Gestational diabetes mellitus or high blood glucose (sugar) levels beginning in pregnancy, affects as many as one in ten pregnant women in Australia. Screening for the condition around the start of the third trimester when women typically develop gestational diabetes is recommended for all pregnant women.

Being diagnosed with diabetes during pregnancy is positive because it means the condition can be managed, primarily by eating a healthy diet and getting plenty of exercise. This minimises risks to mother and baby. However it is also challenging.

We spoke to Lauren about her experience with gestational diabetes in her first pregnancy.

Recognising the symptoms

Diabetes may produce symptoms like extreme tiredness and frequent urination, but being common symptoms in many pregnant women, this makes diagnosis of diabetes during pregnancy on symptoms alone difficult. The majority of women with gestational diabetes don’t experience any symptoms, as was the case for Lauren. “The only one on the list was tiredness and that could just be explained by being pregnant,” she said.

Blood testing for gestational diabetes

Without testing Lauren would have been unaware that she had gestational diabetes. “I did the 2 hour fasting glucose test for diabetes at 25 weeks,” she said. “They take a blood test when you first arrive after fasting all night and then you are given a glucose solution and two further blood tests at 1 hour and 2 hours. If any of the tests are over the tolerable range you are diagnosed with gestational diabetes.”

However the blood samples have to be analysed in a laboratory, meaning the results of the tests are not available immediately. The day after her blood glucose tests, Lauren left for a two week holiday. “Luckily my obstetrician was very good and rang me as soon as my results came through to let me know. I was slightly over the maximum blood glucose level on my 2 hour test. I had gestational diabetes.”

Confronting the challenges with support

“To be honest I was really upset. I didn’t really know much about the condition at the time and wondered if it was something I had done and if I had already affected my baby. I thought about all the chocolate I ate a couple of weekends before when it was Easter and if that would have caused any problems for her.pregnant_woman_baby_inside_belly_200x310

“The main impact on the baby is growing bigger faster than normal. My baby girl had always been measured at slightly above average. Suddenly, rather than putting that down to her genetics as I had always done before – after all both her parents are quiet tall- I worried it was because of me. I was a bit overweight when I became pregnant. I know age is also a factor and I turned 30 this year too so I am just on the threshold there for being at risk of gestational diabetes.

“Luckily with the support of my husband and reassurance of my obstetrician I was convinced that this wasn’t the case. Interestingly enough there was a lady in my gestational diabetes consultation with a low BMI and she also had it and my consultant had it with her first child but not her second (having it previously is another risk factor).”

“It also helped knowing that as long as I managed my glucose levels there was no reason my gestational diabetes would impact her,” Lauren said.

Managing glucose levels in gestational diabetes primarily involves eating a healthy diet with low glycaemic index foods and getting plenty of exercise. Women with gestational diabetes should seek professional advice, for example from a dietician to ensure they are eating correctly.

Starting a diabetes-diet on holidays

“I was on holiday for 2 weeks before I was able to see a special gestational diabetes consultant and a dietician arranged through my obstetrician. I spoke with the consultant over the phone just after I was diagnosed and she emailed me some really helpful information about gestational diabetes.

“For the two weeks I was on the holiday I simply avoided all high fat and sugary foods (not easy to do on holiday!). My husband was pretty supportive and tried to eat what I was having as much as possible too.”

Seeing a gestational diabetes consultant

“I was still overwhelmed and confused at this point though and it was a relief when I met with the consultant and dietician as soon as I got back from my holiday. They set me up with a lot of tools to ensure I was on an appropriate diet to manage my glucose levels and a monitor to test my blood levels 4 times a day.

“The gestational diabetes consultant gave me a monitor that fits in a little zippered black bag about the size of a purse that I keep in hand_pricked_finger_blood_test_140x100my hand bag. It is very easy to use. You just prick your finger and apply the blood to a little strip. You do a fasting test before eating in the morning and then 2 hours after each main meal. I was also set up with a NDSS (National Diabetes Services Scheme) card which made me eligible for significant discounts on the test supplies at participating pharmacies. You need a new test strip for every test and they recommend changing the needle at least daily.

