Gestational Diabetes - Is it an Issue?

Gestational Diabetes or GD is a “syndrome with no risks to mother or baby, and with no symptoms, other than the increased chance of growing a larger than average baby.” -Gail Hart

There is no consensus on GD in pregnancy. Many think it is something that happens depending on the weight of the pregnant person, some say it is just what happens to some people, and others believe that it isn’t real. There are so many variables, and no one truly understands why it happens.

GD is tested around 28 weeks of pregnancy with a drink called Glucola. It has more sugar than most eat in a day, and then your blood is taken 1-4 hours after you drink it, depending on which test you are taking. The level of glucose in your blood tells them how likely it is that you have GD. If your glucose value is above 140 after one hour, you have to take the three hour test, and if it is too high with that test, you either move to a four hour test or are labelled as having gestational diabetes. Once this happens, you are placed on a special diet to help control your glucose levels, and will most likely be induced early to prevent a larger than average baby at birth.

Midwives are torn on this. The research shows that macrosomia (big babies) doesn’t happen that often with mothers with diagnosed GD, which is the biggest worry when diagnosed. It is very different from a person that has type 1 or 2 diabetes and is pregnant. 

During pregnancy, your body is slower to digest sugars, so your fasting glucose level is higher regardless of diet. You swing between high and low more often (one cause of morning sickness), and the normal blood sugar levels are higher. In controlled circumstances of daily urine testing, most pregnant people spill sugar several times during pregnancy, which is normal. 

The biggest problem with the GTT (Glucose Tolerance Test) is that the values they are looking for are LOWER than the values given to non-pregnant people. As stated, your sugar levels are higher in pregnancy as a baseline, so why are they looking for lower levels than pre-pregnancy??

In addition, ACOG says that low risk category women do not need to be screened:

  • Under 25 years old

  • Not “morbidly obese”

  • No family history

  • Not a high risk ethnic group

HOWEVER, even if GD is found, all it is “preventing” is a baby larger than 9 pounds. And even when you are diagnosed with GD, you have a 70% chance of having a baby less than nine pounds, regardless of diet change or insulin use.

Gail Hart theorizes that GD is not a high risk condition, especially if based on failed GTT alone, but in cases where they are having sugar issues in pregnancy, the mother probably was diabetic BEFORE but didn’t notice until the extra strain of pregnancy. 

Just because GD doesn’t have symptoms, doesn’t mean that someone with diabetes before pregnancy won’t as well. If they have diabetes mellitus and don’t know, they will have symptoms of:

  • Excessive weight loss or gain

  • Extreme thirst

  • Poly-uria (increased frequency and amount of urine)

  • Glycosuruia (sugar in urine)

  • Ketonuria (ketones in urine)

  • Possible cardiovascular symptoms (leading to high BP)

  • In pregnancy:

    • Fundal height large for dates

    • Baby will be large for dates

    • Excessive amniotic fluid (hydramnios) is common

A study in Seattle has shown that vitamin c serum levels affect the levels of glucose in the blood, and may affect the development of gestational diabetes. 

Someone that barely fails the GTT is also put in the same category of Gestational diabetic same as someone who massively fails the GTT. There is no variance to the label of GD. As Gail puts it, “a temperature of 100.5 is a fever, right? But should we treat the woman with a temperature of 100.5 the same as we treat a woman with a temperature of 105?” That is how GD is treated, anyone that fails the GTT, regardless of how much they are above the limit, are treated the same way in pregnancy, even if they are in fact not diabetic in that pregnancy.

There are alternatives to the GTT:

  • 28 jelly beans and then a blood draw after one hour

  • Other sugary foods, as long as they equal the amount in the glucola

  • Using a glucometer yourself to test your fasting, 1 hour and 3 hour levels

  • If there are no risk factors of diabetes or GD, simply know what the symptoms are and follow up if any occur

There is still not much known about GD, why it happens, who it happens to, and if it is truly a condition of pregnancy. 

Resources:

Gail Hart - Research Updates for Midwives

Cochrane database

Kayce PearsonComment