Gestational diabetes is diabetes that occurs during pregnancy. I am seeing more and more of this during pregnancy these days and it is definitely on the increase, most probably due to our high carbohydrate diet and lack of proteins.
Diabetes is a very common condition where there is too much glucose in the blood. Insulin (continuously produced in the pancreas) is the hormone responsible for lowering blood glucose levels. Insulin transports glucose from the blood stream into cells of the body for energy. Due to our poor diets these days, we are now putting ourselves at more risk of gestational diabetes and also type 2 diabetes, which can occur one you have had gestational diabetes.
In pregnancy, the placenta produces hormones that help the baby grow and develop. These hormones also decrease the action of the mother’s insulin. This is called insulin resistance. Because of this insulin resistance, the need for insulin in pregnancy is two or three times higher than normal.
Insulin resistance can also be hereditary and if there is a family history of diabetes you have high chance of having insulin resistance by default. Women with PCOS and those doing assisted reproduction (IVF, IUI, ICSI etc) also have higher risk of developing Gestational Diabetes. Consequently, during pregnancy, the mother’s body needs to produce higher amounts of insulin to keep her blood glucose levels within the normal range. If her body is unable to produce more insulin to meet her needs, gestational diabetes develops. After the baby is born, the mother’s blood glucose levels usually return to normal
Unfortunately many women think they can eat whatever they like during pregnancy and this also puts a greater load on insulin and insulin sensitivity, leading them to be at more risk of gestational diabetes. Gestational diabetes is very much a preventable disease and strict diet needs to be adhered to for optimum health of mother and child.
Definition Depending on the specific population, abnormal maternal glucose regulation occurs in 3-10% of pregnancies. Recent studies suggest that the prevalence of diabetes among women of childbearing age is increasing in the Western countries. To be honest the rates are probably up around 50% these days, given how many people are seen with this disease. Australia is now one of the fattest countries on the planet and our diabetes levels have increased exponentially.
This increase is believed to be attributable to (1) more sedentary lifestyles, (2) changes in diet, (3) continued immigration from high-risk populations, and (4) the virtual epidemic of childhood and adolescent obesity presently evolving.
Gestational diabetes mellitus (GDM) is defined as any degree of glucose intolerance with onset or first recognition during pregnancy. Untreated GDM can lead to foetal macrosomia, hypoglycaemia, hypocalcaemia, and hyperbilirubinaemia. In addition, mothers with GDM have increased rates of caesarean delivery and chronic hypertension
To screen for GDM, a 50g glucose screening test should be done at 24-28 weeks of gestation. This is followed by a 100g, 3-hour oral glucose tolerance test if the patient’s plasma glucose concentration at 1 hour during screening is greater than 7.8 mmol/L.
Normalisation of glucose levels in women with gestational diabetes will reduce the risk of complications such as macrosomia, birth trauma, need for caesarean section, and neonatal hypoglycaemia. If diet modification fails to improve glucose values, insulin therapy may be needed. Oral hypoglycaemic agents arecontraindicated during pregnancy
Subsequent pregnancies can be affected, and the risk of developing type 2 diabetes is increased. If maternal glucose levels are uncontrolled, the infant can suffer central nervous system defects, organ failure, cardiac or renal anomalies asphyxia, respiratory distress, increased blood volume, hcongestive heart failure, hypocalcaemia, hypomagnesaemia, hypoglycaemia, or hyperbilirubinaemia, or the child may be stillborn. The effects of Gestations Diabetes are not good.
Aetiology / Risk Factors
- Family history of type 2 diabetes: having a first-degree relative with type 2 diabetes leads to lifetime risk of 40%; similarly 25% to 33% of all type 2 diabetics have a family history of the condition.
- Age older than 40 years
- Excess body fat, particularly truncal obesity with waist circumference >88 cm
- Sedentary lifestyle with diet high grains and refined carbohydrates
- Glucose intolerance, dyslipidaemia, hypertension
- History of gestational diabetes
- History of polycystic ovarian syndrome
- History of assisted Reproduction (IVF, IUI, ICSI etc)
- Aboriginal or Torres Strait Islander, Pacific Islander, Indian or Chinese, African American, Hispanic American, and Native American descent.
- Low birth weight and/or malnutrition in pregnancy may cause metabolic abnormalities in a foetus that later lead to diabetes.
Symptoms of gestational diabetes Gestational diabetes usually has no obvious symptoms. If symptoms do occur, they can include:
- unusual thirst
- excessive urination
- thrush (yeast infections).
