Gestational Diabetes

May 17

Gestational diabetes is elevated blood sugars in pregnancy. This can be due to physiological factors of pregnancy or someone who came into pregnancy with elevated blood sugars and found it through gestational diabetes testing.

In pregnancy our insulin production changes and we become ‘insulin resistant’. This is a physiological change that helps shunt glucose to the baby making sure the baby receives enough - this was most helpful back when we didn’t have consistent access to carbohydrates.

Insulin is a hormone. It is the key that unlocks the door of the cell so the glucose (sugar) can enter the cell and be utilized. In pregnancy you produce more insulin in order to overcome the fact that later in pregnancy the body will be more insulin resistant. Meaning it takes more insulin (keys) to unlock the same doors of the cell to keep blood sugars within a healthy range.

If all adaptations go as planned this is no big deal, you still maintain blood sugar in a healthy range. The body is just doing so with higher levels of insulin.

Why you’ll be offered testing: Glucose crosses the placenta but insulin doesn't. So the baby’s pancreas has to produce its own insulin to handle the glucose (sugar) coming from mom. If the glucose is often elevated the pancreas can become stressed from making excess insulin - this changes the baby’s metabolism and turns on genes that increase the chance of: type 2 diabetes, obesity, and heart disease.

Some of the Possible outcomes for mom with unmanaged gestational diabetes:

Increases the chance of type 2 diabetes in the future.
Increases the chance of developing high blood pressure.
Increases the chance of developing preeclampsia.

Some of the Possible outcomes for baby with unmanaged gestational diabetes:

Genes get turned on that increase the chance of: type 2 diabetes, obesity, and heart disease.
Babies growing in a high glucose environment put on weight in an uneven way - usually around their chest and abdomen. This increases the chance of shoulder dystocia and birth injury.
The baby will continue making excess insulin after birth which can cause hypoglycemia and a need for interventions after birth.

The good news: These undesirable outcomes can be avoided by getting the blood sugars back within normal range.

If we know someone has gestational diabetes the majority of time it can be managed with adjusting diet, movement and sometimes supplements. Rarely, a person will need insulin injections to manage gestational diabetes and in this case the birth would typically be moved to the hospital because blood sugars can be tricky to manage in labor and immediate postpartum.

Early Testing options:

Hemoglobin A1c can be added to the prenatal blood panel at or before 13 weeks to see the average blood sugar level for the last 3 months. This helps us see if someone is coming into pregnancy with blood sugar instability and gives us ample time to bring blood sugar levels back to normal ranges.

HgbA1c of 5.7 - 6.4% is considered ‘pre-diabetic’. anything >5.7% is considered gestational diabetes

HgbA1c of 5.9% or above have 3x rate of macrosomia (large baby) and preeclampsia

HgbA1c of 5.6% of below is considered normal or ‘not diabetic’

Random Glucose Screen - This is a blood draw that can be done any time to see the glucose levels within the blood. This gives us a ‘snapshot’ of someone's blood sugars and can be helpful is we missed the opportunity for an HgbA1c and want a sense if someone is coming into pregnancy with unstable blood sugars.

Around 24 to 28 weeks you will be offered gestational diabetes testing:

Glucometer at home: blood sugars are checked in the morning (fasting number), one hour after eating and two hours after eating. This is done for four days to a week straight, on your regular diet, then the numbers are shared with the midwife.

The midwife will look at the numbers and together you will come up with a plan. Depending on the numbers, further checking may be done only at certain times after eating while we work on getting the blood sugars within normal. If someone has gestational diabetes, they may need to test often throughout the rest of pregnancy while working on getting the numbers within range.

We are looking for 80% of the fasting numbers to be within range and 80% of all the other numbers to be within range to know the body’s adaptations to insulin resistance is working well.

Ideal ranges:

Fasting: 90-95 mg/dl or less

1 hour after first bite of meal: 130mg/dl or less

2 hours after first bite of meal: 120mg/dl or less

Glucose 50gm Challenge screen: tests the body’s blood sugar response to a large amount of glucose. A special 50gm glucose drink is consumed within 5 minutes and the midwife or the lab draws your blood one hour later. I have a dye free glucose drink available or you can order your own 50gm glucose powder through Fresh Test.

This is a screening, so if a person doesn’t pass they move on to a glucometer at home or the fasting 100 gram 3-hour diagnostic test at the lab.

Ideal range 130mg/dl or less