“Sometimes it was a challenge to fit a test in if I was in the middle of something but I was usually able to excuse myself to the toilet and do the test quickly if I had to. My obstetrician and gestational diabetes consultant said that once I had the levels under control and knew that I didn’t need insulin they were happy for me to test every second day but I continued to test every day anyway because for me it helped to keep me honest and motivated to see my results after every meal and know that what I had just eaten was ok.”

Maintaining an exercise routine

“Exercise also helps to keep levels in a normal range. But there wasn’t too much here for me to change as I was usually finding my 30 already. Because of the pregnancy related nausea I got I did stop using the cross trainer because it was like being on a boat! I also used to scuba dive but that is a big ‘no-no’ for pregnant women too.

“I have been able to keep up the walking even if it’s just a lap around the shops while getting groceries or housework. My gestational diabetes consultant said that even 30 mins a day really helps the body to process the glucose levels. I have definitely found this to be true. If I have had an off day and haven’t felt well and done no exercise my blood sugar levels have always been much higher. The diet always meant they were still in range but it was good to know that if I felt I ate a few too many carbs at lunch time for example a 30 min walk would help to maintain my levels.”

Dealing with diet restrictions

“I started eating six portion controlled meals a day. The meals also managed my carbohydrate intake (very important for a pregnant woman). Suddenly with this management I was never hungry and my glucose levels where always in a normal range. I didn’t require insulin injections, but it wasn’t always easy.

“Pregnant women are obviously already on a restricted diet anyway. Soft cheeses were particularly hard for me to give up, so I did feel quiet sorry for myself when I had to give up chocolate too. I am dying to have a soft serve chocolate Sunday!

“Being on a special diet was especially hard on our holiday with friends while they enjoyed their ‘holiday diets’ and cocktails. Eating out is also a challenge when you are restricted by things pregnant women can’t eat and then what diabetics can’t eat as well.”

Seeing the positive side of gestational diabetes

“But I always manage to find something, even if I have to eat less on my plate for portion control. I have found that most places are very accommodating and will make adjustments to meals if you ask. At the end of the day I was in love with my baby girl already and would have sacrificed anything to make sure she grew healthy. And for most women with gestational diabetes it disappears the day baby is born so it really isn’t too much longer before I can have a cheeky chocolate bar.

“The diet has definitely helped with my weight too. I lost a couple of kilograms all within safe ranges and monitored by my obstetrician. As a result I haven’t put on any weight during my pregnancy and my baby continues to grow at a healthy pace. She is due in just over 2 weeks.” The amount of weight a woman should gain during pregnancy depends on her pre-pregnancy BMI, and most should gain 5-18 kg during a pregnancy.

“My husband has been very supportive and generally eats what I eat when he is home (he works fly in, fly out) and usually forgoes dessert- although that might be because I stare at him drooling when he does occasionally eat it. We are both keen to try and stick to the heathy eating after bub has arrived too. Although I do intend to have the occasional dessert as soon as I am allowed!

Advice to other women with gestational diabetespregnant_woman_exercise_stretching_300x200

While there are clear guidelines for coping with healthy eating and exercise, women may also have emotions like guilt and concern to deal with. Lauren advices others with gestational diabetes, “not to beat yourself up about it and just get on with sticking to the diet. It was hard for me at first because I thought, ‘if I was younger or if I was 10kg lighter, would this have happened?’ It may or may not have and the important thing is to take the diet seriously.”

References

  1. Nankervis A, Conn J. Gestational Diabetes Mellitus- Negotiating the confusion. Aust Fam Phys. 2013; 42 (8): 528-31. [Full Text]
  2. Diabetes Australia. Eating Well with Gestational Diabetes. 2012. [cited 15 July 2014]. Available from: [URL Link]
  3. American Diabetes Association. Diabetes Basics- Symptoms. [cited July 2014]. Available from: [URL Link]
  4. Royal Australian and New Zealand College of Obstetricians and Gynaecologists. Management of Obesity in Pregnancy- C-Obs 49. 2013. [cited 22 July 2014]. Available from: [URL Link]