Gestational Diabetes is a condition that can develop during pregnancy for someone that did not have diabetes prior to pregnancy. This affects between 2-10% of pregnancies.
This condition occurs when the body either doesn’t make enough insulin or the body becomes resistant to insulin which increases the need for insulin more. This leads to too much glucose flowing through the blood instead of it being used for energy.
The demand for insulin changes throughout pregnancy due to weight gain from the growing baby and hormonal changes. The insulin needs increase at different times throughout the pregnancies.
Not all pregnant bodies are able to accommodate for these changes due to an insulin resistance that develops. This is a concern for pregnancies because insulin does not cross the placental barrier but the blood glucose does.
Baby then produces their own insulin in response to the elevated blood glucose from the birthing person, and the insulin acts as a growth hormone for baby which could possibly lead to having a larger baby than the body can birth naturally.
Possible Risk Factors
There are populations that are at an increased risk of developing gestational diabetes. The populations at increased risk include:
- someone who is overweight or obese
- being physically inactive
- previous gestational diabetes
- having a previous large baby (9lbs or more)
- hypertension (high blood pressure)
- history of heart disease
- history of PCOS (Polycystic ovary syndrome).
There are certain ethnic groups that are at an increased risk of developing gestational diabetes. They are Asian, Pacific Islander, African, Hispanic, and Native American.
There is always a chance that you can develop Gestational Diabetes without any of those risk factors listed above.
Change in Care
How your care changes after being diagnosed with Gestational Diabetes depends on which type you have.
Both types will have to monitor their blood glucose throughout the day once in the morning before eating anything and then again 1-2 hours after your 3 big meals
but the other interventions depend on the type.
Your provider may also recommend induction, as the concern is gestational diabetes could cause baby to grow larger than normal making it more difficult for a vaginal birth or increase the risk of shoulder dystocia.
Types of Gestational Diabetes
There are two types of Gestational Diabetes. Diet Controlled (GDMA1) and Medication controlled (GDMA2)
GDMA1 is when the person is able to keep their blood glucose levels within the normal range just by altering their diet and exercise routine.
- Close monitoring for baby not necessary per ACOG
- Induction is recommended still but can be held off till 40+6 weeks at the lates if the blood glucose levels are well controlled.
GDMA2 is when the person requires some sort of medication to keep their blood glucose levels within a normal range, the medication can be insulin or some sort of oral medication like metformin or glyburide.
- Baby is monitored closely for any signs of distress and growth is monitored starting at 32 weeks
- Nonstress test 1-2 times a week
- Biophysical profiles
- Growth Ultrasounds
- Induction at 39 weeks
- depending on how well controlled the blood glucose levels were and the growth of baby it may be offered earlier.
Gestational Diabetes Screening
Done between 24-28 weeks.
The insulin resistance usually occurs during the second trimeste.
The screening test is known as the 1 hour OGTT, Oral Glucose Tolerance Test, that is a non-fasting test.
- This is when you drink 50g of glucola within 5 minutes and then have your blood glucose drawn 1 hour later.
- You pass the test if your blood glucose is less than 135-145, depending on your provider.
- If your blood glucose is higher than that 135-145, then you will be advised to take the 3-hour OGTT, Oral Glucose Tolerance Test.
- 3hour GTT: This test is done fasting after following a specific diet for a few days prior to the test.
- This requires drinking a 100g glucola drink
- There are 4 blood draws instead of 1
- fasting
- 1-hour
- 2 hour
- 3-hour
- If 2 out of the 4 numbers above are elevated, this becomes a Gestational Diabetes Diagnosis
Glucola Drink
The Glucola drink is the tradtional glucose drink that has been used for this test.
It has started to be talked about more in the birthing community because some people do not like the drink ingredients and the feeling they get after drinking it.
It has been well-studied as an effective and safe way to screen for gestational diabetes!
BUT There are other alternatives and not many know that!
Brach Jelly Beans
One of the alternatives that has been researched is brach jelly beans. Studies have shown that eating 28 brach jelly beans in 5 mins is an alternative option to the glucola drink that some have liked.
We have tried the brach jelly bean option and unless you really like jelly beans we ourselves did not like the option. We are not huge fans of jelly beans and 28 is a lot to eat!
Well Balanced High Glucose Meal
Another option that some providers use is just eating a well balanced high glucose meal, usually involving orange or grape juice and a banana. The meal is prescribed by the provider and then the blood glucose is drawn an hour after eating the meal.
This has not been studied to prove it is an effective way to screen for gestational diabetes but some still offer it as an option!
The Fresh Test
A newer option we have learned about is the Fresh Test.
This is a natural glucose beverage that is made with 3 simple ingredients, Non-GMO glucose, crystallized lemon, and organic mint.
This drink is Non-GMO, gluten-free, preservative-free, and has no artificial dyes or flavors. This drink is FDA-registered as an option for the OGTT.
If you want to avoid the Glucola drink when doing your OGTT, discussing the other options, including the fresh test, with your provider, can be helpful!
Why do we care about Gestational Diabetes??
We have discussed what it is, but why do we even care!
There are both short-term and long-term effects from having Gestational Diabetes that can affect the pregnancy, birth, and beyond! By identifying and keeping it controlled we can decrease these risks.
For You:
- Increased risk of a larger baby, Baby may grow larger than you would normally grow them in your body which can increase the risk of C-section or birth complications like shoulder dystocia
- Increase risk of elevated blood pressure developing during pregnancy
Increased risk of developing type 2 diabetes later
Blood sugar rollercoaster: Can cause fatigue, headaches, or feeling “off” if not managed.
For Baby:
Larger baby increasing risk for delivery
Increased risk of Low blood sugar after birth
Higher risk of childhood obesity or type 2 diabetes
- Harder time transitioning at birth to life outside the womb
We know the increased risks, so if we can prevent GDMA from developing or keep it from being uncontrolled we can decrease the above risks from happening!