Mamarama: Gestational Diabetes Impact on You and Your Baby
With more than 18 percent of American children being categorized as obese* and about two-thirds of all Americans classified as overweight or obese, we are in a national health crisis. Women, even before pregnancy, have the ability to change the course of their own health and that, in turn, impacts their baby’s health.
There is a great deal of research pointing toward the period of infancy and the prenatal environment that indicates a risk-factor for obesity in childhood and later life. At the top of the list is gestational diabetes (any abnormality in blood sugar during pregnancy) that can impact pregnant women at any weight. However, we do know that if a woman is overweight or obese as she enters pregnancy she is at higher risk for developing this common metabolic condition. Though gestational diabetes can be treated with an adjustment in diet and sometimes with insulin, it also can lead to preeclampsia (abnormally high blood pressure) and create serious complications for mother and baby. Many women consider gestational diabetes to be a temporary condition that is immediately resolved once they deliver their baby; however, it’s worth noting that you’re not entirely out of the woods once you are no longer pregnant.
Doctors are starting to look at mothers who are overweight and with high body mass indexes (BMI) as a starting point for recognizing potential weight problems for her baby as well. Dr. Matthew Gillman, Pediatric Preventive Cardiologist at Harvard Medical School stated in the HBO documentary Healthy Mom, Healthy Baby that there are three basic reasons why an overweight mom contributes to an overweight child. “Obese women give their genes to their kids and there are clearly some genes that are related to obesity. Then there are environmental factors; an obese mom means probably more fast food and sugary drinks in the diet. She becomes a role model and giver of these poor eating habits. Lastly, what is the environment of the fetus that is responding to the mother’s cues and how does that give rise to these long term risks?”
This usually comes as a surprise to most women who do not think their own weight might impact their child negatively. When women consider their weight as it relates to pregnancy, it’s usually relating to the superficial concerns, as in, “I don’t want to get too big in pregnancy, then I have more weight to lose afterward.” It’s clear that weight and BMI are important considerations for just how much weight is healthy to gain during any pregnancy, and how those two issues contribute to maternal health. When a woman is pregnant and visiting her obstetrician it’s unlikely that they will have a lengthy discussion about nutrition and her eating habits, regardless of her pre-pregnancy weight.
“One of the BIGGEST failures in the modern obstetrical system is that there is absolutely no emphasis on nutrition,” said Bonu deCaires, a birth doula and educator with a masters degree in nutritional science. “The vast majority of women will have zero discussions with their care providers about nutrition in pregnancy. Even if obstetricians do not feel qualified to discuss nutrition they should refer every patient to a nutritionist for a couple of sessions early in pregnancy.”
At about week 24-28 all women will have a glucose tolerance test that will determine if she’s having trouble with her blood sugars. Even for those who do not have a strong family history of obesity or diabetes, or those who they feel they are at a comfortable weight, the tests may say otherwise. Based on your weight and BMI you might be instructed to gain as little as 11-20 pounds during the course of your pregnancy. The studies indicate that coming into pregnancy at an ideal weight cuts down your risk of developing gestational diabetes. Basically, the notion of “eating for two” is misleading and unnecessary. You’re essentially eating for 1.1.
“The basic advice is to be aware of carbs, figure out how your body varies in blood sugar levels over the course of the day and spread carbs out over the day,” Bonu advises. “Eat whole grains and don’t eat a ton of fruit.” Bonu says she often finds women are eating large amounts of fruit in pregnancy as a “healthy” way to satisfy sugar cravings; but too much sugar, even from a fruit source, can have a negative effect on blood sugar.
Remember that just walking for twenty minutes a day can be an attainable goal for most women and will go far in helping manage weight. Introducing more complex carbohydrates, more vegetables and more protein also contributes to maintaining a healthy diet. For many women, loading up on everything they are craving during pregnancy can have serious ramifications. All the white starchy carbs are doing you (and your baby) no benefit. This includes potatoes, rice, white bread, pasta and all sugary snacks. If diet and exercise do not work to maintain blood sugar levels, insulin will need to be introduced in addition to maintaining a low-carb diet.
Gestational diabetes also has long term implications for mothers and their babies – both need to be watched for the development of type 2 diabetes as well. You stand a 35-60 percent chance of developing type 2 diabetes within 10 years after giving birth if you had gestational diabetes, so doctors will recommend a postpartum glucose tolerance test. Even modest weight loss can reduce the future risk of risk of developing type 2 diabetes by more than 50 percent. If you had gestational diabetes in your first pregnancy you are also more likely to have the condition in your second pregnancy. However, you can reduce that risk by losing as little as 10 percent of your body weight; that alone can make a difference to avoid repeating the condition in your next pregnancy.
Minimize Risks for Babies
How do we prevent babies from becoming obese or developing diabetes? The growth chart at the pediatricians office is a good place to start. A baby falling in the 85-95 percentile is considered overweight – over 95 is considered obese for a baby. The faster a baby gains weight the more likely he or she is to become overweight later. You may have also heard that “breastfeeding is best” and that the American Academy of Pediatrics recommends exclusive breastfeeding for 6 months, then combined with solids for a year. In the earliest weeks and months of life, mothers can make the biggest difference in changing an unhealthy trajectory simply by breastfeeding. Children are at risk for being overweight or obese when they are also introduced to solids early (combined with formula usage) as well as offered too much juice and fast food. Babies learn “self-regulation” when they are breastfeeding. Coming off the breast when they are full is typical of a breastfed baby, where it isn’t as easy to do with those who are bottle fed.
For more information on Gestational Diabetes, visit the American Diabetes Association website.
* Source: Centers for Disease Control & Prevention: Childhood Obesity Facts