Gestational Diabetes 1 Gestational Diabetes Gestational Diabetes Jordan Trotter The University of Tennessee Nutrition 493, Dr. Kavanaugh Gestational Diabetes 2 There are a variety of health issues that plague American citizens. Due to the fast paced society, Americans are eating on the run and are not conscientiously monitoring their sugar intake. The United States has considerable difficulty controlling blood sugar today, and this is evident in the numerous reported cases of Type I and Type II diabetes. The bodies of those diagnosed with Type I diabetes do not produce insulin. They must take insulin in some form such as in an injection or a pill. According to the American Diabetes Association, “Type I diabetes affects between 500,000 and 1 million Americans…Approximately 17 million Americans have Type II Diabetes” (2005, p.13, 4). Victims of Type II Diabetes produce insulin, but for some reason, their bodies do not utilize the insulin properly and are resistant. These two forms of diabetes are the most common, but there is a third type known as gestational diabetes. This disease affects 2-14% of all pregnant women, and appears around the 24th week of pregnancy. If a woman has high blood sugar while pregnant, she is diagnosed with gestational diabetes. Gestational diabetes can simply be defined as high blood sugar in an expectant mother. (1990, p. 3). Although Gestational Diabetes Mellitus (GDM) has a simple definition, it is a complex disease that alters a mother’s health, affects fetal and infant development, but can be prevented and treated with the use of medication and a good diet. The American Diabetes Association says, “Gestational diabetes develops when a woman’s pancreas is unable to produce enough insulin to cover her body’s needs during pregnancy” (2005, p. 14,15). According to Goer et al. (1991), the disease is defined as a “carbohydrate intolerance of variable severity with onset or first recognition during the present pregnancy.” There are factors that influence this carbohydrate intolerance such as the placenta during pregnancy. “The placenta enables the optimal transfer of nutrients to the fetus and uses hormonal messages to influence maternal physiology. As fetal demand for glucose increases Gestational Diabetes 3 gradually throughout pregnancy, the mother's sensitivity to insulin is reduced” ( 2004, p. 62). When hyperglycemia peaks above the common threshold, the mother is then diagnosed with gestational diabetes. U.S. experts believe the disease is related to fluctuating hormone levels, such as in the hormone Placental Lactogen. This hormone reduces pancreatic functioning in the mother (2006, p. 8). Although hyperglycemia and chaotic hormone levels directly involve the mother, the disease affects both mother and child. The effects can be long lasting, and certain ethnicities and body types are more at risk than others. Mothers are affected in a variety of ways and for different reasons. “Gestational diabetes affects 2-5% of pregnant women in the United States” (2006, p. 8). Those mothers with the highest risk are those who are overweight or obese before or during pregnancy (Henriksen, 2006). Other definite risk factors for mothers are older maternal age, a family history of diabetes, being of an ethnicity with a high prevalence rate, or complications in previous pregnancies (2005, p. 15). Hyperglycemia has a higher risk factor for some mothers more than others. These women with an increased risk include those who had high blood sugar in previous pregnancies, had babies larger than nine pounds, were overweight before pregnancy, or were of Native American heritage (1990, p. 5). There are numerous reasons why mothers and infants are the two people groups affected by gestational diabetes. An upsetting reason is the rise of obesity in mothers. Dr. Tore Henriksen states, “A change in body composition also implies alterations in physiology and metabolism in corresponding proportions of the population. Thus, [obese] women of childbearing age are becoming “diabetic,” with a more “metabolic syndrome-like” metabolism” (2006). These women are becoming “diabetic” because their intake is increasing and their energy expenditure is decreasing. According to Gillen et al (2002, p. 135), the consumption of Gestational Diabetes 4 sugar is increasing worldwide, and carbohydrate consumption correlates directly