Even during a pandemic, the cycle of life goes on. Women are still getting pregnant and having babies, and several of the patients I have seen recently had a type of diabetes that only occurs in pregnancy, called gestational diabetes (GDM).
GDM occurs in pregnancy of someone who has never been previously diagnosed with diabetes. Fortunately, blood sugar levels usually return to normal after delivery. But women who have GDM are at risk for having it again in subsequent pregnancies, and the chance of developing Type 2 diabetes in the future also increases.
As our body digests food into glucose, it makes the hormone insulin to help store glucose in the cells of the body where it is used for energy. During pregnancy, the placenta, which helps nourish the baby, makes other hormones that can counteract the action of insulin, causing an elevation in blood sugar levels. In some women blood sugar can be so high that it can affect the growth and health of the baby.
GDM is usually diagnosed with an oral glucose tolerance test (OGTT), where blood samples are drawn before and after drinking 75 grams of glucose (usually orange-flavored). The reference values used are different from those used to diagnose type 2 diabetes and only one value has to be abnormal to make the diagnosis of GDM.
The OGTT is usually done around the sixth month of pregnancy, but Filipino women have been found to have an increased risk for GDM and so the OGTT should be done at the first prenatal visit, especially if you are 25 years old or older and have a first-degree relative with Type 2 diabetes. Testing should also be done in women who have had a history of irregular menstrual periods and a diagnosis of of polycystic ovary syndrome (PCOS), are overweight or obese before pregnancy, or if during a previous pregnancy your baby weighed eight pounds or more at birth.
If during a current pregnancy the baby is too large for its age, GDM should be suspected. In GDM the baby can gain too much weight, making it difficult to have a normal delivery. A mother’s high blood sugar may also cause early labor. An early delivery may also be recommended because the baby is too big. Babies born to women with GDM have a greater chance of developing diabetes and becoming obese as they grow up.
The cornerstone of managing GDM is a proper diet. It turns out that “eating for two” when you’re pregnant is not true. Another misconception is eating heavy breakfast. If you have problems with blood sugar, breakfast should be the smallest meal of the day, because our blood sugar naturally goes up in the morning. Pregnancy is also not the time to lose weight if you are overweight or obese, so you have to watch your diet and gain weight slowly and not too much.
To get good blood sugar control in GDM, it is necessary to check your blood sugars, by using either a traditional glucometer and pricking your finger to test, or with continuous glucose monitoring. If you have GDM, consult with an endocrinologist who can help you decide on which method is best for you and how often you need to check your blood sugar. Your endocrinologist will also monitor your blood sugar control throughout the pregnancy, as many changes can occur from one trimester to the next.
With proper diet and some exercise, most women will be able to control their blood sugar without medication. About 10 to 20 percent of women with GDM, however, will need medication, and this includes injecting insulin, which is effective and safe to take in pregnancy. As GDM usually resolves after delivery, mothers will not need insulin after delivery.
Another thing to remember is to get an OGTT again six weeks after delivery, to make sure that your blood sugar levels have indeed returned to normal. Half of the women who have GDM develop diabetes in the next five to 10 years, and annual testing is recommended to catch early. To remember it, you have to do the test once a year during the month of your birthday. Think of it as a birthday gift to yourself.
Having GDM can be stressful — dealing with blood sugar monitoring, counting calories, and worrying about how this could all affect your unborn baby’s health. Consult with your doctor regularly, ask questions, and educate yourself, because the more you know, the more in control you’ll feel. Working with a nutritionist can also help. Do not be afraid of the diet and all the testing. Know that you are taking the proper steps toward taking care of yourself and your baby.