Gestational Diabetes

Hey sisters! I’m excited to be back with you in this space! Today, I want to touch on the topic of Gestational Diabetes. It’s a pretty hot topic as more and more women are being tested earlier in pregnancy, the guidelines for “acceptable” numbers are being changed and many women are “risking out” due to numbers that aren’t within the “acceptable” guidelines.

My hope here is to present you with factual information that will raise your own free-thinking questions and have you doing more of your own independent study on this topic, especially if you’re in a situation where you may need to advocate for yourself and stand your ground. I’m not here to convince you one way or another, only you can make your decision based on the information you glean from the sources you research. I’m just here to present you with factual information and solid resources.

This is another time that I want to remind you about the BRAIN acronym in decision making.

Here’s a whole blog post I wrote about Informed Choice and Asserting Your Rights.

B: Benefits

How will this help my pregnancy?

How will this help my baby?

How will this help my birth

How will this help me?

R: Risks

How will this affect my pregnancy?

How will this affect my baby?

How will this affect my birth?

How will this affect me?

A: Alternatives

What other options do I have?

(Because, there are ALWAYS other options.)

I: Intuition

What does my gut say?

What does God say?

N: Need Time

“I need more time to think this decision through.”

“I need a private moment to talk to my family.”

“I would like to wait for now.”

“I do not consent.”

I’ll open with this quote from Gail Hart

“Gestational Diabetes is a syndrome with no risks to the mother or the baby, and with no symptoms, other than the increased chance of growing a larger than average baby.”

There is no consensus on Gestational Diabetes in pregnancy. Many speculate that it is something that happens depending on the weight of the pregnant woman, some speculate that it just randomly happens to some women, yet others speculate that it isn’t real at all. It’s really just one big guessing game with so many variables and no one truly understands why it happens.

What is Gestational Diabetes?

To put it simply, it’s a type of diabetes that develops during pregnancy and a type of diabetes that is first diagnosed during pregnancy.

All of this began in 1979 when it was decided to include a diabetes diagnosis for pregnancy, so Gestational Diabetes was declared a disease. It’s considered glucose intolerance of pregnancy and by having an “official” name of Gestational Diabetes, insurance is allowed to reimburse for it. The official name also promotes women and doctors to take it seriously.

Type 1 Diabetes and Type 2 Diabetes have signs and symptoms and will create damage, this is not seen with Gestational Diabetes. The diagnosis is based on lab values that have been changing over the years and even differ from practice to practice across the country.

It is normal to have slightly higher blood sugars during pregnancy because a pregnant body digests sugars much more slowly. Many women will experience blood sugar fluctuations, especially first thing in the morning and due to the fluctuating blood sugars, that’s how we get what we call Morning Sickness.

It’s also worth noting that women with TRUE diabetes will likely have fertility problems.

Even ACOG has criteria that says low-risk women do not need to be screened:

Under 25 years old
Not “morbidly obese”
No family history
Not a high risk ethnic group

Difference Between Types of Diabetes

Type 1 Diabetes

Not lifestyle related
Pancreas stops producing insulin

Type 2 Diabetes

Develops later in life
Developing in children

Related to Gestational Diabetes

Not caused by lack of insulin, not as a response
Insulin resistant
Pancreas can eventually fail after many years

Gestational Diabetes

Develops during or first diagnosed during pregnancy
Physiologically can become insulin resistant
Weight gain, more insulin resistant
Higher levels of placental hormones, brings insulin resistance
Sending more nutrition to the baby
Third trimester, triple insulin levels
Normal pregnant women, blood sugar is lower
Risk factors mimic Type 2 Diabetes
Higher risk of Type 2 Diabetes in the future
Pregnancy is the first signal that there’s an issue

How Common is Gestational Diabetes?

It really depends on the diagnosis, the screening method and the cutoff numbers. Gestational Diabetes is the most common complication of pregnancy right now. 1 in 7 will be diagnosed with Gestational Diabetes.

Testing

The testing is really all over the place and it’s not a fun experience. On average, Gestational Diabetes is tested for around 28 weeks of pregnancy.

The Glucose Tolerance Test (GTT)

One of the biggest issues with the Glucose Tolerance Test (GTT) is that the values that they are looking for are actually LOWER than the values given to non-pregnant women. Why are they doing this? If it’s already known that a pregnant woman’s blood sugar levels are naturally higher in pregnancy as a baseline, then why are we looking for values lower than a non-pregnant woman?

So, the diagnostic criteria is not standard. There are food dyes, preservatives and huge quantities of sugar in the Glucola drink. If you’re someone who naturally eats a low sugar and low carb diet on a consistent, normal basis, your body is likely to have an abnormal response to the Glucola because your pancreas is not adapted to large quantities of insulin.

With that said, there are a lot of false positives AND a lot of false negatives. Because, on the contrary, if you’re someone who regularly consumes pure sugar and a lot of carbs, your body already produces a large quantity of insulin.