with insulin resistance. This increase in sugar intake in these overweight women causes their bodies to become insulin resistant, and their pancreas, therefore, stops working (2006, p. 8). Studies of the mother’s own birth weight have shown that mothers with a large birth weight do have an increased risk of gestational diabetes in their first pregnancy (King, 2003, p. 24-5). As previously stated, energy intake increases but energy expenditure decreases in most of the mothers affected with GDM. A lack of exercise is known to increase chances of GDM in mothers, which is the reason it is critical to be active before and during pregnancy (2004, p. 18). There are daunting risks involved for mothers and infants affected with GDM. According to Alive: Canadian Journal of Health and Nutrition, “Women with GDM have a higher risk for diabetes in their next pregnancy and a 40 % greater chance of developing type 2 diabetes later in life” (2004, p. 18). Maternal hypertension preeclampsia and fluid retention is a large risk for mothers with GDM. The American Diabetic Association states, “Preeclampsia is frequently accompanied by swelling, often in the hands and face, headache, blurred vision, and pain in the upper stomach (2005, p. 18). Gillen et al. (2002, p. 135) states that mothers with GDM are more likely to have babies with higher birth weight; therefore, caesarean sections are more common in mothers with GDM. Many hazards are possible with C-sections such as risk of infections, longer hospital stays, and longer recovery time. Urinary tract infections are more common in mothers with GDM, along with Ketonuria, a sickness in which the mother’s placenta is not supplying the baby with enough nutrients. There are symptoms involved with GDM that allow mothers to know they are at risk. The most common symptom in mothers is high blood sugar. If a mother’s blood sugar is above 140 mg/dl, she may have gestational diabetes (2005, p. 16). Gestational Diabetes 5 The infant is subject to dangerous risks, as well. GDM infants often suffer from Macrosomnia, or “a baby that is larger than normal for its developmental age” (Anonymous, 2005, p. 17). Goer et al. (1991, p. 21) says that there are subsequent risks for Macrosomnia infants including a “resultant increase in operative deliveries, birth injuries and birth asphyxia.” Infants are susceptible to hypoglycemia, because the lack of nutrients received from their mother. They are at risk of contracting Jaundice (hyperbilirubinemia) and Respiratory Distress Syndrome (RDS). Also, because the babies are of higher birth weight, they become more susceptible to premature birth. When born prematurely, the lungs may not be fully developed, which results in RDS (2005, p. 17,8). Infants of mothers with GDM have an increased risk of prenatal death, congenital abnormalities, hypocalcaemia (low serum levels in the blood), and polycythemia (Goer, Jones, Weston, Rose, Gillmor, & Hunter, 1991). Polycythemia is a disease in which the proportion of blood volume to red blood cells increases. The threat of a future diagnosis of diabetes in the infant is augmented. Although the risks involved with GDM are grim, there are many preventative measures to protect mothers and infants from contracting this disease. Quality nutrition is crucial in women of childbearing age. Alive: Canadian Journal of Health and Nutrition elucidate, “To maintain a healthy weight and keep blood sugar levels normal, it is essential for women before, during, and after pregnancy to have a healthy lifestyle (2004, p. 18). Excellent nutrition means having a well-balanced diet. This is a diet low in simple sugars found in refined grains, cookies, and sweets. Carbohydrate intake should be monitored closely along with a moderate intake of fats, and an increased intake of fruits and vegetables (2004, p. 18). Key nutrients are carbohydrates, fats, and proteins. Carbohydrates, for a healthy woman, should compose 40-45% of her diet. Proteins should make up 20-25% of her diet, and 30-40% of her diet should consist of fats. High Gestational Diabetes 6 fiber intake is critical because it allows blood glucose to rise gradually after a meal. An increase of folic acid and calcium is imperative, as well, for the health of the baby. Healthy weight gain is vital for expectant moms. Twenty-five to thirty-two pounds are considered appropriate weight