Gestational Diabetes

What is Gestational Diabetes?

The medical definition of Gestational Diabetes (GD) is diabetes mellitus (Type II diabetes) that develops in pregnancy and resolves after delivery. When you take in nourishment, your body converts it to glucose, a fuel immediately useable by our bodies. If we get more fuel than we need immediately, the liver can store a form of glucose for up to 12 hours, in case more fuel is needed later. Insulin, secreted by the pancreas, metabolizes and regulates glucose levels in your bloodstream, however a physiological glucose-sparing mechanism exists in pregnancy because of the insulin-suppressing hormones produced by the placenta, which peaks around 28 weeks (after which the baby will be gaining the most weight and need the most fuel to grow). As a result, maternal blood glucose levels after eating rise linearly throughout pregnancy, which is a normal response. After eating, some pregnant women will have abnormally high glucose values because their insulin surge (again, to metabolize the extra sugar from the glucose load) is impaired or delayed. In this case, a woman is labeled diabetic due to different blood sugar levels established for pregnant women, even though higher blood sugar levels may be normal due to the physiological insulin-suppression of the placenta.

Am I likely to develop GD?

The following are risk factors for developing gestational diabetes:

Previous baby >9pounds
Previous baby with congenital birth defects
Previous unexplained stillbirth
Previous pregnancy with GD
Multiple miscarriages
Family history of diabetes (parent, sibling)
Non-pregnant weight of >200 pounds
Excess amniotic fluid
Recurrent sugar in the urine
Maternal age over 30

For women with four or more risk factors, following the Brewer diet is recommended with a fasting blood sugar test and further testing if necessary, however it is not required.

What are the risks of GD?

While there are risks to true diabetes mellitus, it is difficult to link abnormal glucose tolerance to perinatal outcome. The small increase in stillbirth associated with abnormal glucose tolerance appears to be predicted as much by the risk factors for GD as by the test result. The only risk that has been convincingly shown to be caused by GD is a large baby (>9 pounds). Even so, up to 70 percent of babies of GD mothers will be of normal weight and treatment has little effect on reducing risk. Some research indicated an increased risk of neonatal hypoglycemia and jaundice. In uncontrolled diabetes, maternal risks include toxemia, circulatory problems, visual disturbance, kidney problems, hypertension, and maternal infection; neonatal risks include learning disabilities and lowered IQ, prematurity, respiratory distress, birth defects, stillbirth, neonatal hypoglycemia or jaundice. If you have GD, you are more likely to develop overt diabetes later in life.

What are the symptoms of GD?

Symptoms of GD are the same as symptoms of ordinary diabetes: increased urine output, recurrent urinary glucose and ketones, increased thirst and appetite, recurrent infection and/or slow healing, acetone breath, weakness, and weight loss.

What tests are available?

If there are no risk factors or symptoms of diabetes, testing is not necessary. In women with diabetic symptoms or four or more risk factors, a fasting blood sugar (FBS) test is recommended but not required. The FBS is a small finger prick test first thing in the morning. The results should be less than 105-120 mg/dl. Another available test is the Oral Glucose Tolerance Test (OGTT); a test where blood sugar is checked one hour after a large glucose load. This test is only 25% accurate.

What can I do if I am diagnosed with GD?

You should follow a strict, low-glycemic Brewer diet and check your blood sugar with a glucometer at least after every meal. Evening exercise of at least 15 minutes (a brisk walk is sufficient) is recommended to help burn excess glucose. Chromium picolinate (1 tablet daily) and cinnamon supplementation (up to 6mg daily or as needed) are suggested. If blood sugar levels, taken after each meal, can be controlled with diet alone, homebirth may proceed normally. A bio-physical profile may be requested if pregnancy proceeds beyond 42 weeks. If insulin is required, transfer to a hospital-based provider is necessary.

How will my baby be treated after birth?

Breastfeeding should be immediate and often. If your baby develops symptoms of hypoglycemia, s/he will be treated with goat’s milk or 1 tsp. molasses in 1 cup water, administered via eye dropper or oral syringe until symptoms resolve. To prevent jaundice, nurse on request (at least 12 times in 24 hours) and sunbathe baby uncovered in a sunny window several times a day.

References:

Bradley worksheet R-477, “Eat Well For Your Baby”

Davis p60-61, 72

Enkin p41, 43

Frye 1002-1003, 1341-1343

ICAN email, Bonnie A., 12/06/99

ICAN email, Kmom, 12/06/99

Mayes, p611

MT 43, p17; MT 44, p65; MT 66, p60; MT 69, p56; MT 72, p62

OMRR p158-159, 162

Peckmann p53, 55-56

Sagefemmes email, Sharon H.R., 12/06/04