Pregnancy Problems: Gestational Diabetes Mellitus

So you've been eating a steady diet of Ding-Dongs and angel-hair pasta, and now your doctor tells you you've got gestational diabetes mellitus (GDM). Or maybe you've been following a completely whole-food diet and limiting portions, but your blood glucose was still high at your last exam. Let's face it, even glam goddesses like Angelina Jolie and Salma Hayek (reportedly) developed GDM during their pregnancies.

Either way, don't beat yourself up about it. Between 3 and 5 percent of all pregnant women develop GDM, and rates are on the rise, likely because more women are obese and/or older when they become pregnant. Certain ethnic groups are at greater risk for GDM. Rates are on the rise for diabetes in general (both Type 1 and Type 2) for women of all ages and ethnicities.

So why does diabetes develop when you're pregnant? Those same hormones that the placenta produces to maintain your pregnancy can also interfere with insulin's role in bringing glucose to your body's cells. Even though your body is making more insulin than it did before you were pregnant, sometimes it's not enough to handle all the sugar in your blood, and that creates insulin resistance. If your doctor tells you your blood glucose level is borderline high, a few dietary changes may do the trick. Once my sister dropped her bag-of-gummy bears-a-day-habit, her blood sugar level returned to normal. When my friend Tanya gave up her sugar-smacked Kool-Aid, she too was able to avoid GDM.

You're at greater risk for GDM if you fit into the following categories, but keep in mind that many women who don't have any of these risk factors end up developing gestational diabetes:

• You're of African-American, Asian, Latino, Native-American, Pacific Islander, or South Asian descent.

• You're overweight or obese.

• You're not physically active.

• You have high blood pressure.

• You have high cholesterol (more than 200 total).

• You're carrying multiples.

• You've previously been diagnosed with GDM.

• You have a family history of diabetes.

• You have polycystic ovary syndrome (PCOS).

• You have a history of cardiovascular disease.

• You're age thirty-five or older.

Side Effects/Dangers of Having GDM

Often, a woman won't know she has GDM because she doesn't have any symptoms. But blurred vision, fatigue, frequent infections (like bladder infections), increased urination and thirst, or weight loss despite an increase in appetite are common side effects. Of course, several of these symptoms go hand in hand with pregnancy, so it can be tough to pick up on a change. Your doctor should screen you for GDM between twenty-four and twenty-eight weeks, because a surge in pregnancy hormones during that period can cause insulin resistance. If you have risk factors for GDM, the American College of Obstetrics and Gynecology says you should get tested at your first prenatal visit.

What to Expect

If you are diagnosed with GDM, your doctor will advise you to control your blood glucose with diet. But God bless them, doctors aren't always the most gifted people for communicating nutrition and diet advice. Ask your doctor to refer you to a registered dietitian (RD) who will provide you with specific dietary guidelines.

Here are some basics:

• If you've followed the advice in this book, you're probably already eating small, frequent meals. To better manage your blood sugar, you need to make meals smaller and more frequent to help keep things stable.

• Make an effort to eat a combo of healthy fats, whole grain and high-fiber carbohydrates, and lean protein at each meal. An ideal meal would be a spinach salad with grilled chicken and avocado, or black-bean soup with a small whole-grain roll.

• Add daily moderate exercise to your schedule. Physical activity helps lower your blood glucose levels. Talk to your doctor about how much exercise you should aim for.

• Post-pregnancy, keep up a healthy diet and regular exercise. Many women with gestational diabetes develop full-on diabetes within five to ten years after delivery.

Your doctor should monitor your blood glucose level at each appointment for the rest of your pregnancy, and she may ask you to check it daily at home with a glucose monitor as well. If dietary modifications aren't working well enough to control your blood sugar, you may need to start taking insulin. Also, your doctor may perform an ultrasound and a non-stress test between weeks thirty-eight and forty-two (if you're overdue). The non-stress test reads your baby's heart rate as he's moving in your belly. These tests can be performed as early as the beginning of the third trimester.

Sources:

Lawrence J et al."Trends in the prevalence of pre-existing diabetes and gestational diabetes mellitus among a racially/ethnically diverse population of pregnant women," 1999-2005. Kaiser Permanente study. Diabetes Care 31:899-904, 2008 DOI: 10.2337/dc07-2345.

ACOG Pamphlet on Gestational Diabetes. www.acog.org/publications/patient_edu- cation/bp051.cfm.

National Library of Medicine Medline Plus Gestational Diabetes Fact Sheet. www. nlm.nih.gov/medlineplus/ency/article/000896.htm.