Bittersweet

Being diagnosed with gestational diabetes can be a shock, but it could also turn out to be a long-term boon for you and your baby.

gestational-diabetes-pregnant_0.jpg

Besides being an “older” mom, Cecilia Paetsch had no risk factors for gestational diabetes mellitus (GDM, or high blood sugar during pregnancy). “i thought it was really only a concern for obese women, and my weight wasn’t an issue,” says the 35-year-old attorney from Northbrook, Ill. “I was also pretty conscientious about what I ate, and somewhat consistent about exercise, so I figured i was in the clear.” Paetsch’s pregnancy was normal and routine—until she was diagnosed last year with GDM at week 25.

Paetsch is one of a growing number of women being diagnosed with GDM, which the U.S. Centers for Disease Control and Prevention reports now affects 2 percent to 10 percent of expectant women. in 2011, the American Diabetes Association endorsed lowering the threshold for diagnosis, but most OB-GYNs are still utilizing the old standard. If the proposed new criteria are used, the number of women diagnosed with GDM could jump to 18 percent—nearly 1 in 5, says Mark Landon, M.D., chairman of the department of obstetrics and gynecology at the Ohio State University Wexner Medical Center in Columbus.

GDM develops when hormones from the placenta compromise a woman’s ability to use the insulin produced by her pancreas. Though most women compensate by producing extra insulin to break down glucose (blood sugar) for energy, some can’t; their excess glucose builds up in their blood and passes through the placenta to the fetus. Recent studies indicate GDM can have long-term consequences for mothers and children and that it poses risks at lower blood-sugar levels than previously thought, says Landon, the lead author of a large 2009 study published in The New England Journal of Medicine that demonstrated clear benefits to treating even mild cases of GDM.

Are You At Risk?

You are at higher risk for gestational diabetes if you:

> Are black, Hispanic, Asian, Native American or Pacific Islander

> Are older than 25

> Have a family history of type II diabetes

> Have a personal history of prediabetes or gestational diabetes

> Have had a very large baby or a stillbirth in a previous pregnancy

> Have a prepregnancy body mass index (BMI) of 30 or higher (Calculate your BMI). Note: Only 50 percent to 60 percent of women diagnosed with GDM are overweight, indicating that it can develop because of a genetic predisposition or other factors;

> Gain excess weight in your first trimester, especially if you start your pregnancy overweight

> Drink five or more sugar-sweetened sodas a week before conceiving

> Have gum disease

> Are a frequent snorer.

Long-Term Risks To Moms And Babies
In many pregnancies affected by GDM, the baby absorbs the mother’s glucose and grows bigger than he or she should, and a Cesarean section is often necessary. in others, the baby is underdeveloped and has a low birth weight. Babies born to mothers with GDM may also have problems with breathing, low glucose levels or jaundice. After delivery, the mom’s blood sugar levels typically revert to normal, but according to a study of nearly 10,000 mother-child pairs, this may not be the end of the story for either mom or baby.

Researchers at Kaiser Permanente Center for Health Research in Portland, Ore., and Hawaii found that the higher a mother’s blood sugar was during pregnancy, the more likely her baby would be overweight by age 7. “Quite a few studies have shown that if you’re overweight at ages 5 to 7, you’re much more likely to be overweight as an adult,” says endocrinologist Teresa Hillier, M.D., the study’s lead author. Hillier found an increased risk of childhood obesity even among GDM babies who weren’t large at birth. “To me, that suggests something has been metabolically changed that allows the baby to more easily store fat,” she says.

Among women diagnosed with GDM, 50 percent will develop type II diabetes within five to eight years, and 70 percent to 85 percent will develop the disease during their lifetimes, says Boyd E. Metzger, M.D., a professor of medicine and endocrinology at Northwestern University Feinberg School of Medicine in Chicago. The National Diabetes Education Program and the American College of Obstetricians and Gynecologists recently joined together to state that women who have GDM (as well as their children) should be followed closely after childbirth to monitor—and minimize—their risk of developing diabetes.

In addition, a 2012 study published in the journal Circulation found that having had GDM boosted a 50-year-old woman’s 10-year heart disease risk by 26 percent. Researchers suggest that women with GdM might need to have their blood pressure as well as their blood sugar checked more regularly as they get older.

Diet And Exercise Can Help
A GDM diagnosis can serve as an early warning, motivating at-risk women to make permanent lifestyle changes. “Even if treatment only delays diabetes by 10 or 15 years, that’s huge,” Metzger says.

Hillier found the risks to children were reduced when women with GDM were treated with diet changes, such as eating fewer sweets and starchy foods, smaller, more frequent meals and more fruits and vegetables; increased exercise; and, if that was insufficient, by adding medication, typically insulin. When women remained untreated, their baby’s risk of being overweight or obese at ages 5 to 7 was nearly twice as high. “But the children of women who were treated for GDM had no greater risk of obesity or being overweight compared with children of mothers who had normal blood sugar during pregnancy,” Hillier says. “This suggests that treating moms during pregnancy gives their babies a fighting chance for a normal metabolism.”

Like Paetsch, Jennie Wolter, 32, was shocked by a GDM diagnosis because she, too, had no obvious risk factors. “But I came to terms with it when I was assured by my health care providers that I could manage the risks and have a healthy baby,” says Wolter, the community relations manager for a nonprofit organization in Sacramento, Calif. in addition to changing her diet with the help of her midwife, a nutritionist, a nurse and a supervising OB, Wolter also credits exercise with helping her avoid having to take insulin. “My team told me that blood sugar could be well controlled by getting some exercise after each meal,” she says. When Wolter delivered her 8-pound, 6-ounce baby vaginally, she was only 15 pounds over her prepregnancy weight—with her caregivers’ blessing.

Paetsch did need to take insulin during her pregnancy, and she credits her diet and exercise changes for feeling better physically at that point than she had in a long time, for weighing about 10 to 12 pounds less today than when she became pregnant and for teaching her a healthier way to live, long-term. “Monitoring my diet was a huge pain at the time, but I learned a lot about how much self-restraint i could actually have,” she says. She also learned she could fit in small amounts of exercise throughout the day and have it count, the way experts say it will. “GDM felt like such a devastating diagnosis at the time,” Paetsch says, “But it was actually a bit of a blessing in disguise.”

Life After Gestational Diabetes
To date, no intervention has been proven to prevent gestational diabetes [GDM],” says Mark Landon, M.D., chairman of the department of obstetrics and gynecology at The Ohio State University College of Medicine. “However, there is evidence that diet, exercise and medication can help women with a history of gestational diabetes avoid developing diabetes postpartum.”

Breastfeeding may help as well. A 2012 study published in Diabetes Care found that women who’d had GDM and were exclusively or mostly breastfeeding at six to nine weeks postpartum had improved fasting blood glucose levels compared with women who were mostly or exclusively formula-feeding their babies. More research is needed to determine if the benefits are long-lasting, Landon says.

Nursing may also help their children. Researchers reporting this year in the International Journal Of Obesity studied children from birth to age 13 whose mothers had any type of diabetes and found that those who’d gotten at least six months of mother’s milk had significantly lower BMIs, smaller waists and less body fat than the offspring of diabetic mothers who breastfed less.

Did you know? Women who ate the most animal fat before pregnancy were 88 percent more likely to develop GDM than those who ate the least. Replacing 5 percent of animal fat with plant foods reduced risk by 7 percent. — National Institutes Of Health And Harvard University Research.

close