Monday, January 22, 2018

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Expanding Bellies Mean Growing Concern

Written by  Tina Joyce

Technology, social media, and the abundance of available information make having a healthy pregnancy and preparing your body for the rigorous road ahead seem easier. However, a lingering concern for some women is whether they will develop gestational diabetes.  

It may seem like there is no shortage of unsolicited advice given by family members and complete strangers to women who are trying to become pregnant or to mothers who are expecting their first children. However, there are many proactive women, like Jennifer Fariss of Roanoke, who try to alleviate worry and risk by seeking well-respected prenatal care.

Jenny’s pregnancy was progressing normally; while diabetes is very common on her mother’s side of the family, she experienced no precursors of gestational diabetes mellitus. However, at a routine prenatal appointment, Margaret Grove, MD of Physicians to Women in Roanoke noticed that Jenny’s standard gestational diabetes screen was abnormal. This observation prompted a follow-up diagnostic test, ultimately confirming that Jenny did indeed have GDM.

Diabetes is a condition in which the body does not properly process food for use as energy. Most of the food eaten is turned into glucose (sugar) for the body to use for energy. The insulin-producing pancreas makes the hormone to help glucose penetrate the cells of the body; it also helps manage blood sugar levels. When a person has diabetes, the body either doesn’t produce enough insulin or cannot use its own effectively, causing a sugar build-up in the blood.

There are two types of diabetes, type 1 and type 2. Type 1 diabetes is caused by genetics and other unknown factors; type 2 is caused by genetics and lifestyle. Like Jenny, pregnant women who have never had diabetes before but who have high blood glucose (sugar) levels during pregnancy are said to have gestational diabetes mellitus.

During pregnancy, a woman’s body not only makes more hormones — her existing hormone levels change. In addition to other body changes such as weight gain, these alterations cause her body to use insulin less effectively, thus increasing the need for more insulin.

After receiving the diagnosis of gestational diabetes, Jenny remembers, “I was terrified — especially when receiving information regarding how my baby could be affected. I attended a class on gestational diabetes and was also shocked to realize that the ‘healthy’ food items I was eating were actually helping to contribute to my high sugar levels. I craved peaches and fruit throughout my pregnancy and naively thought I was eating healthy for my baby and myself. Learning the amount of sugar found in some fruits shocked me. After that class, I was able to control my blood sugar levels through diet, which was very fortunate.”

According to the American Pregnancy Association, “Approximately 2-5 percent of pregnant women develop gestational diabetes; this number may increase to 7-9 percent of mothers who are more likely to have risk factors. The screening for this disease usually takes place between the 24th and 28th week of pregnancy. Doctors test for gestational diabetes during this time because the placenta is producing large amounts of hormones that may cause insulin resistance. If the results indicate elevated levels, further testing would be done to confirm a gestational diabetes diagnosis.”

Dr. Grove explains, “Some women have no noticeable signs or symptoms and are very disappointed once they screen in.” This is why it is important to adhere to the screening recommendations of your healthcare provider.

Although the American Diabetes Association confirms that professionals do not know the exact causes of gestational diabetes, they do offer suggestions to lower the risks of mothers developing the condition during pregnancy.

Women are at risk of developing GDM if they:

  • Have a BMI greater than 30;
  • Have high blood pressure;
  • Have unhealthy cholesterol levels;
  • Smoke;
  • Are physically inactive;
  • Have unhealthy eating habits; and/or
  • Are of certain ethnic backgrounds.

Women can greatly reduce their risk of developing GDM by improving their daily habits prior to becoming pregnant. Being more active and quitting smoking are two low-cost initiatives that not only improve a woman’s own health, but also the health of her unborn baby.

The dangers associated with GDM potentially include increased infant birth weights, increased likelihoods of premature delivery and cesarean births, and the development of jaundice. Larger infant birth weights can also lead to delivery risks, such as injuries to the baby’s shoulders and arms. Additionally, a woman who develops gestational diabetes has an increased risk of developing type 2 diabetes later in life, as does her child.3

“We first treat a patient diagnosed with gestational diabetes in a non-pharmaceutical manner. We send her to a registered dietitian to discuss carbohydrate intake and modifications to diet and exercise,” says Dr. Margaret Grove of Physicians to Women.

According to the American Diabetic Association, a healthy meal plan for people with diabetes (or gestational diabetes) is generally the same as a healthy diet for anyone – low in saturated and trans fat and moderate in salt and sugar, with meals based on lean protein, non-starchy vegetables, whole grains, healthy fats, and fruit.

Diabetic and "dietetic" foods generally offer no special benefit. Most of them still raise blood glucose levels and are usually more expensive; they can also have a laxative effect if they contain sugar alcohols.

A woman who is looking to improve her own health as well as the health of her unborn child should consult her doctor to discuss implementing a safe plan to achieve long-term results. Women who go into pregnancy with a healthy lifestyle are more likely to return to a healthy weight after delivery in addition to reducing their risk of developing gestational diabetes.

After her pregnancy, it was as if Jenny’s body ‘reset’ on its own. “I am more aware of diabetes for myself now and in the future,” she explains.

Jenny also offers this general advice: “Educate yourself! I was never a ‘sweet eater’; I would rather eat fruit than ice cream or cookies and never could have imagined that I would have gestational diabetes. Unfortunately, I think many others have the misconception that all diabetics are addicted to sweets. And of course, never ignore your diagnosis! It helped to raise my awareness of the importance of diet in your pregnancy and listening to your body.”

It is also important to remember that gestational diabetes results from complex biochemistry and is not a reflection of an expectant mother’s desire to care for her infant or have a healthy pregnancy.

A pregnant woman’s growing belly is a beautiful gift, but it can also lead to increased worry and concern. By working in tandem with her healthcare team during and after her pregnancy, Jenny successfully managed the complications that arose, resulting in the birth of a healthy baby girl named Macy.


Expert Contributor:
Margaret Grove, MD, with Physicians to Women in Roanoke

Center for Disease Control and Prevention,
American Diabetes Association,
American Pregnancy Association,