With the GTT, you have to fast for 6-8 hours in order to get your fasting glucose. Then you drink a 50g glucola drink, which is typically more sugar than most will consume in a day, wait an hour and get another blood draw to see how your body has metabolized the sugar. If the 1 hour value exceeds 140, the woman is then advised to take the 3 hour GTT test. If that test is failed, then she is slapped with a Gestational Diabetes label.

If a woman fails without symptoms then there is no risk because there is no diabetes. She likely has totally normal glucose metabolism in pregnancy. Fear in birth is never a good thing… and if your care provider is fearful, it’ll plan that seed within you. Low calorie diets are dangerous in pregnancy and with low calorie diets, there is a much higher risk for pregnancy complications such as Pre-Eclampsia, preterm birth, etc. Keep in mind, too, that the baby’s size is going to be what it’s going to be; regardless of the woman’s diet.

Alternative Testing

I’m not going to go over all of these individually, but you can google search them, checkout your favorite home birth/natural birth Facebook group. There’s lots of information floating around out there if you’re willing to take the time to read it!

Fresh Test
28 Jelly Beans

Only used for the 50g test

Sugary foods equaling the amount in the glucola drink
Eat a Real Meal & Test with a Glucometer

You can eat a real breakfast of eggs, protein, pancakes and some syrup. After an hour has passed since your meal, test your blood sugar.

Fasting Levels

True Diabetic: 145-300 (or higher)
105 or below: 99% you don’t have Gestational Diabetes

Hemoglobin A1C Test

Only accurate in the first trimester
Add to your first trimester pregnancy labs
Very indicative of Gestational Diabetes later in pregnancy
It’s not a perfect test
It does not test insulin levels

A study done in Seattle has shown that Vitamin C Serum levels affect the levels of glucose in the blood and, therefore, may affect the development of Gestational Diabetes.

If You Have Gestational Diabetes, What Does That Mean for your Pregnancy, Labor and Baby?

Well, the evidence shows that normal outcomes occur if the blood sugar is under control. With normal blood sugar, there is no higher risk. You get the opportunity to be proactive with your lifestyle choices.

What is the Healthiest Way to Manage Gestational Diabetes?

Eat a lower glycemic index and lower carb nutrition. This will lower your chance of needing insulin by 50%. The standard prescribed diet for those with Gestational Diabetes actually makes blood sugar worse. A high carb diet just doesn’t make any sense.

Real Diabetes Symptoms

Our bodies are really good at telling us when something isn’t right! Gail Hart theorizes that Gestational Diabetes is not a high risk condition, especially if the diagnosis is based on a failed GTT. In cases where the woman is having sugar issues in pregnancy, the mother was likely diabetic BEFORE pregnancy but did not notice until the additional strain of pregnancy.

Excessive weight loss or weight gain
Excessive thirst

Cannot ever quench thirst
In a normal situation, excessive third does not lead to increased urination

Poly-Uria (peeing a ton)

In a higher volume and increased frequency

Glycosuruia (sugar in your urine)

Ketones + Sugar

Cardiovascular Symptoms

High Blood Pressure

Fundal Height is Large for Dates
Large Baby for Dates

Large in a strange way
Baby is filled with fluid

Hydramnios (increased Amniotic Fluid)
All Lab Values Will be Out of Range

Fasting Glucose
1 hour
3 hour

How Can You Prevent Gestational Diabetes?

Well, sometimes it is completely out of your control. Sometimes it’s just that the pancreas isn’t adapted enough this pregnancy. It could be that you were pre-diabetic before your pregnancy. Some proactive lifestyle choices you can make that can help are such things as eating enough protein. Especially in the first trimester, you want to aim for 80-100+ grams of protein. Watch your carb intake, especially refined carbs. Nuts are GOOD! Nuts do not raise your blood sugar levels. Excessive fruit intake will increase your risk and is also linked to more weight gain. Keep moving your body. Getting regular exercise two to three times a week for 30-60 minutes will reduce your insulin resistance. Get plenty of Magnesium and Vitamin D.

It doesn’t make sense that someone who barely fails the GTT is put into the same category being labeled as a Gestational Diabetic as someone who massively fails the GTT. There’s no variance to the labor of Gestational Diabetes.

Gail Hart states:

“a temperature of 100.5 is a fever, right? But should we treat the woman with a temperature of 100.5 the same as we treat a woman with a temperature of 105?” This is the mentality surrounding the treatment of Gestational Diabetes. Anyone who fails the GTT, regardless of how many points they are about the limit, are treated the same way in pregnancy, even if they are, in fact, not diabetic in that pregnancy.

So, I hope you found this helpful, sister. As you’re making your way through the giant list of pregnancy and birth decisions, doing your research and practicing your informed consent and informed refusal.

Again, as always, don’t take my word for it! Do your own research and make empowered, informed choices about your care. Take what I have to say and expand upon it by looking at the resources I’ve linked, resources you find along your way, podcasts, etc.

Until next time, sister. Stay wild and free!