed meal plan, you will not feel well, have less
energy and your blood sugars can remain high, which in turn affects your
baby.
4. How does exercise help and what exercises can I do?
Exercise will help keep your blood sugar level in a normal range. You
will also feel better. Walking and swimming are good choices. Ask your
physician before you start and be careful to start slowly if you are not
used to exercising. Start out with 15 minutes and build up to 20 or 30
minutes. Generally exercise is safe as long as you are not at risk for
pre-term labor (PTL) or have any other conditions that would affect your
ability to exercise. If you become dizzy, have signs or symptoms of contractions,
bleeding, or your water breaks, call your doctor immediately.
5. What tests will I need to do while I’m pregnant?
You may be asked to check your blood sugar level at home, usually four
times a day. Recommended test times include: before breakfast and 1-2
hour after breakfast, lunch, and dinner. Testing blood sugars give you
immediate feedback of how you are doing and adjustments can be made if
needed.
6. Will my baby get insulin when I take insulin?
Insulin does not cross the placenta. Normally your body makes insulin
to process the food you eat. When you have GDM, your pregnancy hormones
may interfere with your body’s normal production of insulin. Therefore,
when you take insulin, by shot, you are allowing the insulin to process
the foods you eat so the baby does not receive excess sugar. If you don’t
take your insulin as prescribed by your doctor, you will not feel well
and will have symptoms of high blood sugar, such as blurry vision, frequent
urination, and tiredness. Your baby also receives excessive amounts of
sugar, which in turn can lead to potential problems at birth. Insulin
lessens the chance of this happening because blood sugars are maintained
at a normal level.
7. Will the diabetes go away after pregnancy?
GDM should go away after pregnancy. However, nearly half the women who
have GDM are at risk for developing Type 2 diabetes within 10 years.
8. What are my chances of having GDM with my next pregnancy?
According to most experts, you have a 66% chance that the diabetes will
come back again. Therefore you should plan ahead.
a. You should be tested for diabetes at your post partum checkup visit
and then yearly. You should also be tested for diabetes if you have any
signs and symptoms, such as frequent urination, excessive thirst, blurry
vision or always feeling tired.
b. Plan your next pregnancy. Discuss with your doctor good birth control.
c. See/call your dietitian for updates or changes in your meal plan i.e.
weight management, breastfeeding.
d. It is important to stay updated on new diabetes treatments as therapies
improve all the time.
9. Will I be able to have other children?
That’s between you, your significant other, and your doctor. You
should be able to have other children as long as you check with your doctor.
You will need to plan your pregnancies due to the risk of GDM or Type
2 diabetes, but that shouldn’t stop you if you want more children.
Stay on the same method of birth control until your doctor says its OK
to try to conceive.
Gestational diabetes is one of the few things that you can manage effectively
during your pregnancy. Remember, you control diabetes, it does not control
you. By following self-management and medical recommendations, you can
have a healthy baby. After you have your bundle of joy, take good care
of yourself, exercise, eat well, maintain an acceptable weight, and get
checked for diabetes. By continuing with the good health habits that you
have acquired during your pregnancy, you might be able to prevent or delay
the onset of diabetes.