Nov 24, 2015 | Pregnancy

Gestational Diabetes

I’m a little late to the party, but November is American Diabetes Month. In case you missed it, I’ve covered the topic of diabetes a few times on the blog: Diabetes 101, Diabetes on the Rise, and Prediabetes and Cancer. But today I want to help answer the question, “what is gestational diabetes”.

What is gestational diabetes?

Gestational diabetes is the form of diabetes that occurs in expecting mothers. The difference is that the women did not have diabetes before they got pregnant. According to a 2014 analysis by the Centers for Disease Control and Prevention, the prevalence of gestational diabetes might be as high as 9.2%.

What causes it?

It’s not 100% clear what causes gestational diabetes, but here are some risk factors to consider:

  • Excess weight. If your BMI is 30 or higher, your risk increases significantly.

  • PCOS, or polycystic ovary syndrome, is a hormone disorder that can impact insulin and blood sugar management.
  • Family or personal history. If you had gestational diabetes during previous pregnancies, you had pre-diabetes prior to pregnancy, or a 1st degree family member (parent or sibling) has type 2 diabetes.

  • Giving birth to a baby over 9 lbs, or an unexpected stillbirth.

  • Being over 25. In an urban setting in 2015, that’s most women. Don’t stress about this.

  • Being non-white. African American, Hispanic/Latino American, American Indian, Alaska Native, Native Hawaiian, or Pacific Islander women are all at higher risk.

Pregnancy puts a significant demand on mom’s insulin needs, with a dramatic increase during the second trimester. The increased need, along with hormonal and physical changes, can cause one of two issues: either an inability to make enough insulin, or an inability for the body to use the insulin properly.

What are the health concerns?

If mom had diabetes prior to pregnancy, the health concerns are much greater than if mom has gestational diabetes. However, untreated or uncontrolled gestational diabetes can still have a negative impact on your baby. Specifically, the extra glucose (sugar) in baby’s bloodstream can cause more energy to be stored as fat, leading to a large baby.

While the most obvious ramifications are on delivery, having a large baby also can cause newborns to have very low blood sugar at birth, have a higher risk for breathing problems, and a higher risk for obesity and type 2 diabetes as they age.

How is gestational diabetes diagnosed?

Pregnant women must take a glucose tolerance test somewhere around 24-28 weeks of pregnancy. You’ve probably heard stories from friends or family about this. It’s not exactly the greatest part of pregnancy. The test involves drinking about 8 ounces of a very sweet drink, and then having your blood drawn after an hour.

Unfortunately, you can’t eat or drink anything else (a glass of water would have been amazing), and you have to hang out at the doctor’s office (no physical activity allowed). Most women I know (and myself included) get a little jittery from all the sugar, and baby tends to get really active.

Depending on your personal risk factors, and your doctor’s recommendations, you start with a 1-hours test, and you may have to also do the 3-hour test. The exact amount of sugar will match the length of the test. Basically, the test shows how quickly your body can process the sugar, and how quickly your body can return to “normal”. This is an indicator of how much and how well your body is using insulin.

What happens if you are diagnosed with gestational diabetes?

Most women can manage gestational diabetes through diet and activity. The biggest lifestyle change will likely be having to test your blood sugars regularly. Side note: It can be intimidating to prick your finger at first, but most women get used to it quickly.

There are, however, some women who need medication to manage their gestational diabetes. Some of my patients have expressed concerns about taking prescription medications while pregnant. Rest assured, the drugs are not only safe for use during pregnancy, but using them properly will actually benefit the baby.

So what dietary changes are required? This is a big topic, and one that I cover more in-depth in Chill the Fork Out and with my one-on-one clients. The two biggest things I focus on with clients are reducing the total number of carbohydrates and increasing the quality of those carbohydrates. Then we look at avoiding concentrated sweets and “naked carbs” (no protein or fat). You may also need to avoid juice or fruit in the morning, as insulin resistance is higher at that time.

Increasing physical activity during the day also makes a difference. Women should exercise as much as they can while pregnant, while continuing to be safe. Walking may be the only form of cardiovascular exercise you’re able to do, but it is still a great option. It may be more feasible to take multiple, shorter walks during the day instead of one long one. Research shows a 10- to 15-minute walk after eating can make dramatic improvements to blood sugar control.

Post-partum: what happens to gestational diabetes?

For most women with gestational diabetes, their body will return to normal after giving birth. Some people joke that the cure for gestational diabetes is having a baby. However, that isn’t the end of the story. Women who have gestational diabetes are at an increased risk of developing type 2 diabetes within 5-10 years. That risk is anywhere from 3-7x greater. Again, we don’t know exactly why.

It may seem “unfair” or like a huge burden to change your eating habits after having a baby. All the research we have indicates that mom will have to be more careful about maintaining a healthy weight and limiting concentrated sweets. But you know what? Most of these healthy habits are what I recommend to all my postpartum clients, anyway.

If you are diagnosed with gestational diabetes, you should definitely talk with a dietitian. I’d love to help you, or you may be given a referral from your OB/GYN. You can also download my free snack guide – 97 Healthy and Easy Snack Ideas for Pregnancy – which works great for all moms and moms-to-be, including those with gestational diabetes.

Want to learn more about pregnancy or prenatal nutrition?
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I’m Katie Goldberg (AKA The Pregnancy Dietitian), mom of 2 little humans, health coach, and registered dietitian nutritionist. I can guide you through the research and best practices (and avoid all the B.S.) to help you confidently nourish your body and your baby during this unique season of life.

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