What is Gestational Diabetes?
In a nutshell, Gestational Diabetes (GD) is a label applied when a pregnant person’s Blood Glucose Levels (BGL) are higher than “normal”. Regardless of your general health or existing risk factors for developing GD, you will likely be asked to take a test around the midway point in your pregnancy (you know the one we’re talking about - the “dreaded” and somewhat controversial orange drink you’ve likely heard about from your friends?) What they are testing for is to see how quickly your body is able to work to bring your blood sugar levels back down to a normal range after shocking your system with a huge sugar bump.
What does having GD mean, exactly?
Around the 20th week of pregnancy, your placenta starts releasing hormones that cause some level of insulin resistance in your cells (ie. the insulin naturally produced by your body cannot absorb the excess glucose from your blood as easily because the cells have become resistant to insulin). When this happens, the body starts producing more insulin to capture as much excess glucose as possible, but sometimes the body can’t keep up. When this happens, there is an excess of glucose in your blood and you may be labelled as having Gestational Diabetes. The good news is that this condition is temporary and will typically resolve itself after you give birth to your beautiful baby! However, while you are pregnant, there are some things you should know about the label of Gestational Diabetes and some of the choices you may have to make in the coming months.
How can having high BGL affects me and my baby?
When a pregnant person has high BGL continuously during pregnancy, there is an increased risk of the pregnant person struggling with high blood pressure, developing pre-eclampsia and possibly Type 2 Diabetes or heart disease later on in life. Because your baby is also receiving some of that extra glucose, their body will bump up their level of insulin production to regulate their own BGLs and after birth, when that extra insulin isn’t needed, baby could have some trouble regulating their BGL while glucose and insulin levels balance out. If the high BGLs are not managed well, there is an increased risk of preterm or complicated birth as well.
One of the biggest concerns that people (including health care providers) have when GD comes into the picture of the potential of having a “big baby”. While it is possible that a bigger baby could mean a tricky birth due to shoulder dystocia or a possible cesarean section, it is certainly not a foregone conclusion! Yes, when babies are getting more glucose during gestation they do tend to get a bit chunkier, especially in the upper body, but there is no reason to panic. People give birth to “big” babies (what does “big” even mean?) all the time! If you have high BGLs or have been labelled as having GD, make sure you take some time to read up a bit on this issue because your care provider will almost certainly have concerns and you will want to be an informed participant in an important conversation!
For more information on Gestational Diabetes, “big babies” and inductions check out this great post over at Evidence Based Birth Does Gestational Diabetes Always Mean a Big Baby and Induction?
So, if I am labelled as having Gestational Diabetes, what does that mean for my pregnancy and birth?
For most people, managing Blood Glucose Levels and having a healthy and happy pregnancy is totally achievable with a little extra self-care and good communication with your health care team throughout your pregnancy. Having Gestational Diabetes does not mean you are sick or that you cannot physically have the birth you have envisioned for yourself.
Advocating for evidence based care (as opposed to routine care) will be very important if you are hoping to have a vaginal birth or to avoid an induction because, unfortunately, many care providers feel the risk of a “big baby” outweighs the risks of induction or cesarean birth, even though the evidence does not necessarily support that conclusion.
The reality is that once you have been labelled as having Gestational Diabetes, even if your BGLs are within normal limits after the initial “diagnosis”, you will be faced with limitations on when and where your care providers are comfortable with you giving birth. Giving birth at home is often ruled out as an option (though not always - so if this is a goal make sure to you advocate for yourself) and inductions or planned cesareans become part of the conversations you will be having with your team as they work to reduce documented and perceived risks to you or your baby.
Keep the conversation going with your healthcare providers about what their concerns are and above all, ask for evidence based information to help you decide how you would like to move forward with your birth.
What can I do to take care of myself and regulate my BGLs?
Depending on how high your BGLs are, you will be able to help regulate your levels through diet, exercise, oral medications or insulin. There is some evidence to suggest that, if medication is needed, managing BGLs with oral medications in place of insulin may reduce the risk of your baby having low-blood sugar after birth (for more see Cochrane review here) . One more thing to add to your list of questions when you talk to your doctor or midwives!
Whether or not medication is required, connecting with a dietitian to help you meal plan in a way that will keep you happy and healthy is a great idea and will take some of the guess work out what can seem like a big life change. If you are reading this blog post and are from the Peterborough, ON like we are, you can check out this great list of Registered Dietitians in our area to get started.
Your body. Your baby. Your birth!
Finding out that you have Gestational Diabetes is probably not the news you were hoping for but it isn’t necessarily bad news. You can have a happy and healthy pregnancy - we promise! Ask questions, work with your healthcare team to get the care that you want, and remember when it comes to birth it is your body and your baby and you are the one calling the shota!