Diabetes, no one plans to develop diabetes, especially not mums to be. In fact it probably wouldnt even cross most womens mind when they have just found out they are pregnant. However, Gestational Diabetes (GD) will affect around 5% of UK pregnancies. Once diagnosed there are so many misconceptions within society, these women end up feeling guilty. Thinking somehow, they have caused it to themselves. Support from the NHS OK, but hindered by offering advice based upon Type 2 Diabetes (a low fat diet due to the link with obesity). GD, however is hormone driven. Most women will struggle to follow type 2 dietary advice, due to the fluctuations of their hormone levels during pregnancy.
Hopefully this post will give you a brief overview of the condition, how you can help yourself manage GD and quash a few misconceptions associated with it.
What is Gestational Diabetes?
GD is defined as Diabetes that develops or is first diagnosed during pregnancy. Also known as ‘Carbohydrate intolerance’ (sugars also come from carbohydrates) . In general, Diabetes is the result of too much sugar in the blood . Blood Sugar levels (BSL) are controlled by a hormone called Insulin. We eat and digest our food. Some of which will be broken down into glucose (a type of sugar). Glucose is transfered into the bloodstream. In response, the pancreas produces insulin to help our cells absorb the glucose to use as energy. As this happens BSLs lower.
Pregnancy hormones cause our cells to respond less efficiently to insulin ( this is insulin resistance) and BSL can remain elevated. To some extent, this happens to all pregnant women and this is totally normal. This response would allow for a fetus to survive under famine conditions. In response to elevated BSL More insulin is produced and BSL should drop. However, in some women their cells become more and more resistant to insulin. Therefore, their cells can’t absorb the glucose efficiently. When the pancreas has produced as much insulin as it can and cells continue to struggle, BSL continue to remain high, and this is GD.
Can anyone develop Gestational Diabetes?
YES!! Do not think just because you are young, fit, and/or healthy that you are not at risk. Many young women with a healthy BMI who eat a healthy nutritious balanced diet and exercise regually end up being diagnosed with GD. GD does not discriminate! Having said that, some factors can put you at a slightly increased risk:
- A BMI of 30 or more
- A family history of diabeties
- A previous diagnosis of GD
- A previous pregnancy with a large baby (10lb+)
- Are of South Asian, Black African of middle Eastern descent
What are the risks of Gestational Diabetes?
If your BSL are well controlled (with diet or medication) then you can greatly reduce any complications associated with GD. Most women will go onto have a normal healthy pregnancy and baby. Most complications are rare, but some can be serious:
- Macrosomia – A large baby for gestational age and can lead onto Shoulder Dystocia (below)
- Shoulder Dystocia – Babies head passes through the vagina but the shoulders get stuck behind the pelvis
- Premature Birth
- Hypoglycaemia after delivery – Low Blood Sugar
- Newborn Jaundice
- Placenta insufficiency – Early aging of the placenta
- Polyhydramnios – Excessive Amniotic Fluid
- IUGR – Intrauterine growth restriction, babies growth is slow or ceases
- Pre – Eclampsia
After delivery, your babies BSL will be tested a number of times. Therefore expect to stay in hospital for at least 24hrs after birth.
How is Gestational Diabeties Diagnosed?
At your booking in appointment, if the midwife feels there are any risk factors for developing GD (for me it was maternal line Type 2) you will be booked in for a Glucose Tolerance test (GTT) at 28 weeks. If you have had GD you will automatically be tested for GD before 28 weeks. You will be required to fast for around 12 hours (overnight), a fasting blood sample is then taken. You are then given a syrup glucose soloution to drink. 2 hours later another blood test will be taken. To pass the test (and remain non GD) your fasting BSL must be under 5.3Mol and your 2 hour test under 7.7mol (this may vary slightly by region).
One thing to remember is that GD is progressive and insulin resistance increases the further into pregnancy you get. If you pass the 28 week test, you could still go onto develop GD at any point later. If you think this is the case you must talk with your midwife. My SIL passed her 28 week GTT, but at a rotuine growth scan at 32 weeks showed her babies belly was in the 99th centile, and being really thirsty and a family history of diabetes she requested another GTT. This one she failed.
How is Gestational Diabeties Controlled?
Once diagnosed you will be issued with a BSL monitor, lancet and testing strips. This will enable you to monitor your BSL throughout the day. How many times and when you test will be dependant on your hospitl trust. For me in the South East, I had to test my sugars 7 times a day. On waking (before food), 1hr post breakfast, Before Lunch, 1hr post lunch, before tea,1 hr post tea and then again before bed. You will be given target BSL, these again depend on your trust. For East Sussex my BSL should of been <5.3mol before food and <7.8mol 1hr after food.
Depending on your diagnosis results, you will likely be asked to try to stablise your BSL initially through diet and exercise. This should involve cutting out refined sugars and limiting your intakes of natural sugars i.e fruit and limiting your carbohydrate portions. You should also cut back on white breads, white pastas, potatoes and breakfast cereals. Swapping for Seeded granary breads, whole wheat pastas and sweet potatoes. Unfortunatley most GD women can not tolerate any form of breakfast cereal and is one of the hardest changes to make . Snacks are great between meals to help stabilise BSL but they must be GD friendly. Ideal snacks would be nuts or oat cakes with cheese. You can have some treats such as No added suagr Jelly and No Added sugar Angel delight, but these are best eatern with a helping or cream!
The more exercise the better, however if you can’t do much even a 20 minute stroll after dinner can help reduce BSL.
After diagnosis, if your BSL were very high you may be put straight onto medication, usually though medication is prescribed if diet and exercise alone are not keeping you below your target BSL. This is quite common with most women, especially as GD gets progressively worse (although some women can remain diet controlled until the end!). Metformin is a tablet prescribed and is often trialled first in various doses. If your BSL still remain unstable than you may be prescribed insulin or a combination of Metformin and Insulin.
Controlled BSL, greatly reduces the risk of any of the complications associated with GD.
….So what does Gestational Diabetes mean?
It means you have not given yourself GD, GD just happens sometimes. They myth that you can control it is just that, a myth. You can help manage GD by monitoring and watching your diet. You can help manage GD by doing exercise, but you can not control GD. You can not control how your cells react to the pregnancy hormones. GD does not mean you will definatley have a big baby, it does not mean you will have to have a cesarean, it does not mean you can’t have a VBAC or that your baby will need to go straight into special care.
If you have tried to stabilise your GD with diet and exercise but you still need medicine, be kind to yourself, sometimes there’s nothing you can do. Accept you just need some extra help, don’t beat yourself up. You still have options and most women with GD will go onto to have a calm relaxed birth and a healthy baby.
For GREAT advice and furthur infomation please visit Gestational Diabetes UK.