Pregnancy and Diabetes
The nurse was just doing her job. She was simply teaching me how to prick my finger and test my sugar with a glucose monitor. In actuality, she was giving me a rude awakening as to what my future may look like. Diabetes runs in my DNA, but I was not ready to let it run my life just yet. Having recently been diagnosed with gestational diabetes, I am at a higher risk, up to 50 percent higher, of developing Type 2 diabetes later in life. As if seeing both my parents’ health suffer for many years with diabetes was not enough, this was the warning sign I needed to put things in proper perspective for me. Diabetes is that slow, torturous disease that can do major damage if it is not properly controlled. By being proactive now, I plan on fighting my stubborn genes and having a better quality of life.
Gestational diabetes, one of the most common health problems in pregnancy, is a specific form of diabetes that only occurs during pregnancy and requires special care and monitoring. Between 2 and 10 percent of expectant mothers develop it. The healthy body is designed to turn digested food into a sugar called glucose. With the help of insulin, a hormone made by the pancreas, cells use the glucose as fuel. Hormonal changes that occur in the body during pregnancy can make the cells less responsive to insulin. This is not a problem for most pregnant women because, when the body needs more insulin, the pancreas secretes more of it. However, in a case like mine, when the pancreas is not able to keep up with the increased insulin demand, blood glucose levels rise too high, resulting in gestational diabetes.
Since gestational diabetes usually has no symptoms, almost all pregnant women have a glucose screening between 24 and 28 weeks of pregnancy. The test is safe and simple. Samples of blood are taken after consumption of a sugary solution. If the results show a high blood sugar level, a diagnostic test will be given to check glucose tolerance. This test measures the amount of time it takes for sugar to leave the blood. A blood sugar level that is too high can cause problems for mom and baby and, therefore, needs to be properly controlled and monitored.
First time mom Ida Moretti of Oak Lawn, Illinois, was not expecting to fail her glucose screening. The full-time pharmacist was regularly exercising throughout her pregnancy and was not overweight prior to expecting. However, diabetes does run in her family, so she was definitely at risk of developing gestational diabetes. “I was very surprised and disappointed when I found out that my blood sugars were so high in my pregnancy,” shares Moretti, the youngest of seven siblings. “I wanted to get my glucose levels regulated right away for the sake of my baby, so I got on medication and changed my diet accordingly.”
Sometimes dietary changes and exercise are enough to keep blood sugar levels under control; other times, as in Moretti’s case, medication may be needed as well. About 15 percent of women with gestational diabetes need medication. Most patients start with oral medication instead of injections.
According to nutritionthatfits.com dietitian and diabetes educator Hannah El-Amin, feeling disappointed or blaming oneself are common reactions amongst women who are diagnosed with gestational diabetes. About a third of the patients she sees in her Chicago practice come in with gestational diabetes. “These women are very concerned about the well-being of their babies, some even scared and confused about how they will manage their health and eating with the diabetes,” says mom of two El-Amin. “They feel like they have done something wrong, and I reassure them it is not their fault. The reality is some people have a genetic predisposition to it, but the thing is to put a positive spin on things. A majority of the time, gestational diabetes goes away right after delivery, and it can be easily managed if patient is well-informed and willing to make the necessary lifestyle changes,” she concludes.
As expected, Moretti’s diabetes disappeared post delivery. She gave birth to a healthy baby girl named Milayna who is 16 months old now and thriving.
“Most women who develop diabetes during pregnancy go on to have healthy babies,” states Dr. Rima Makhiawala, who specializes in obstetrics and gynecology in Livingston County, Michigan. “Yes, the effects of gestational diabetes can be issues like having potentially larger babies, tougher deliveries, or a higher chance of Cesarean delivery, but the sooner we know the patient has high glucose levels, the sooner we can start helping her,” she says.
Like most prenatal care facilities, Dr. Makhiawala’s practice requires all its expecting patients to be screened for gestational diabetes. “In the past, only those pregnant women who were considered being at high risk for diabetes used to be screened,” tells Dr. Makhiawala. “Women of Hispanic, African American, Native American, Asian Americans, and Pacific Islander ethnicity, or overweight patients, or those with diabetes in their family and/or over the age of 25 were tested more regularly for high blood sugars. However,” she continues, “now we have to test all our patients as part of their prenatal care. Even the patient with no apparent risk factors may end up being diagnosed with gestational diabetes.”
