Pregnancy can be tough, and when you add gestational diabetes into the mix, things can get a lot harder not only physically, but mentally and emotionally as well.
Diabetes occurs when the pancreas fails to produce enough insulin to regulate glucose (sugar) in the blood. In the case of GDM, the medical abbreviation for gestational diabetes mellitus, a woman who has never had diabetes before experiences high blood glucose levels during pregnancy. If it’s not well controlled, the condition can be dangerous for the mom-to-be and also for her baby, as excess glucose can cross the placenta and cause complications such as premature birth and stillbirth.
So while a woman diagnosed with a GDM pregnancy is already worrying about the effects it might have on her and her baby, she might also worry about what people will think and how to handle the diagnosis. If you know someone with GDM, the best thing you can do is educate yourself about the disease.
We spoke with the head of the diabetes program at Maternal Fetal Medicine Associates in New York to bring you clear, honest feedback on the truth about GDM.
"Although obesity is certainly a risk factor for developing gestational diabetes, not all obese or overweight women will develop this condition," says Mariam Naqvi, M.D., an OB/GYN with a sub-specialization in maternal-fetal medicine and director of the diabetes program at Maternal Fetal Medicine Associates in New York City.
Gestational diabetes often has less to do with weight and more to do with the way our bodies process glucose. During pregnancy, Dr. Naqvi adds, our cells are not as sensitive to insulin, which is the hormone that moves glucose into the blood.
Not all women with gestational diabetes will require insulin, says Dr. Naqvi. In fact, many women will be able to achieve normal blood sugar levels with modified meal plans and physical activity. If insulin is required, it's usually a small dose. Larger doses of insulin can be somewhat painful, though typically women with GDM take lower doses up to four times a day.
Some women with GDM can take oral medication instead of insulin injections, which many find more preferable. Although the Food and Drug Administration has not yet approved their use in gestational diabetes, a 2008 FDA report in addition to several research studies have shown that oral medications are both safe and effective in the management of GDM.
"Gestational diabetes does not mean cesarean delivery," Dr. Naqvi states. While it is true that women with GDM are more likely to undergo a C-section than women without this condition—especially if the condition is not carefully managed—many will have uncomplicated vaginal deliveries.
Women with GDM are at higher risk for a delivery complication known as shoulder dystocia, which happens when there's difficulty delivering the baby through the pelvis. This is sometimes due to a larger-than-average birth weight, known as macrosomia. If your GDM is kept under control, however, this is less likely to be a problem.
Typically blood glucose levels return to normal shortly after delivery in those with gestational diabetes. However, women who develop gestational diabetes are more likely to develop Type 2 diabetes years later than women without GDM. Also, once a woman has had gestational diabetes, chances are 2 in 3 that it will return in her future pregnancies, according to the American Diabetes Association.
Doctors used to believe that GDM only affected 2 to 5 percent of all pregnancies, but according to a 2014 analysis by the Centers for Disease Control and Prevention, that number is as high as 9.2 percent. That means you're not alone!
It may feel isolating and scary, but if your GDM is treated and well-managed throughout your pregnancy, you are very likely to have a healthy pregnancy and deliver a healthy baby.
Some women do experience weight gain with GDM, but if you keep your blood sugar levels under control, then your pregnancy can proceed normally. Dr. Naqvi recommends that all patients with gestational diabetes receive nutritional counseling to avoid excessive weight gain and to optimize glycemic control. In general, she recommends foods with a lower glycemic index, which results in fewer spikes in blood glucose after meals.
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Screening for GDM typically happens between the 24th and 28th week of pregnancy, says Dr. Naqvi. However, women who may be at higher risk of having diabetes can get earlier screening.
For example, women who have had GDM in a prior pregnancy or who are obese may have underlying pre-gestational diabetes and can benefit from an early screening in order to get a head start on handling their GDM.
If you're diagnosed with gestational diabetes, it's only natural to be worried. But if you arm yourself with the right knowledge and mindset, you can maintain a healthy pregnancy for both you and your baby. Focus on making little changes, getting in moderate exercise (with your doctor’s approval), and keeping a positive outlook.
And remember, it won't last forever!