Gestational Diabetes: Your Questions Answered

Disclaimer: This is a guest post from Dr. Leanne Redman, associate professor of women’s health studies at Pennington Biomedical Research Center. You can get to know her more here and read her first post here. Her facts and opinions are based on her personal research. Red Stick Moms Blog was not paid to promote any specific medical viewpoints or studies. Always consult your physician with any medical questions.

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November was National Diabetes Month and with 30 million Americans diagnosed with diabetes and 86 million diagnosed with prediabetes, there is an obvious need for national attention and action. Of the 3 types of diabetes (type 1 diabetes, type 2 diabetes, and gestational diabetes), let’s focus today on one that can affect many moms: gestational diabetes, also called GDM.

What is GDM?
GDM, or gestational diabetes mellitus, is when a woman who has not been diagnosed with diabetes before develops high blood sugars during pregnancy. With gestational diabetes occurring in nearly 10% of pregnancies, it is likely that we have either had GDM ourselves or know someone who has.

How do I know if I have GDM?
Testing for GDM is “standard of care” during pregnancy, meaning it is expected of all obstetricians to test their pregnant patients for GDM. This testing typically occurs within 24-28 weeks of pregnancy with an oral glucose tolerance test, or OGTT, which includes drinking a sugary beverage and having blood sugar levels monitored periodically for 1-3 hours after.

The hope is that your body will be able to process the sugar you’ve ingested and bring your blood sugar back to normal within an appropriate amount of time. But if you have GDM, your body has difficulty bringing your blood sugar down to normal levels and sugar remains in your blood much longer than expected.

What’s the harm?
When our blood sugar levels remain too high for too long it can impact the health of mom and baby. It could increase the risk for having a larger (not stronger) baby, which in turn could lead to a c-section. It could make baby have a difficult time controlling their own blood sugar after birth. Also, high blood pressure and preeclampsia are more common in mothers with GDM.

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Am I at risk?
Though testing for gestational diabetes occurs during the 2nd trimester, factors before pregnancy and during the 1st trimester could contribute to the likelihood of having GDM. Risk factors for developing GDM include:
1. having a previous pregnancy with gestational diabetes
2. having a BMI greater than 25 kg/m2 before becoming pregnant (calculate your BMI here)
3. gaining excess weight early in pregnancy (the Institute of Medicine recommends gaining about 1-4.5 pounds in the first trimester)
4. being more than 25 years old
5. having a family history of diabetes
6. being of certain ethnic groups like African American, Hispanic, American Indian, Alaska Native, Native Hawaiian, or Pacific Islander.

Granted, some of these factors we cannot change (and we may be proud of) such as our age, heritage or family history, some we can control through healthy eating and physical activity.

What can I do if I have GDM?
Get support! I know it can be difficult to ask for help, but there are incredible resources available and you will be glad you did. Ask your doctor or midwife for additional resources and referral to a dietitian or diabetes educator for help in making these lifestyle changes. The improvements made to our eating and physical activity is good for everyone including our partner, family members, and friends whether they have diabetes or not. You never know who you might inspire! A friend of mine once told me he was the healthiest he had ever been when his wife had GDM!

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Here are a few tips from our dietitian:

  • It is generally recommended to reduce normal overall food intake slightly (by about a third) and eat managed portions of carbohydrate at 3 meals and 2 to 4 snacks per day. It is also important to know that avoiding carbohydrates all together is not recommended and can be dangerous to mom and baby.
  • Working with a dietitian or diabetes educator can provide you with personalized meal plans, portion sizes, and tips to control your blood sugar. Building a balanced plate is a great place to start.
  • This video along with Six Easy Steps to Create Your Plate from the American Diabetes Association provides step by step instructions to building a healthy plate.
  • If you’re ever short on recipes there are countless diabetic cookbooks out there and many free resources including these gems: Tasty Recipes for People with Diabetes and Their Families and American Diabetes Association Healthy and Tasty Recipes.
  • Get moving! Physical activity is also important throughout pregnancy (even for those without gestational diabetes) and can help your body control blood sugars. The first step is to ask your doctor if s/he has any concerns about you exercising. The second step is to think about your current physical activity level. Generally, if you were physically active before you became pregnant, it is safe (and healthy) to continue exercising. If you weren’t all that active before pregnancy, you’ll want to build up to your goal instead of hitting the ground running. A good goal for most pregnant women is 30 minutes of moderate activity on most days of the week.

Happy ending?
For most women, blood sugar control will return to normal after their baby is born, but all cannot be forgotten! The risk for developing type 2 diabetes later in life once you have had GDM increases 700%!

One tip for keeping tabs on your blood sugar control is to follow up with your doctor after your baby is born. The Endocrine Society recommends an oral glucose tolerance test 6-12 weeks postpartum and periodically throughout life especially before your next pregnancies. The wonderful changes to improve eating and physical activity made during pregnancy can be continued throughout life no matter the outcome of the oral glucose tolerance test. Continuing to eat healthy and doing regular physical activity can help maintain a healthy weight (or lose weight if needed) and reduce the risk of developing gestational diabetes in a future pregnancy or developing type 2 diabetes later in life.

There is great ongoing research aimed to help women prevent and control gestational diabetes. If you are interested in participating or knowing more about the research in this area, visit Pennington Biomedical Research Center and Clinicaltrials.gov.

DR-REDMAN_Jan2012_2_croppedDr. Leanne Redman works at Pennington Biomedical Research Center as an Associate Professor while holding adjunct appointments with the LSU Graduate School as well as the Obstetrics and Gynecology Department of the LSU Medical School. She is a wife to her wonderful and supportive husband, Tim, and mother to their four beautiful children, Jesse 14, Caleb 10, Stella 4 and Emery 3. You can follow Dr. Redman on Twitter @DrLeanneRedman.

 

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