Challenging Situations: Gestational Diabetes

Welcome back to my Challenging Situations Series! This is blog number two in the series and the topic this week is Gestational Diabetes. I’m going to break down what it is, how provider’s test for it, how it impacts you and baby and strategies to cope or deal with it.

So what is Gestational Diabetes?!

Gestational diabetes is essentially a glucose intolerance developed in pregnancy where there is some issue in the way the pregnant body adjusts to the increased glucose load. Pregnant women go through a lot of metabolic changes as it is and certain people’s body’s are able to handle the adjustments and others struggle more. This can occur in women without any history of diabetes previously. Some factors which may influence the risk of gestational diabetes include being plus-sized, being older, history of gestational diabetes, history of having a large baby for their gestational age, diabetes in a close relative, and certain ethnicities. Most resources suggest that 2-10% of women are diagnosed with gestational diabetes.

How are you tested for it?

In order to detect it early and help treat or manage it, pregnant women are typically asked to complete a diabetes screening test between 24-28 weeks. There are a few different screening methods and some controversy over what may be the best way to diagnose.

The most common method you hear about in the United States is you eat/drink normally, then drink a sugary drink (typically 50 grams of a glucose solution called Glucola), wait an hour and then your blood is drawn to test your blood sugar level. From there depending on your blood sugar level, you may be told you passed and don’t have to take any further tests or they may ask you to complete a second 3-hour test.

The second test follows a similar format, however, the blood sugar is measured after fasting overnight, then again each hour for 3 hours after drinking the 100 gram version of Glucola. Depending on the provider, the cutoffs and rules for diagnosis may vary slightly but in most cases, 2 or more high blood sugar results indicate gestational diabetes.

Alternatives to the glucola drink are sometimes accepted and offered, again typically dependent on the provider. These include eating specific candy or drinking juice which has the same amount of sugar, as well as there is a newer test called The Fresh Test which is a drink that is meant to be a more natural option of the glucola, not including some of the preservatives/stabilizers, flavorings or dyes. There is not a ton of research out there about most of these and because of that not all providers will be on board with utilizing those options.

Lastly, if you did want to decline testing for it, some providers may let you monitor your blood sugar regularly for a period of time based on your regular diet as if you were already diagnosed and tracking it. Then based on those results they may encourage you to continue monitoring or may advise that you do not have gestational diabetes and can forgo continuous monitoring.

I’ve been diagnosed with Gestational Diabetes…. Now what?

In a lot of cases, it just means being more conscious of your diet and exercise and keeping an eye on your blood sugar levels. In more extreme cases, it may mean using medication to help manage your blood sugar.

Other recommendations you may receive are:

• Meeting with a dietitian
• Frequent blood-sugar testing with a glucose meter at home
• Closer monitoring of fetal growth and health with ultrasounds, nonstress tests and other tests.
• Induction at 38 or 39 weeks or earlier if blood sugar is not able to be managed well
• Risk of cesarean may increase due to size of baby
• Frequent checks of blood sugar during labor for mom and for newborn following delivery
• Additional measures to manage blood sugar levels in labor and delivery

There are some things to be aware of in regards to your baby and gestational diabetes as well. First, it is important to remember with the timing of the testing and proper management, a lot of the risks or complications which could occur can be prevented.

Some of the main concerns include:

• Baby weighing more later in life and developing diabetes
• Pre-eclampsia
• Fetal high blood sugar
• Increased risk of cesarean
• Premature birth
• Higher birth weight
• Shoulder dystocia
• Jaundice
• Newborn low blood sugar

Coping and Dealing with a Diagnosis

Gestational Diabetes can feel like a major bummer and a bit overwhelming. Here are some ways to help feel more in control and better about working with the diagnosis:

• Ask your provider or dietitian for additional resources so you may feel more educated about how to manage your blood sugar. There are even some prenatal specific dietitians out there that would be a wealth of knowledge.
• Be aware of the additional tests or interventions you may be asked about and prep how you would like to handle those ahead of time so you don’t feel so blind-sided.
• Try to focus on what you can do, rather than some of the limitations this diagnosis can bring with it.

Resources

• The Birth Partner - By Penny Simkin
• https://evidencebasedbirth.com/gestational-diabetes-and-the-glucola-test/