Buntis Ngayong Pasko? How To Prevent Gestational Diabetes During Pregnancy And Celebrate Safely

The holiday season is one filled with merriment, reunions, feasts, and travels. It's valid for pregnant women to feel worried that they might develop diet-related problems during this time.

A condition called gestational diabetes mellitus (GDM) is so common, however, not a normal finding in pregnancy. According to a 2017 study by the International Diabetes Federation, it said that, “GDM affects approximately 14% of pregnancies worldwide, representing approximately 18 million births annually.” One of the reasons why this problem arose is from the busy, sedentary lifestyle that many lead and the convenience of consuming a fast diet that is readily available and well-commercialized. But this can be reversed before pregnancy if we start taking care of ourselves.

Normally, we secrete the hormone insulin from our pancreas that helps allow the cells of the body to convert sugar (glucose) into energy to be used by the muscles and other organ systems to essentially function. 

READ ALSO: Exercising While Pregnant May Help Your Baby Fight Obesity, Diabetes As An Adult

Diabetes, explained

Diabetes, in a nutshell, is as follows: If a person has an abnormality in the pancreas in which it cannot produce insulin, we call it Type 1 Diabetes Mellitus. In some cases, when a person has too much sugar in the body and the pancreas cannot produce insulin adequately, it can lead to Type 2 Diabetes. Another reason where type 2 diabetes happens is when a person develops insulin resistance, wherein the organ system is no longer sensitive to the action of insulin. The cause of insulin resistance outside pregnancy is still unclear, but factors such as high fat in the abdominal region, family history, or obesity can contribute to this. This chronic metabolic problem can lead to a lifelong health issue and can affect various organs in our body.

In pregnancy, we are more at risk of having GDM due to our body changes alone. An expert in the field of hormones and nutrition, Dr. Hannah Ruth Labajo-Pagaduan, an endocrinologist fellow practicing in the Philippines, a mother of two, and a fitness enthusiast, explains the phenomenon of GDM and what measures we can take to avoid having it.

Medical expert weighs in on diabetes during pregnancy

What is gestational diabetes mellitus?

Gestational diabetes mellitus (GDM) is when the blood sugar level of a pregnant woman increases during the second or third trimester of pregnancy. 

Unlike your Type 1 diabetes where there is a lack of insulin, GDM happens when the pregnancy progresses, certain hormones are present during pregnancy that makes the woman temporarily insulin resistant. They have no history of diabetes or elevated blood sugar prior to their current pregnancy. It is when the mother’s insulin secretion cannot adequately compensate for the demand of pregnancy that GDM develops. Although GDM generally resolves once the woman has given birth, it becomes an important risk factor in developing Type 2 diabetes mellitus in the future.

When and how do we diagnose this? 

GDM generally does not pose signs and symptoms. Once the pregnant woman has reached her 24th week, her obstetrician will request an oral glucose tolerance test (OGTT). She will be instructed for an 8-hour fasting where her blood will be extracted and afterwards, she will drink a juice containing 75-gram glucose. Blood will be drawn twice, on the first and second hour after intake. However, if it is a high-risk pregnancy or the patient has risk factors indicated below, the doctor will request a work-up after the first prenatal visit.

What are the risk factors? 

The risk factors for GDM are advanced maternal age, obesity, physical inactivity, family history of diabetes, and certain ethnicities, including Asians, GDM in the previous pregnancy, a history of giving birth to a baby with a weight more than 4kg, and polycystic ovarian syndrome (PCOS).

What are the complications? 

Fetal complications include abnormally increased weight for newborns (macrosomia) that can lead to the baby’s shoulder being stuck in the birth passage (shoulder dystocia), abnormally low sugar for the newborn (neonatal hypoglycemia), abnormal red cell count of the newborn (polycythemia), abnormally high bilirubin count in which neonates can have jaundice (hyperbilirubinemia), breathing problems in the newborn (neonatal respiratory distress syndrome), and increased perinatal mortality.

Maternal complications meanwhile include hypertension, preeclampsia, an increased risk of developing diabetes mellitus post-pregnancy, and an increased risk of cesarean delivery.

READ ALSO: Postpartum Preeclampsia: The Complication to Watch Out for After Childbirth

How do we treat GDM?

Studies have shown that 4 out of the 5 pregnant women diagnosed with GDM can be controlled with lifestyle modification alone. Here are the recommendations:

1. Exercise.

It is recommended that exercise (aerobic, resistance, or both) and duration of exercise (20–50 min/day, 2–7 days/week of moderate intensity) improve glucose control. Aerobic exercises are your low-impact exercises. Prenatal pilates and prenatal yoga would be a good idea. Swimming, brisk walking are also recommended for cardio. Resistance or functional strength training is also recommended by using bands or lighter dumbbells. Talk to an expert for a tailored program for you.

2. Watch what you eat.

Pregnant women with GDM should avoid large meals, food with a high percentage of simple carbohydrates (such as baked goods, soda, fruit juices, etc.) and highly processed foods.

3. Eat small, frequent meals.

There should be a restriction of carbohydrates that should be distributed in 3 small to moderately sized meals and 2-4 snacks in a day. The consumption of frequent small meals is the best strategy to reduce the risk of after-meal sugar shoot up (postprandial hyperglycemia). Choose the proper food; the preferred food in this case is those high in fiber and fresh vegetables as your complex carbohydrate source.

4. Listen to your doctor.

If GDM cannot be controlled by diet, insulin supplementation safe for pregnancy is introduced by a specialist doctor as well as regular blood sugar level monitoring. However, a mindful diet and adequate physical activity are still the key in reducing insulin dose requirements.

How to avoid GDM?

As they say, prevention is way better than cure. Before getting pregnant, you may be able to prevent GDM by having a more active lifestyle and by losing weight if you are overweight or obese. If you are already pregnant, you can avoid it by choosing a healthy diet, avoiding sugary drinks and food, maintaining a healthy weight, and exercising with the clearance of your obstetrician.

Stress reduction can also lessen your risk of GDM. Cortisol is a stress hormone that is usually higher in pregnancy. With a higher range, it promotes higher blood sugar level and insulin resistance. Having adequate sleep and indulging in activities that lower your stress levels can prevent you from having GDM. Avoiding vices such as alcohol and smoking, as studies show, remarkably reduce your chances of developing GDM.

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Accommodating a growing baby inside entails a lot of physiologic changes that will push our body to its highest potential, making motherhood so empowering. We might face some physical hurdles, but with proper steps, we may be able to enjoy our journey of pregnancy. Nevertheless, we do not have to restrict ourselves from enjoying some simple pleasures but need to find the balance between indulgence and healthy boundaries for our lifestyle.

Dr. Hannah Ruth Labajo-Pagaduan is an endocrinologist who promotes healthy living rooting from uncomplicated healthy eating and exercise as prevention for chronic metabolic health issues. She loves spending time with her family- her two girls, and compensates for her busy lifestyle with some endorphin pump by indoor cycling and rhythm boxing. She practices in some hospitals in Quezon City.