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What's the Deal With Gestational Diabetes?

10/15/2022

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What is it?
Gestational diabetes is the label given to diabetes that is diagnosed during pregnancy. For some mothers, gestational diabetes may be diabetes or prediabetes that was undiagnosed before pregnancy. Sometimes, diabetes may resolve after pregnancy only to appear in subsequent pregnancies. A diagnosis of diabetes during pregnancy increases the risk of having diabetes after pregnancy. ACOG recommends every woman get tested for diabetes at around 24- 28 weeks gestation.

How is it diagnosed?
Symptoms of gestational diabetes may be increased thirst, increased urinary output, fatigue, or recurring yeast infections (most women have no symptoms). Also, if there are any predisposing factors such as PCOS, multiple unexplained miscarriages, or a family history of diabetes, we might want to consider testing.  I like to check HbA1c which measures average blood sugar for the past 90 days during the first trimester (after the first trimester, the results aren’t as reliable). If the HbAic results are elevated, or in the high end of the normal range, we may discuss testing for diabetes. Typically gestational diabetes is diagnosed by having the mother drink a hyper-sweetened beverage and then have a blood sugar check in one hour to see how well your body processed the sugar. If sugar levels are too high with that test, then a second test using an even sweeter beverage and checking blood sugar over 2-3 hours is done. There are other testing options I prefer to use if we decide there is a reason or if a client wants to check for gestational diabetes. I like to start with checking fasting blood sugar, so you would stop eating at least 8 hours before your test. If your blood sugar is outside of normal range, we may want to run a two-hour postprandial blood test. For this test, you would fast for eight hours or overnight, have your fasting blood sugar checked and then go eat a high carbohydrate meal and have your blood drawn two hours after you started eating your meal. These two blood glucose numbers will tell us if your body is handling sugar in an appropriate manner.

What are the risks of gestational diabetes?
Your baby will have an elevated blood sugar, so baby’s pancreas reacts by overproducing insulin, leading to an increase in growth so you may birth a very large baby. Baby’s increased insulin production can interrupt production of surfactant in the lungs which can lead to respiratory distress. The newborn may have severe problems with hypoglycemia (low blood sugar) or hypocalcemia (low calcium levels) after birth. The risks to the mother includeincreased risk of high blood pressure, higher risk of developing preeclampsia, higher risk of polyhydramnios, and a high risk of postpartum hemorrhage.

What is the treatment if I have it?
Treatment for diabetes in pregnancy depends on how severe it is. A diet that is high in protein and complex carbohydrates and low in simple sugars is the first thing to adopt to manage blood sugar. Regular exercise is also key to managing blood sugar levels. The goal of all treatments is to hold blood sugar steady at a safe level. For some women, insulin therapy may be needed to manage blood sugar in addition to diet and exercise.

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Miracles

10/1/2022

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As a midwife, I never find my work boring or routine. 
 

We know a lot about the science behind birth.  We know what hormones play a role, we know that baby's body manufactures a special type of hemoglobin that can hold 4 times the oxygen of normal hemoglobin.  We know how baby's body will need to move to be born whether head down or breech. It seems we know so much that sometimes pregnancy and birth can be stripped of the wonder because of all the knowledge we have.

Every time I am called to a birth, I use everything I know about birth. I monitor baby's heart rate, I assess how labor is progressing and how Mom is handling labor. Even with all the scientific knowledge though, I find myself in a place of wonder at the miracles that are happening before my eyes.

Birth is a miracle. There is that moment between birth and baby filling his or her lungs with air for the first time that is truly miraculous. The line between birth and death is a razor's edge and yet I trust that birth will result in the miracle of life.  Birth is only part of the miracles I get to witness.

Watching the moment Dad falls head over heels in love with his baby, watching Mom realize the strength she has, watching baby look into Momma's eyes for the first time, hearing that first cry of the newborn, seeing how quickly Mom's body shifts from birth to recovery, seeing Mom with a confidence she did not have before the birth of her baby, seeing parents work together as a team to bring baby into the world, seeing a sibling meet baby for the first time and more. All these things are a portion of the miracles I hold witness to. It is an honor beyond anything I ever imagined. I can know all the science there is to know about pregnancy and birth, and yet that knowledge will never diminish the awe I feel when I witness the miracles that occur when I am working.



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    Author

    Gail Webster, CPM

    Gail is a Certified Professional Midwife serving Manhattan, Junction City, Fort Riley and other areas in Kansas.  


    When Gail is not occupied with birth work, she enjoys reading, quilting, baking, riding her motorcycle and spending time with family.
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