What to do when you have gestational diabetes
I shuffle quietly into the kitchen and open the refrigerator. The rest of the house is sleeping when I twist the cap off and take my first swig. The orange syrupy drink goes down smooth, but the sugary aftertaste lingers in my mouth far too long. I’ve been fasting since the night before, and my glucose screening is in an hour.
My stomach is rumbling as I head to my OB’s office and twiddle my thumbswhile I wait for the lab tech to call me back. Then—with a single finger pick—my pregnancy takes an unexpected turn.
I have gestational diabetes.
A common problem
According to Tasha Beenken, DO, OB/GYN at West Des Moines OB/GYN in West Des Moines, Iowa, I’m not alone. In fact, 5 percent of women are diagnosed with gestational diabetes at some point during their pregnancy.
“It’s a very common problem that can be difficult to deal with,” says Beenken. “It’s difficult because people can’t feel when their blood sugar is high. And since they feel fine, it’s hard to believe they have a condition that can have serious side effects and require treatment.” While many women with gestational diabetes go on to deliver healthy babies, the risks of not managing glucose levels can be serious to both the mother and child. Early induction and C- section rates are higher for women with gestational diabetes because being exposed to elevated glucose levels can cause babies to be larger than normal (macrosomia). Even if they are normal size, Beenken says infants born to diabetic mothers tend to gain weight in their abdomen and chest more than those born to nondiabetic mothers.
“Both of these things cause an increased risk of shoulder dystocia, where the fetal head delivers, but the body does not. This can stretch the nerves in the baby’s neck and cause temporary or permanent paralysis,” she says, adding that most of the time these serious outcomes can be avoided with a skilled physician and nursing staff.
Other risks include stillbirth, high blood pressure for the expectant mom and low blood sugar (hypoglycemia) in the baby after birth. That’s why Beenken says it’s critical to receive proper care with consistent monitoring of blood sugars during pregnancy to minimize the risks.
A hard adjustment
Being diagnosed with gestational diabetes can be life-changing. Long gone are the days of satisfying pregnancy cravings with convenience store doughnuts and gooey chocolate chip cookies fresh from the oven.
“Pregnancy alone is an adjustment, and then you throw in a new diet and routine and having to monitor blood sugar levels four times a day—it can be really hard,” says Whitney Ceretti, certified physician assistant at Iowa Diabetes and Endocrin- ology Center at Mercy Medical Center in Des Moines, Iowa.
Ceretti’s patients meet with her as soon as they fail their glucose test. Together, they go over expectations of healthy blood sugar levels and set individualized diet and activity goals.
The American Diabetes Association recommends women have a blood sugar reading below 95 after fasting and below 120 two hours after a meal. However, Ceretti says there’s significant research that shows the best fasting numbers for diabetic moms-to-be are between 60 and 90, and she looks for her patients’ blood sugar levels to read lower than 120 just one hour after a meal.
“Keeping these numbers within a healthy range has been proven to significantly decrease risks to mother and baby,” she says.
A standard protocol
The first option for women to control blood sugars is through a strict high- protein, low-carb diet coupled with routine exercise.
“Timing is everything. It’s important to get on a good schedule,” Ceretti says. “Women with gestational diabetes should be eating balanced meals and snacks every three to four hours during the day. They should also be watching their lifestyle—how often they’re exercising and hydrating.”
But it’s not just a matter of eating right and staying active. “Stress levels, hormones, sleep habits and hydration can also impact blood sugar levels,” adds Ceretti, who reviews her patients’ blood sugar logs and notes any spikes or abnormal peaks on a weekly basis.
An alternative route
If blood sugars can’t be controlled through diligent diet and exercise, it’s not necessarily a mom-to-be’s fault.
“Every woman is different. Some may be genetically predisposed to insulin resistance while others aren’t prioritizing a healthy lifestyle, but sometimes the hormones in the placenta just make it more difficult for the body to work the way it should,” Ceretti explains. “And in those cases—where diet and lifestyle changes can’t control blood sugars—I’ll prescribe medication to keep those blood sugars in a healthy range.”
While many women aren’t thrilled to rely on medication to help manage their blood sugars, Ceretti says it’s safe for the baby, and it’s worth it. “I always tell women regardless of whether they’re diet- controlled or dependent on medication that they shouldn’t feel guilty. It’s not their fault,” she said. “At the same time, if they do have poor choices surrounding their diet and lifestyle, now is a good time to change them.”
A long-term impact
A postpartum glucose test usually happens between 6 and 12 weeks after birth. While most women’s blood sugars go back to normal after delivery, a gestational diabetes diagnosis is one of the most predictive factors of developing diabetes later in life.
“Patients should try to look at their diagnosis as an early warning sign that their bodies may be prone to difficulty processing sugar and carbs,” notes Beenken.
According to Beenken, 50 percent of women diagnosed with gestational diabetes will develop diabetes 22 to 28 years after pregnancy—that percentage is even higher for Latina women. “That’s why it’s good to look at a gestational diabetes diagnosis as an important risk factor for women that will hopefully lead to lifelong vigilance and adherence to a healthy way of life,” she says.
A silver lining
While gestational diabetes isn’t something I’d wish upon anyone, my diagnosis has caused me to think twice before reaching into the cookie jar. It’s forced me to choose healthier foods and maintain an active lifestyle, not just for me but for the baby who is depending on me to make good choices.
Sure, checking my blood sugar and planning out meals and snacks can be overwhelming, but in a way it’s preparing me for another demanding routine: one as a mother to a newborn. And that makes it all worthwhile.
By Shelley Skuster