gain for healthy moms. Moms should gain between two and four pounds in the first 3 months and one pound per week after that. Weight gain pattern is more important than the number of pounds gained. Healthy weight gain along with exercise will help ensure a healthy, GDM-free infant (2005, p. 29, 30). Exercise increases the insulin sensitivity of muscles and glucose uptake into muscular cells, resulting in a lower glycemic index (2004, p. 62). If a mother is diagnosed with GDM, exercise lowers blood glucose by helping body cells become more sensitive to insulin, overcoming insulin resistance. The mother should consult her doctor about exercise if on insulin and pregnant (2005, p. 38, 40). If diagnosed with GDM, many treatments and therapies are available to help the mother and infant cope in a healthy and effective way. In most cases, gestational diabetes can be treated by diet alone. An abundance of fruits and vegetables along with consulting a registered dietician are helpful. If the mother is obese, cutting calorie intake by a third can reduce the risk of high blood sugar and triglycerides (2006, p. 8). There are special tests that mothers can utilize to monitor blood sugar and monitor their health. The Oral Glucose Tolerance test is a standard test given to those with GDM (Goer, Jones, Weston, Rose, Gillmor, and Hunter, 1991). The Hemoglobin A1C test monitors blood sugar over a period of two months prior to taking the test. The doctor may want this test to be conducted once a month. An ultrasound shows the size of the baby, and monitors Macrosomnia. Amniocentesis looks at the respiratory health of the baby in order to protect the infant from RDS (1990, p. 19). A health care provider may even recommend insulin injections or medications. Glyburide is an oral diabetes medication that was Gestational Diabetes 7 found in a study conducted in 2000 to work well in diabetic women and not cross the placenta, affecting the infant (2006, p. 8). Gestational Diabetes Mellitus is a grim diagnosis for any mother and her infant. Although the risks for mothers and infants are great, there are many preventative measures and treatments an expectant woman can practice in order to maintain good healthy for herself and her baby. By maintaining a well-balanced diet with exercise, women give themselves the upper hand in the battle against GDM. In order to keep mothers and infants safe, it is imperative for women to educate themselves about GDM and take every precaution to ensure a pregnancy free from GDM and its serious complications. Gestational Diabetes 8 References Austin, S. (1998). Preventing Gestational Diabetes with Nutrition. Quarterly Review of Natural Medicine, 44. Retrieved from Alt HealthWatch database. Avoid diabetes during pregnancy. (2004.) Alive: Canadian Journal of Health & Nutrition, (265), 18. Retrieved from Alt HealthWatch database. Effects of Gestational Diabetes on Prenatal Morbidity Reassessed. (1995). Journal of Prenatal Education, 4(3), 49. Retrieved from Alt HealthWatch database. Gestational Diabetes. (2006). National Women's Health Report, 8. Retrieved from Alt HealthWatch database. Gestational Diabetes Overview. (2004). Midwifery Today, (72), 62. Retrieved from Alt HealthWatch database. Gestational diabetes: what to expect. (2005). Alexandria, VA: American Diabetes Association. Gillen, L., Tapsell, L., Martin, G., Daniells, S., Knights, S., & Moses, R. (2002). The type and frequency of consumption of carbohydrate-rich foods may play a role in the clinical expression of insulin resistance during pregnancy. Nutrition & Dietetics, 59(2), 135. Retrieved from Alt HealthWatch database. Goer, H., Jones, L., Weston, M., Rose, J., Gillmor, M., Hunter, D., et al. (1991). GESTATIONAL DIABETES. International Journal of Childbirth Education, 6(4), 20- 30. Retrieved from Alt HealthWatch database. Henriksen, T. (2006). Nutrition and Pregnancy Outcome. Nutrition Reviews, 64(5), S19-S23. doi:10.1301/nr.2006.may.S19-S23. (1990). How to have a healthy baby. Albuquerque, NM: HIS Diabetes Program Headquarters How to have a healthy baby. (1990). Albuquerque, NM: HIS Diabetes Program Headquarters Gestational Diabetes 9 West. King, D. (2003). Gestational Diabetes Mellitus. International Journal of Childbirth Education, 18(4), 24-25. Retrieved from Alt HealthWatch database.
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