Once diagnosed, there is a usual protocol taken to help patients manage their glucose levels. Some obstetricians may refer these individuals to specialists in maternal fetal medicine. Patients may also consult with registered dietitians to educate them on diabetes and learn how to adjust their diets to regulate their sugars. They will also receive training from their healthcare provider on how to keep diligent track of their glucose levels using a home glucose monitor. Most insurance plans cover treatment for gestational diabetes so women have adequate access to information and resources.
“At a first-time consultation with me, I give the patient a very detailed questionnaire about her diet and lifestyle including what foods she eats and how much sleep she gets regularly,” says El-Amin. “I also inquire about the level of stress she deals with on a daily basis, because it all impacts diabetes. We talk about carbohydrate counting and derive a customized meal plan based on her height and weight and what her daily routine is to schedule proper meal timings. As for exercise, I may suggest walking after meals but it depends on the patient’s pregnancy health and what her doctor prefers.”
The principles of the diabetic diet are good for everyone in general to follow. It is an opportunity to create healthier eating habits for oneself and one’s entire family. El-Amin highly emphasizes the importance of pregnancy nutrition right from the start. “It is so often overlooked until there is a problem,” she says.
So what about those women who are already diabetic before pregnancy? According to the American College of Obstetricians and Gynecologists, in the past, women with diabetes were advised not to become pregnant. The health risks to both mother and baby were too high. Today, there is a better understanding of diabetes and improved prenatal care making it easier for women with diabetes to have successful pregnancies and healthy babies.
Dr. Saadia Mian, an endocrinologist from Saline, Michigan, shares that many of her patients suffer from diabetes. “For women with diabetes who want to get pregnant, first and foremost, they need to have their diabetes under proper control,” says Dr. Mian. “Pregnancy can wreak havoc on blood sugars, and poor control of diabetes may be harmful to the baby and the mother.” Dr. Mian notes that those women who develop Type 2 diabetes along with a history of polycystic ovary syndrome (PCOS) find it difficult to get pregnant and to maintain pregnancy. “PCOS Interferes with the growth and release of eggs from the ovaries when a woman’s body overproduces hormones called androgens causing anovulatory cycles, which leads to difficulty in conceiving,” she says. “Even after conception, the risk of miscarriage is high.”
Once her patients do happen to conceive, Dr. Mian refers them to an obstetrician/gynecologist who specializes in high-risk pregnancies to follow them through to delivery.
Sakina Syeda of Chicago, Illinois, was monitored very closely by both an endocrinologist and an obstetrician during her pregnancy. She was diagnosed with PCOS at the age of 17. In March of 2011, she was told she also has Type 2 diabetes. “I was taking medicine and insulin injections to regulate my sugars during pregnancy,” shares Syeda, a teacher for the Zainab Center. “I was on a very restricted diet and checking my glucose levels up to 6 times a day. My fingers developed little, tiny black scabs from being pricked so much,” she recalls.
Despite the many prenatal appointments and ultrasounds, and even some emergency hospital runs, Syeda says it was all worth it in the end when she held her healthy baby Safiyyah Kotelensky in her arms. “I was given ample care and support throughout my pregnancy, and by the will of God, was blessed with a healthy, beautiful baby,” gushes the first-time mom. “It was not an easy journey, but your baby is a great motivator to take your health seriously. I did not want anything happening to my baby so I was extra careful and learned so much along the way about eating better and healthier.”
Syeda states that a baby is a trust from God and so are our bodies, so our health cannot be taken lightly. Having diabetes should not hinder anyone from trying to reach motherhood. It is doable with sincere commitment and diligence and faith. She has continued many of the lifestyle changes she made during her pregnancy into her postnatal care as well. “Diabetes has helped me portion my food intake. I plan out my meals weekly and have reduced my intake quite a bit,” she says. “Even now I will eat smaller meals throughout the day and carry a water bottle and healthy snacks wherever I go. I also want to set a proper example for my daughter and have reduced refined sugars from my diet drastically.”
Nobody imagines being put on a diet during pregnancy. It is definitely not something I preferred doing. However, gestational diabetes has been a blessing in disguise. I am eating lighter and healthier, have learned how to increase my quality of life, and am no longer giving into my cravings. I plan on sustaining these healthy habits post delivery as well. I want to minimize my risk of developing diabetes in the future to the best of my ability. Chances reduce dramatically by keeping one’s weight down, making healthy food choices, controlling portions, and exercising regularly. All of this can help ward off the disease.
Tayyaba Syed has written for numerous publications and been featured on NPR and Radio Islam. She teaches and volunteers with the youth in various communities. Tayyaba lives in Illinois with her husband and two kids.