Wednesday, March 21, 2018

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Expanding Bellis Mean Growing Concern

Written by  Tina Joyce

Technology, social media, and abundant information make having a healthy pregnancy and preparing a mother’s body for the rigorous road ahead seem easier. However, a lingering concern for some women is whether or not they will develop gestational diabetes.  

It may seem there is no shortage of unsolicited advice given by family members and complete strangers to women trying to become pregnant and mothers expecting their first child. However, there are also many proactive women, like Laura Maher of Richmond, who work to alleviate worry and risk by seeking quality prenatal care.

Laura’s pregnancy was progressing normally, and she was experiencing no precursors for gestational diabetes mellitus. However, at her routine 28-week appointment with Andrew Moore, MD, of Virginia Women’s Center in Richmond, he noticed that her standard gestational diabetes screening was abnormal. This observation prompted a follow-up diagnostic test, ultimately confirming that Laura 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 by a person without diabetes is turned into glucose, or sugar, for the body to use for energy. The insulin-producing pancreas produces the hormone that helps 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 buildup in the blood.1

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 Laura, 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.2

During pregnancy, a woman’s body not only produces more hormones, but her existing hormone levels change. These changes, in addition to other bodily changes such as weight gain, cause her body to use insulin less effectively, thus increasing the need for more insulin.

“When I was first diagnosed [with gestational diabetes], I was overwhelmed knowing there were eating changes ahead. I have a medical background so I also understood the risks involved, maybe more than others,” remembers Laura.

According to the American Pregnancy Association, “Approximately 2-5% of pregnant women develop gestational diabetes; this number may increase to 7-9% 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. Moore explains, “The symptoms of GDM may be difficult to notice at first, but may include: fatigue, excessive hunger, excessive thirst, frequent urination, lethargy, and excessive weight gain. Unfortunately, many of these symptoms are noted in healthy pregnancies, which 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 cause of gestational diabetes, it does offer suggestions for lowering the risk of developing the condition during pregnancy.

Women at risk of developing GDM are those who:

  • Are overweight.
  • Have high blood pressure.
  • Have unhealthy cholesterol levels.
  • Smoke.
  • Are physically inactive.
  • Have unhealthy eating habits.
  • 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.

"If left untreated, gestational diabetes can lead to health and safety issues for mother and baby as well as complicating labor and delivery,” notes Dr. Moore.

The dangers of developing GDM include the risk of large birth weight, premature delivery, development of jaundice, and cesarean birth. Larger birth weight may also lead to delivery risks such as injuries to the shoulders and arms of the infant. Additionally, a woman who develops gestational diabetes has an increased risk of developing type 2 diabetes later in life, as does her child.

“We treat patients with gestational diabetes by starting with a modified diet and exercise, then treating with oral medications, and lastly treating with injected insulin if other methods prove ineffective,” says Andrew Moore, MD, of Virginia Women’s Center.

According to the American Diabetic Association, a healthy meal plan for people with diabetes (including gestational diabetes) is generally the same as a healthy diet for anyone —low in saturated and trans fats, 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 benefits. Most of them still raise blood glucose levels, are usually more expensive, and can also have a laxative effect if they contain sugar alcohols.

At first, Dr. Moore and Laura tried altering her diet and increasing her exercise. When her glucose levels could not be regulated, she experienced large swings from hypoglycemia to hyperglycemia, once resulting in her passing out in the shower. She was very sick. “It became clear after trying diet and exercise regulation that medication was needed,” explained Laura. She opted not to try oral medications but requested insulin injections in an attempt to gain control of her gestational diabetes.

Laura was hospitalized three times before her delivery, due to unstable blood sugar levels. Because of this instability, her healthcare team induced her at 37 weeks. “Toward the end, there was no regulation of my blood sugar. I was going in [to the practice] almost every day to be monitored,” says Laura. “It was either way too high, or way too low.”

Despite close monitoring by Laura’s healthcare team at Virginia Women’s Center, her gestational diabetes was difficult to regulate. She and her husband have talked extensively about the possibility of future children. “We agree, prior to my next pregnancy, we will make sure I am at a healthy weight and I will change my diet and exercise beforehand to help reduce risks.”

A woman looking to improve her own health, as well as the health of her unborn child, should consult with her doctor to discuss steps for implementing a safe plan to achieve long-term results. Women going 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.

Dr. Moore encourages all of his patients to adhere to screening guidelines and to maintain a healthy diet and exercise program throughout their pregnancy. “Gestational diabetes can occur in any pregnant woman, and is a result of complex biochemistry, not a reflection of one’s care for their pregnancy,” he says.

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

“I really appreciate the practice. I had the best care,” says Laura. At six weeks after delivery, Laura’s blood sugar levels have returned to normal, and baby Reagan is flourishing.


Expert Contributor:
Andrew Moore, MD, with Virginia Women’s Center

1 Centers for Disease Control and Prevention:
2 American Diabetes Association:
3 American Pregnancy Association: