Pregnancy is a monumental time in many women’s lives. They’ll experience the beauty of growing a human life, see the astonishing transformation that a woman’s body can accomplish, and have the honor of birthing a baby. While the majority of pregnancies go without metabolic complications, it’s important to be aware of conditions that can arise in pregnancy, such as gestational diabetes. In the United States, between 2% to 10% of pregnant women will be diagnosed with gestational diabetes. This condition is typically self-limiting and may resolve after childbirth, but it’s essential to understand what it is, the risk factors associated with it for both you and the fetus, and your options for care.
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What is Gestational Diabetes?
During pregnancy, changes in blood sugar regulation can occur, resulting in gestational diabetes (GD). This condition arises between weeks 24 to 28 of pregnancy due to placental hormone changes, which may affect insulin release or its effectiveness. When insulin does not function properly, blood sugar may not enter the cells efficiently, leading to elevated levels in the blood. This can impact both the mother and fetus but can often be managed through diet, lifestyle modification, or medication. In many cases, GD is self-limiting to pregnancy, with a return to typical blood sugar functioning after childbirth.
Risk Factors And Potential Complications For Both The Mother And Baby
While diet and lifestyle are important, any pregnant woman can develop gestational diabetes. There are risk factors that may increase the likelihood of this condition. These include heart disease, high blood pressure, obesity, polycystic ovarian syndrome (PCOS), family history or past medical history of GD, being pre-diabetic, inactivity, or having a previous large birth weight baby of nine pounds or more. If a woman develops diabetes during the last half of pregnancy, it can increase her risk for a cesarean birth due to large fetal development, type 2 diabetes (T2D) that continues after the birth, and preeclampsia. The baby can also face potential complications from unregulated blood sugar during the mother’s pregnancy. This ranges from prematurity to hypoglycemia at birth, which can lead to seizures, breathing difficulty at birth, increased birth weight, increased risk for developing T2D later in life, or a stillbirth.
Current Standard Medical Interventions For Gestational Diabetes Management
When diagnosed with gestational diabetes, it’s important to address the mother’s blood sugar regulation. Monitoring blood sugar with a glucose meter or continuous glucose monitor (CGM) can help track and manage blood glucose. This provides insight into foods that may affect insulin stimulation and processing. With that in mind, consistently elevated blood sugar can be concerning for both the mother and the fetus. Making dietary changes is often the primary mode of blood sugar management in GD. Some straightforward alterations include reducing processed and high sugar content foods, eating smaller meals, and maintaining consistency in meal times. Recent research suggests that a low glycemic index diet, compared to a low-carbohydrate or calorie-restricted diet, may reduce the need for insulin and decrease the risk of a high birth weight infant. In addition to diet, exercise is important and can help the body use glucose more effectively. If these lifestyle interventions are not having the desired effect, or if the situation worsens, a doctor may prescribe insulin to help manage blood sugar.
The Role of a Multidisciplinary Team For Gestational Diabetes Management
Collaboration among healthcare providers working towards optimizing a mother’s health and the well-being of her unborn child is ideal. Pregnancy care typically starts with an obstetrician or midwife. The standard care of practice is to test for gestational diabetes between weeks 24 to 28 by doing a glucose challenge test. If blood sugar is high after consuming the testing solutions (a high-sugar drink), a glucose tolerance test is needed. It’s essential to approach this test by fasting. Blood glucose is measured before the test begins and then again at intervals of one, two, and three hours after consuming the high-sugar drink. A positive result on this test indicates gestational diabetes. Visits with an obstetrician may become more frequent after this point, as they’ll want to monitor the mother and the growing baby. A referral to a nutritionist can help establish a dietary plan. Movement is encouraged to help manage blood sugar as well. Evidence shows that by conventional medical standards, there is typically a two-week lifestyle and dietary intervention window to see if that makes a positive impact on blood sugar regulation. If the situation worsens or hyperglycemia becomes more present throughout the day, a referral to an endocrinologist is warranted to discuss pharmaceutical options. Insulin is the primary drug intervention for gestational diabetes, but a doctor may also discuss options such as Metformin or Glyburide, which are medications to help manage blood sugar. Even with lifestyle interventions, about 15-30% of women with gestational diabetes may need medication intervention. Additional options for care include adding a naturopathic doctor or functional medicine practitioner to the team who is trained in nutrition counseling and lifestyle modification such as stress management, optimizing sleep, vitamin and nutrient therapy, botanical medicine, and the importance of movement on physiology.
Functional Medicine Labs to Test That Can Help Individualize Treatment for Patients With Gestational Diabetes
Proactive investigation and assessment through functional labs can help guide a holistic doctor in treatment recommendations. Looking at basic lab values in a CBC, blood sugar markers in a diabetes screen, or even a comprehensive micronutrient panel can provide valuable insight.
Comprehensive Pregnancy Panel
Getting bloodwork early on in pregnancy provides a baseline of health status. The Obstetric Panel by Access Medical Laboratories can provide indications of any disturbances associated with red and white blood cells.
Diabetes Screening
If there is a personal or family history of gestational diabetes, getting screening testing done early on can help detect trends toward GD. Markers, like glucose, insulin, and hemoglobin A1c (HbA1c) are valuable for monitoring gestational diabetes.
