Gestational Diabetes: What Can We Do?

Written By: Grace Keane; SLU Dietetic Intern

        There is a greater focus now more than ever on healthy conceptions, pregnancies, and births across the United States. However, even with this increased attention to healthy pregnancies, the number of cases of gestational diabetes, also known as GDM, is on the rise. According to the CDC, the rate of GDM diagnosis went up 30% from 2016 to 2020. To put that into perspective, that’s about 91,607 more pregnancies that qualified for a diagnosis of GDM in 2020 than in 2016! The reasonings for this increase are unstudied, but it’s likely thought to be connected to the increase in processed food intake during this time frame and the rise of the obesity epidemic.

What is GDM?

        Before we can talk about what we can do about GDM, we have to talk about what it is. Gestational diabetes is defined as “any level of the early of first detection of glucose intolerance in pregnancy” by the World Health Organization. In other words, GDM is when your body cannot efficiently use the carbohydrates you are consuming during pregnancy. This is normally diagnosed in the second trimester.

        Normally, when we eat things with carbohydrates or sugar, our digestive system breaks them down into smaller sugar molecules which are transported into our bloodstream. From here, our pancreas releases a hormone called insulin. Insulin attaches itself to our cells, which allows the sugar molecules to enter into the cells. These sugars are then used as energy sources. In GDM, there is a problem with how insulin interacts with the cells, so much of the sugar stays in the bloodstream. This sugar is passed through the placenta to the baby. To combat these high sugar levels, the baby’s pancreas is going to secrete a lot of insulin. This causes the baby to grow at a faster rate than we want and for the baby’s pancreas to become used to releasing a high level of insulin all the time. Both of these things put both mom and baby at risk for complications during pregnancy, at birth, and postpartum.

How do you treat GDM?

        There are many treatment options for gestational diabetes. While you cannot “cure” if diagnosed during your pregnancy, you can manage it to a point that the risk for complications is low. Below are many treatment options that, when used in various combinations or sometimes by themselves, can control GDM.

• Working with an interprofessional healthcare team
• This should be a standard for anyone diagnosed with GDM. Your team may include doctors, nurse practitioners, dietitians, nurses, certified diabetes educators, or many other healthcare professionals. This can help ensure that you and your baby have the safest possible outcomes and are cared for from all angles. While the other treatments below are options, your medical team will decide what is best for you and your baby.
• · Monitoring your blood sugar
• While monitoring your blood sugar won’t treat GDM, it can help you be aware of what is affecting your levels. Foods that have carbohydrates and sugar—such as bread, pasta, rice, fruits, starchy vegetables, dairy products, desserts, regular sodas, and much more—will cause your blood sugar, also known as blood glucose, to rise. You can watch these changes using a monitor prescribed by your medical team. As a rule of thumb, you want to check your blood sugar four times per day: when you wake up and one hour after each meal. The goal is to have your first reading of the day to be below 90 mg/dL, and the others to be below 130 mg/dL. Keeping track of these readings will help your healthcare team come up with an effective treatment plan for you.
• Eating a balanced diet
• Eating a diet balanced with carbohydrates, protein, fruits, veggies, and dairy is good advice for almost anyone. This is no different with GDM. However, we do want to pay attention to serving sizes and the proportions of our food groups. At each meal, it’s best to have about two servings of carbohydrates along with your protein and non-starchy vegetables. Check above to see foods that count as carbohydrates! This will help deter a large spike in your blood sugar, as can happen when we eat carbohydrate-heavy meals. You may hear this method referred to as the “consistent carbohydrate diet”. While diet can be a scary word for some, it’s not meant to restrict your food intake! It’s meant to keep your carbohydrates, and therefore blood sugar, steady throughout the day.
• Another method is called the “low glycemic index diet”. With this strategy, instead of managing your carbohydrates throughout the day, you avoid specific foods that will cause the biggest spikes in blood sugar. This tactic is not completely validated for GDM yet, but there is plenty of research happening now that suggests it can be just as effective!
• Exercising
• When someone works out, their muscle cells use a much greater amount of sugar than they do at rest. This can reduce the extra sugar in your bloodstream before it’s passed down to your baby. Exercise doesn’t need to be intense to be effective. A walk around your neighborhood or a park is also effective! Make sure you’re cleared with your medical team to exercise before making any sudden changes to your routine.
• Taking medications
• Some providers may start you on medications for GDM at the diagnosis, while others may wait until later in the pregnancy or not prescribe them at all. This is based on many factors and is tailored to the individual patient. Some common medication names you may hear are Metformin, Levemir, Lantus, Humalog, or Novolog. While these have different mechanisms of action, they all have one goal: to decrease your blood sugar, thereby decreasing your baby’s blood sugar. If prescribed one of these, you should take it exactly as directed by your medical team.

        Overall, more and more pregnancies are being affected by gestational diabetes. But that doesn’t mean there’s nothing we can do. There are many strategies available to combat GDM and lead to a healthy and happy pregnancy, delivery, and life for you and your baby.

Sources

        Nguyen, Thinh Phu. “What's a "High-Risk" Pregnancy? (for Parents) – Nemours KidsHealth.”                Kids Health, 2022, https://kidshealth.org/en/parents/high-risk.html.

        Choudhury, Abbas Alam, and V. Devi Rajeswari. “Gestational Diabetes Mellitus: A Metabolic and         Reproductive Disorder.” Biomedicine and Pharmacotherapy, vol. 143, no. 1, 2021, pp. 122-183.            Science Direct, https://doi.org/10.1016/j.biopha.2021.112183.

        Gregory, Elizabeth C. W., and Danielle M. Ely. “Trends and Characteristics in Gestational                    Diabetes: United States 2016 - 2020.” National Vital Statistics Report, vol. 71, no. 3, 2022, pp. 1-           9. CDC, https://www.cdc.gov/nchs/data/nvsr/nvsr71/nvsr71-03.pdf.

        Moses, Robert G., et al. “Can a Low-Glycemic Index Diet Reduce the Need for Insulin in                        gestational Diabetes Mellitus?: A randomized trial.” Diabetes Care, vol. 32, no. 6, 2009, pp. 996-           1000. American Diabetes Association, https://doi.org/10.2337/dc09-0007.