When you hear gestational diabetes, what do you think of?

The ultra sweet, awful orange tasting beverage you needed to gulp down in minutes during your pregnancy and then wait. And wait. And wait.

Oh but the pregnancy!! It was all worth it! And then just like that, for most women who’ve had a baby, that drink was just a memory. A little blip to add to the ol’ memory bank. Something you have in common with the younger soon to be mom at the checkout counter at Target.

But for a growing number of women whether it’s their first pregnancy, 4th or 8th, they get to sit and wait longer. The first test checking their blood sugar was high. After an additional test or 2, it’s confirmed they have gestational diabetes.

Pregnancy alone can be a crazy time. There’s the emotional roller coaster part. The cravings. The exhaustion. And worse, the strangers wanting to touch your belly.

Now you are essentially being told that not only are you pregnant which should be this uber joyous part of your life, but you are going to be diagnosed with diabetes. Nothing like taking the wind out of your sail. Like winning the lottery, then realizing how much you’ll need to pay in taxes. It’s still the best thing ever but…….

Although I love to fill these blog posts with humor and whimsy, diabetes is a serious condition. And gestational diabetes is equally, if not more just as serious. After all, you are growing A HUMAN!! (It still freaks me out that I grew 3!)

So let’s take it back to the basics.

What is Gestational Diabetes Mellitus (GDM)?

Gestational Diabetes occurs during a woman’s pregnancy. It’s typically diagnosed in the 2nd trimester around 22 weeks give or take a few weeks.

What causes GDM?

That lovely placenta that some people keep after delivery to eat or use as facials (yep, can’t make this stuff up) produces hormones that can increase the sugar in your blood. There’s also a component of insulin resistance that increases significantly in the 2nd and 3rd trimester. In most, the pancreas will make extra insulin to take care of the extra sugar and resistance. However if the pancreas can’t quite handle it, voila high blood sugars.

Who’s at Risk?

  • Those that are overweight or obese before pregnancy (thus the growing number of GDM cases)
  • African-American, Asian, Hispanic, or Native American women
  • Those with prediabetes or insulin resistance
  • Diabetes in your family history
  • Women that have had GDM with previous pregnancies
  • Some sources say age. And not even that old, like 25 old.
Think you’re in the clear though if you don’t meet any of those risk factors, think again. That just increases your risk of GDM, it doesn’t exclude you.
How is it treated?
Just like Type 2 diabetes, there’s different methods depending on your blood sugar control. You may need to just change up your daily eating and exercise routine. Per Diabetes Care journal, Volume 40, January 2017 70-85% of women diagnosed with GDM can control their blood sugars with lifestyle modifications alone. But for some, medications are necessary. Insulin IS the first line for treatment since there’s minimal cross of insulin into the placenta. With pills (commonly metformin or glyburide), both can cross into the placenta and there are no long term safety data available yet. Plus with glyburide there’s a risk of the baby having issues with HYPOglycemia (low blood sugar) and with metformin there’s an increase risk of prematurity.
And here is what most women don’t want to hear. With gestational diabetes, whether controlled with lifestyle changes and/or medications, checking your blood sugar is critical. Target blood sugar ranges are:
  • Pre meal/ FASTING: </= 95mg/dl
  • 1 hour after eating: </= 140mg/dl
  • 2 hrs after eating: </= 120mg/dl

Someone with diabetes will know a 2 hour post prandial (after eating) blood sugar goal is 180mg/dl. However, with GDM, tighter control is imperative. And with tighter control, means frequent blood sugar testing.

What could happen to my baby (or me) if the GDM isn’t controlled?

The very scary words include: spontaneous abortion (death), preeclampsia, macrosomia (very large baby) and fetal anomalies. Then there’s pre-term delivery which in turn could lead to respiratory issues as well as an unplanned c-section. Also an increased risk of obesity and diabetes later on in the child’s life to boot.

As for mom, there’s an increase risk of developing GDM for future pregnancies or Type 2 DM later on in life. Per the Mayo Clinic “of those women with a history of gestational diabetes who reach their ideal body weight after delivery, fewer than 1 in 4 eventually develop type 2 diabetes.”

Next week, we will meet Betsy who was kind enough to do a little Q&A with me regarding her experience with gestational diabetes. So make sure to sign up for weekly in box messages here if you haven’t done so yet and like my page on Facebook. I’d also love to hear your experiences re: GDM, please comment below.
And yes, I can help you make those lifestyle changes if you’ve been diagnosed with GDM, pre-diabetes or Type 2 Diabetes. However, as any good clinician will do when faced with something outside their expertise, they refer. If insulin is required for your treatment, I highly recommend working with a CDE (Certified Diabetes Educator) or an Endocrinologist specializing in GDM.
As always HUGS,