In Canada, gestational diabetes mellitus (GDM) is a growing concern: it now affects about 7% of pregnant women. This disease, easily managed with lifestyle changes when caught early, can also be a menace because it often presents with no symptoms. While race, ethnicity and socioeconomic status all weigh in as independent risk factors, research shows that the most significant qualifiers for GDM are older maternal age, body mass index (BMI), and a prior diagnosis of GDM.
So what’s the deal with GDM?
Pancreas, Insulin, and Glucose Metabolism in Pregnancy
Gestational diabetes mellitus (GDM) only occurs during pregnancy. During the second and third trimesters of pregnancy, insulin requirements are more than twice the normal demand. This might be explained by a progressive increase in the production of anti-insulin hormones (placental hormones, cortisol, and other hormones), which are essential to the success of a pregnancy and the health of the fetus and the mother. Under normal circumstances, this resistance to insulin stimulates the pancreas to compensate by producing more insulin. However, in gestational diabetes, the pancreas doesn’t produce this extra insulin and the result is hyperglycemia, or excess sugar in the blood. High blood sugar during pregnancy can lead to:
Risks for the mother
- High blood pressure and preeclampsia
- Miscarriage
- Urinary tract & vaginal yeast infections
- Macrosomia, or babies that are born too big, leading to long labours, birth trauma, increased medical interventions, and Cesarean delivery
- Premature delivery & Low birth weight
- Type 2 diabetes, GDM in future pregnancies
- Postpartum depression
Risks for baby
- Birth defects
- Low blood sugar at birth, which can lead to other problems
- Jaundice
- Obesity
- Respiratory distress syndrome
- Lifelong risk of diabetes
Ideally, blood glucose tests are performed for pregnant women during early pregnancy. This makes it possible for midwives and doctors to monitor women with GDM and to help them manage their blood glucose levels with diet or medication before any problems arise.
Postpartum
Typically, GDM disappears within a few weeks of delivery. However, it does increase the future risk for type 2 diabetes in women and their offspring. GDM itself does not present obstacles to breastfeeding, though women whose bodies are very large may find it challenging, especially if they are also recovering from birth trauma or surgical interventions. Breast milk provides a child with future protection against obesity and diabetes, and women are encouraged to exclusively breastfeed for a minimum of 3 months, though most doctors agree that extended breastfeeding benefits babies and mothers throughout their first year and beyond.
Specials thanks to Christina Moxie for writing this article.
[expand title=”References“]
Nancy A. Melville. Gestational Diabetes a Risk Factor for Postpartum Depression. Accessed March 1, 2017.
US National Library of Medicine National Institutes of Health. Risk factors for gestational diabetes mellitus: implications for the application of screening guidelines. Accessed March 1, 2017.
Canadian Diabetes Association Clinical Practice Guidelines Expert Committee. Diabetes and Pregnancy. Accessed March 1, 2017.
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