Micronutrient Panel
Studies have found an association between micronutrient alterations and gestational diabetes. Findings among women with gestational diabetes included high folate with low vitamin B12 or, vice versa, high B12 with low folate status. There have also been amino acid changes detected, particularly betaine and choline, which play a role in methylation, placental function, neurodevelopment, and epigenetics. A micronutrient test that also includes amino acids is a great option for investigating imbalances and providing individualized solutions.
Integrative Medicine Techniques for Gestational Diabetes Management
Taking an integrative medicine approach in addressing gestational diabetes can be an excellent way to support mother and fetal development. Making changes in the area of nutrition, exercise, and mental-emotional support can truly help manage this temporary situation with no long-term effects.
Nutrition for Gestational Diabetes Management
Dietary modifications are the primary intervention when it comes to managing gestational diabetes. Reducing simple carbohydrates, which tend to have a higher glycemic index, thus spiking blood sugar, is a focal point. Recent evidence suggests that a Mediterranean-style nutrition plan can provide optimal nutrition and guidance for supporting blood sugar and insulin response. This should include lean protein, with an emphasis on seafood, fresh and antioxidant-rich fruit, and vegetables, healthy fats from olive oil, nuts and seeds, and minimally-processed whole grains. A Mediterranean diet aligns with a low-glycemic way of eating, which is ideal for gestational diabetes.
Exercise for Gestational Diabetes Management
Physical activity and safe exercise during pregnancy are encouraged to help support a healthy pregnancy. The American Diabetes Association recommends engaging in 30 minutes of exercise per day for those with gestational diabetes. This can help support glycemic control and promote insulin sensitivity. If someone regularly exercised prior to pregnancy, they should maintain exercise at a moderate intensity. If someone has lived a more sedentary lifestyle, is overweight, or is newly diagnosed with GD, it's recommended to start with low-intensity aerobic exercises. This can include around 15 minutes of walking, biking, or circuit training. As comfort increases, functional movement can be increased to 30 minutes per day, at a minimum of five days a week. This may sound daunting if new to implementing an exercise routine, so starting slow, setting realistic goals, and working with a professional if necessary is advised.
Mindfulness And Stress Reduction for Gestational Diabetes Management
During pregnancy, the body goes through drastic changes while growing a baby. While exciting, this poses both physical and mental-emotional stress. A systemic review explored the literature on mental health in correlation to gestational diabetes. Results of a meta-analysis of 18 studies revealed that women with GD are at an increased risk of developing both anxiety and depression. Likewise, there is a positive correlation between women who suffer from anxiety prior to pregnancy and the development of gestational diabetes. With this in mind, it’s crucial to incorporate techniques for managing stress and promoting emotional well-being if diagnosed with this condition. Leaning on a good support system such as friends, family members, or the community can help ease the mind and assist with physical stress. Resting when possible, practicing deep breathing, and allowing oneself to process emotions through crying or laughing can be therapeutic. While meditation is not specific to gestational diabetes, it can greatly benefit women while they are pregnant by inducing relaxation, increasing mental clarity, reducing negative feelings, decreasing anxiety, and being a great stress coping mechanism.
Complementary Therapies for Gestational Diabetes Management
Integrative medicine and complementary care options can be an asset to health. In addition to conventional medicine care, consider traditional Chinese medicine (TCM) modalities and evidence-based natural blood sugar support supplements.
Acupressure
The use of acupuncture and acupressure has not been widely investigated in women with gestational diabetes. There is one study that found promising results during the 12-week trial. The end result suggested that gestational diabetes management may benefit from improved glycemic control and insulin sensitivity. Working with a TCM practitioner that also does acupuncture could be a beneficial holistic approach.
Traditional Chinese Medicine and Herbs
Utilizing Chinese medicine and traditional herbal medicine can be beneficial for pregnancy and gestational diabetes. Being cautious about the safety of plant-based medicine is essential, as many are not safe for pregnancy. There are three evidence-based remedies that have shown promising results in supporting blood glucose and insulin function- Zuo Gui Wan, Rubus Ideaus (red raspberry leaf), and Astragalus. Working with a trained TCM practitioner or herbalist is the best way to approach this condition with herbal medicine.
Myoinositol Supplementation for Gestational Diabetes
Inositol, which is a sugar produced from glucose in the body, can be taken exogenously in the form of myoinositol to support pregnant women with gestational diabetes. A study of 69 women with GD found that the study group who took both folic acid and myoinositol had significantly lower glucose and insulin results compared to the control group who took only folic acid. This study also suggested that the combination of folic acid and myoinositol may support increased adiponectin, which is a marker of cellular response to insulin.
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Summary
Gestational diabetes can occur in both women with a predisposition and completely healthy pregnant women. The causation is due to hormonal changes from the placenta, which may affect insulin function, resulting in elevated blood sugar. Thankfully, there are dietary and exercise practices that can be put into place to help manage this condition and support a healthy pregnancy. As complementary and integrative medicine continues to gain traction, these modalities of care are being sought out to support women through conditions such as gestational diabetes. Seeking out a holistic practitioner as part of a multidisciplinary team can assist in the pregnancy journey and help manage the challenges of this condition.
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