Gestational Diabetes

Gestational diabetes mellitus (GDM) is defined as a carbohydrate intolerance of varying severity that occurs in about 6% of pregnancies in the U.S.  

When women develop GDM, they are at higher risk for adverse pregnancy outcomes and long-term negative outcomes for mom and baby. Potential complications  of GDM include preeclampsia, polyhydramnios (excess amniotic fluid), higher weight gain in the fetus (possibly leading to C-section or shoulder dystocia), newborn complications (jaundice, nerve damage, low blood sugar), and of the mother developing Type II diabetes after pregnancy.

When we take in nourishment, we convert it into glucose, a fuel immediately usable by our bodies. Insulin metabolizes and regulates glucose levels. Diabetes can be simply defined as the result of a weakened pancreas producing too little insulin. This causes an abnormally high amount of glucose in the blood.

There are several factors that may contribute to an abnormally functioning pancreas, the primary ones being family history and obesity. Genetic weakness can be aggravated by a diet high in sugars, processed foods, and alcohol along with smoking, emotional stress, and lack of exercise.

Insulin is the key that tells our body to either store extra glucose in the liver as glycogen, use it immediately, or release glycogen for energy in the absence of enough glucose in the bloodstream. During pregnancy, placental hormones that peak around 28 weeks suppress insulin levels raising the mother!s blood glucose level. This occurs because the baby will be gaining the most weight and needs the most fuel to grow during the last 12 weeks of pregnancy.

I have spent the last couple of weeks researching information and guidelines on gestational diabetes, in an effort to create a guideline to use in my practice.  There is much new information and research available and this has led me to a change in thinking and new recommendations for my clients.  My plan is to use a simple screening algorithm to allow low-risk clients to avoid testing, while moderate and high risk clients are screened a second time and finally tested if necessary.

While gestational diabetes can have serious consequences, it is usually very easily controlled by diet and exercise.  The risk of complications decreases dramatically when GDM is controlled.   And the lifestyle changes that are required to control GDM are positive ones that many of us would do well to follow  (yours truly included!) and to continue even after the birth to help reduce the risk of Type II diabetes later.

I still recommend that my clients eat 70+ grams of protein in their diet each day and to avoid refined flours, starches and sugar.   Your focus should be on protein, fruits and vegetables for optimal health!

Evidence Based Birth  – notes on the NIH Consensus Conference, Day 1

U.S. Preventive Services Task Force recommendation (2014)