Gestational Diabetes: Part 1
Gestational diabetes is a hot topic today. It seems as the incidence of diabetes, obesity, and poor health grow in the modern world, these problems also increase for moms. It's especially concerning for moms who want the most healthy, natural start for their babies. I have hesitated to write on gestational diabetes and other pregnancy complications because they're so emotionally charged. But I've been asked to give my opinions on them, and actually feel it's important to do so.
Remember I'm not a doctor. I'm a mom who is passionate about healthy babies. I also don't believe in being politically correct in any way, shape, form, or fashion. In general I spare you my views on life – but when it comes to birth and babies it's hard for me to sugar-coat things (pun intended :p). I've been criticized in the past for writing bluntly about nutrition and mother-baby health… and I may be again. But you, dear mama, deserve it straight the way I see it. So here it is – I recommend you research for yourself, but this should give you a jumping-off point.
What is Gestational Diabetes?
Gestational diabetes is, by definition, higher levels of blood sugar during pregnancy. In general there are no symptoms other than those found by a gestational diabetes test. I'll talk more about this “test” later.
Gestational diabetes is a controversial diagnosis. There's not a strong correlation between a gestational diabetes diagnosis and poor outcome of pregnancy. This has been shown by extensive meta-analysis done by the Cochrane Collaboration. The Cochrane Collaboration is a respected body that reviews all available research on topics for outcomes. Their work on topics dealing with pregnancy and childbirth is very thorough and accurate.
Insulin resistance in pregnancy is actually normal – women's bodies become resistant so that the glucose a mother takes in won't be stored into her cells. Instead, it stays in the blood stream so that it moves to the baby. Glucose is vital for the baby, so this is a physiological adaptation to ensure that the baby gets what he or she needs. The placenta actually destroys insulin to further ensure that the baby gets what he or she needs.
In the past we didn't get huge amounts of sugar, so this makes perfect sense. The small amounts of sugars in traditional diets needed to go to our babies.
Complications arise when we get massive amounts of sugar. Carbohydrate cravings are normal during pregnancy because the baby needs glucose to grow and develop… the problem is that we now have carbohydrates everywhere. Women are getting a lot more than they did when carbohydrate (remember, all carbohydrates = sugar, including “complex” carbohydrates) sources were not as easy to come by.
Women with a problem such as PCOS almost always go into pregnancy slightly insulin resistant, which can compound the natural effects of pregnancy.
It's also important to note that during pregnancy women store glycogen in the liver. This keeps blood sugar levels stable, and slightly elevated of what may born “normal” for a given woman pre-pregnancy. In fact, work done by pregnancy nutrition researchers shows that it's poorly-nourished women who have no glycogen stores in the liver! These poorly nourished women also had low blood sugar levels between meals.
Testing for Gestational Diabetes
Testing for gestational diabetes is one of the most horrible experiences invented by modern medicine. I am not exaggerating. The main test done is called an “oral glucose tolerance test” and it is a horrific test requiring you to drink a “drink” that's actually a bottle of pure glucose after an overnight fast of 8-12 hours.
Many women have horrible responses to this test, including nausea, vomiting, and dizziness. Many say their babies go from moving and kicking to being completely still, or begin moving frantically. It is scary and completely unnatural.
One hour after the drink is consumed your blood sugar is tested. If your levels are above the normal range you're required to take the three-hour test. The three-hour test includes the long overnight fast, then a repeat of the one-hour test with levels drawn at 1, 2, and 3 hours. If your levels are high at any time during the test, you are labeled as having gestational diabetes. In general, these are the levels looked for:
- 1 hour level less than 180 mg/dl (10 mmol/L)
- 2 hour level less than 155 mg/dl (8.6 mmol/L)
- 3 hour level less than 140 mg/dl (7.8 mmol/L)
It's interesting to note that these “acceptable” levels have continuously been dropped over the past few decades, even for pregnancy women who physiologically have a higher insulin resistance. In fact, the fact that a pregnant woman's body is not considered any different from that of a non-pregnant woman is a cause for concern.
It is also important to note that a woman is advised to eat a diet of at least 150 grams of carbohydrate daily before the fast and the test. If a woman normally eats a low carbohydrate diet that includes less than this her test results will most likely be skewed. Please also be aware that a woman (or man) following a low carbohydrate diet typically has slightly higher fasting blood glucose levels than somebody eating a modern level of carbohydrate.
Other factors may return false positive results with this test (besides the noted fact that it's a completely artificial situation, and that pregnant women normally have slightly elevated levels of blood glucose/insulin resistance). Remember the glucose tolerance test is a horrible test. Most women experience significant stress going into the test and especially during the test. This triggers a “fight or flight” response which causes the body to release adrenaline. Adrenaline surges trigger glycogen release from the liver to provide extra energy – so your body generates even more of a blood sugar surge than just the drink.
Other options for testing include post-prandial testing, which is testing done after meals using a blood glucose meter, and the A1C test, which analyzes blood glucose levels over a 3-month period.
The post-prandial test is a good option for women who want to get a true picture of what their blood glucose levels are doing during their normal daily lives. Many midwives are open to this option, and even doctors and fetal medicine specialists are usually willing to use this system to get a true picture of what blood sugar levels are doing. Monitor your blood glucose at agreed-upon intervals and keep your care provider up to date with what your levels are.
More to Come
Since this article is already getting long, I'm going to break it up into a two-part series. In the second part I will discuss how to manage gestational diabetes – what conventional medicine does and possible alternatives for mothers who have gotten a diagnosis.
I am also going to introduce you to an awesome mom who had severe gestational diabetes in her first four pregnancies and is handling her fifth pregnancy with a specific diet and one oral medication while working together with a fetal medicine specialist. Even her specialist thinks she's doing an awesome job!