Management and Prevention of gestational diabetes
Health professionals such as an Endocrinologist, Nutritionist, Naturopath, or Diabetes specialist can help you understand what you need to do and will support you in managing your gestational diabetes. The same principles apply for the prevention of Gestational Diabetes as well. Some advice may include:
- Diet – You need to follow a strict Low GI diet and the best diet to follow is a grain free diet such as the Paleo/Primal/Zone Diet. This way you are cutting out the inflammatory foods that spike your blood sugars and then spike your insulin. Basically you should be having 5-7 small meals per day. You need to have 2 serves of nuts per day, 2 tablespoons of healthy oils per day (coconut, olive oil etc), only on serve of starchy carbs per day (rice, potatoes etc-No wheat grains at all), every meal or snack should have some form of protein in it (meats, fish, avocado, cheese, nuts etc), 5 serves of veggies per day (including salads), 2 pieces of low GI fruit per day (Berries, Strawberries, Apples etc), 8 glasses of water per day and some form of electrolyte daily.
- Physical activity – such as walking, yoga, pilates etc, helps to keep you fit, prepares you for the birth of your baby and will help to control your blood glucose levels. Check with your health care professional before starting a new or particularly strenuous exercise regimen
- Monitoring your blood glucose levels – is essential. It gives a guide as to whether the changes you have made to your lifestyle are effective or whether further treatment is required. A diabetes nurse educator can teach you how and when to measure your blood glucose levels and discuss the recommended blood glucose levels to aim for. Your health care profressional, or diabetes educator, can help you link in with the National Diabetes Services Scheme (NDSS) for cheaper blood glucose strips. Regular contact with your health care practitioner, diabetes educator, or doctor is recommended
- Take a good multivitamin, some omega 3 oils, a probiotic and an insulin regulating formulation to help with staying healthy, providing adequate nutrients to the baby and help in preventing gestational diabetes. Acupuncture is also great in the prevention on gestational diabetes.
- Insulin injections – may be needed to help keep your glucose level in the normal range. In Australia, blood glucose lowering tablets are generally not used in pregnancy. Insulin is safe to take during pregnancy and does not cross the placenta from the mother to the baby
- Education – including information and support from your diabetes educator or doctor, regarding the action of insulin, insulin injection technique, insulin storage, signs and symptoms of hypoglycaemia (low blood glucose levels) and its treatment, as well as safe blood glucose levels for driving.
After the baby is born (If you have Gestational Diabetes)
After their baby is born, most women will no longer need insulin injections, as gestational diabetes usually disappears. Breastfeeding is encouraged. The best way to control GD and prevent the onset of Type 2 diabetes in the future is by diet and lifestyle changes Blood glucose levels are measured before breakfast and two hours after meals to make sure that these are within the normal range. An OGTT is done six to eight weeks after the baby is born to make sure that the mother no longer has diabetes. Following the birth of your baby, it is important that your baby’s blood glucose levels are measured to make sure that their blood glucose is not too low. If it is, this can be treated by feeding your baby breastmilk, or formula if necessary. A baby whose mother had gestational diabetes will not be born with diabetes. However, they may be at risk of developing type 2 diabetes later in life. This is why all children should be shown healthy eating habits from a young age so that they reduce the risk of inheriting disease states from their parents.
Reducing your risk of type 2 diabetes
Women who have gestational diabetes have a high chance (almost one in two) of developing type 2 diabetes within 10 to 20 years. Type 2 diabetes can be prevented, so it is important to take steps to reduce your risk. You should:
- maintain a healthy eating plan
- maintain a healthy weight for your height
- engage in regular physical activity
- have a follow-up blood test (OGTT) every year.
Things to remember
- Gestational diabetes is diabetes that occurs during pregnancy.
- When the pregnancy is over, the diabetes usually disappears.
- Women who develop gestational diabetes have an increased risk of developing type 2 diabetes.
- A healthy lifestyle with a grain free diet, is important for both mother and baby to reduce their risk of diabetes in the future.
- In future pregnancies, an OGTT will be performed early in the pregnancy to make check that your blood glucose levels are in the normal range. If this test is normal, then a repeat OGTT will be done, usually between 22 and 28 weeks gestation.
Prevention is the best way to deal with gestational diabetes and Type 2 Diabetes. Preconception preparation with good foods, good supplements, exercise and a healthy lifestyle should be adopted before trying to fall pregnant. These healthy eating and lifestyle changes should then be followed into the pregnancy as well. At Shen Therapies we can help you with gestational diabetes and also prevention of this condition also.