Have you been diagnosed with gestational diabetes or are you at risk?

Have you been diagnosed with gestational diabetes or are you at risk?

Jacky Dixon, fertility and women’s health specialist explains the risk of pregnancy-related diabetes, strategies to deal with a diagnosis and prevention.

Did you know, 1 in 10 pregnant women in Australia will develop gestational diabetes and 50% of those women will go on after pregnancy to develop type 2 diabetes. However, most women can avoid it when armed with the right information and support.

What is Gestational Diabetes?

Try to imagine insulin is a key, floating through your bloodstream, unlocking doors to allow sugar to enter the cells.

During pregnancy, the placenta releases hormones which reduce your sensitivity to insulin, so the key doesn’t go into the door as easily as it did before.

As a result, the placenta releases more insulin to allow sugar to enter the cells around the body. Gestational diabetes occurs when your pancreas is unable to release enough insulin to get the sugar into your cells, increasing the amount of sugar left floating in your bloodstream. This additional sugar will instead go to the baby resulting in higher birth weight and placing stress on the baby’s developing pancreas.

Risk factors include:
  • Glucose in the urine, on routine analysis
  • Family history of diabetes
  • History of glucose intolerance in including previous pregnancy
  • Obesity
  • Previous baby with high birth weight
  • Women over 40
  • History of PCOS
  • High weight gain in the first pregnancy

 

How is gestational diabetes diagnosed? What does the test involve?

The oral glucose challenge test is done at a pathology lab. You need to fast overnight before having this test. Blood will be taken to check your fasting blood glucose level.

After this, you will be given a sugary drink (which can make you feel sick) and have your blood tested one and two hours later. You will be asked to sit and wait between tests. If your blood glucose level is above the normal range in these tests, you are diagnosed with gestational diabetes.

In Australia, medical guidelines recommend all pregnant women should be screened between 26 – 28 weeks’ gestation. Women at high risk should be screened earlier with a repeat screening at 24 – 28 weeks.

 If you have a positive result the risk factors for the baby include:
  • Larger baby, higher risk of caesarean section
  • Low blood sugar and mineral levels at birth
  • Jaundice
  • Pre-term birth
  • Respiratory problems
  • For the mother and baby, a miscarriage and high blood pressure leading to preeclampsia

 

How to reduce your risk 
Diet

The most crucial start is to get your diet right. The best way to avoid gestational diabetes and to minimise its impact when it has been diagnosed is to eat a low GI diet of quality proteins, this includes:

  • Eggs, meat, fish, chicken
  • Full-fat yoghurt (If you can tolerate dairy)
  • Tofu
  • Nuts and seeds
  • Good fats – avocado, EVOO and nuts butter
  • Complex carbohydrates – vegetables, beans, chickpeas, lentils, quinoa, whole oats and barley

Unfortunately, often the recommendations after diagnosis of poor glucose control is a diet high in sugar and carbohydrates with little regard for quality proteins, vegetables and good fats.

Foods such as bread, pasta, rice and crackers are foods which raise your blood sugar, so concentrating on whole grains is the key!

Having small snacks between meals is important to maintain your blood sugar balance. 5 small meals can be better tolerated than 3 large meals, this can also help reduce nausea.

I often see women at NatMed who have poor test results and when we discuss what they ate the night before, the meal is heavy in carbohydrates and low in protein and good fats – so it is important to stay on track.

Need help with your diet? Click here for your FREE insulin resistance diet resource

Exercise

The other crucial factor is exercise. Exercise helps manage gestational diabetes by increasing the number of doors available for the insulin keys to fit in. This subsequently increases the amount of sugar which can be burned by cells. Exercise also helps reduce blood sugar levels through the additional energy expended during the exercise and in the hours after exercise.

The ideal exercise program is something you can complete most days of the week with a mix of both aerobic exercise and strength training.

Options include walking, swimming, light weights training, bodyweight exercises and Pilates.

Also factoring in daily pelvic floor strengthening exercise

But we have to be realistic, most women I see are still working and have small children at home, so if you are struggling with energy during your pregnancy – try a pregnancy yoga class, walking in the pool, walking at a cool time of day – aim for 15 minutes every day and see how you go.

Supportive Supplements

As a Naturopath and Medical Herbalist, I am fortunate to have at hand a number of safe and effective herbal and nutritional medicines to assist with

  • Blood sugar regulation
  • Enhanced insulin sensitivity
  • To help reducing sugar and carb cravings

One very important nutrient is vitamin D. Recent research has shown low serum levels of vitamin D (under 50 nmol/L) were found to inversely affect blood glucose levels and were associated with poor glycaemic control.

I am constantly surprised by the vast number of women I see who are deficient in vitamin D. In pregnancy, it is essential protection for the developing baby and reduces the risk of gestational diabetes. Unfortunately, it is not always tested in early pregnancy or in preconception blood tests

As we get over another holiday season it’s now time to get back on track with the implementation of a healthy diet and lifestyle, particularly if your goal is conception or you are at risk of gestational diabetes.

I highly recommended a consultation if you think you are at risk of gestational diabetes or have been diagnosed as this consistently leads to significantly better outcomes, including the minimisation of the need for insulin injections and further intervention.

Call 9339 1999 or SMS  0488 854 005 to book in for a free 15-minute scoping session if you would like more information.

References

  1. Moses RG, Morris G, Petocz P, et al. Impact of the potential new diagnostic criteria on the prevalence of gestational diabetes mellitus in Australia. Med J Aust 2011;194:338-1340
  2. Aghajafari F, Nagulesapillai T, Ronksley PE, et al. Association between maternal serum 25-hydroxyvitamin D level and pregnancy and neonatal outcomes: systematic review and meta-analysis of observational studies. BMJ 2013;346:f1169.
  3. Teale GR, Cunningham CE. Vitamin D deficiency is common among pregnant women in rural Victoria. Aust NZ J Obstet and Gynaecol. Published online 1 April 2010
  4. Carr DB, Gabbe S. Gestational diabetes: detection, management, and implications. Clin Diabetes 1998;16(1):4
  5. Buchanan TA, Xiang AH. Gestational diabetes mellitus. J CliniInvest 2005;15(3):485-491.
  6. Kelly L, Evans L. Messenger D. Controversies around gestational diabetes. Medecin de famille canadien 2005;5:688-695
  7. Sung CC, Liao MT, Lu, KC, et al. Role of vitamin D in insulin resistance. J Biomed Biotechnol 2012:634195.
  8. Thorand B, Zierer A, Huth C, et al. Effect of serum 25-Hydroxyvitamin D on risk for type 2 diabetes may be partially mediated by subclinical inflammation; Results from the MONICA/KORA Augsburg study. Diabetes Care 2011;10:2320-2322.
Jacky Dixon
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