Gestational Diabetes

What is gestational diabetes?
Gestational diabetes is the development of diabetes during pregnancy. Although the symptoms disappear after the baby is born, according to the U.S. Centers for Disease Control, about half of all women diagnosed with gestational diabetes will develop type 2 diabetes later in life. Diabetes occurs when the body does not produce or properly use insulin, a hormone necessary to convert sugar, starches and other food into the energy needed for daily life. According to the National Institutes of Health, gestational diabetes occurs in about 5 percent of all pregnancies in the United States, resulting in about 200,000 cases a year.

What are the symptoms?
Most women have no symptoms at all, although in rare cases, excessive thirst and increased urination may occur. However, when gestational diabetes develops, women are at increased risk of high blood pressure throughout the pregnancy as well as at increased risk of having a large baby and needing a cesarean section at delivery.

All women receiving prenatal care are tested for gestational diabetes between the 24th and 28th weeks of pregnancy, although those at higher than average risk may be tested sooner. In some cases, high-risk women are tested as soon they learn they are pregnant. The test measures blood glucose (sugar) levels to make sure they fall in a normal range and aren’t elevated. This may be done after a four-to-eight hour fast and again after consuming a sweet drink. Alternatively, your blood glucose may be checked an hour after you drinking a sugary concoction. If your blood sugar is normal, you probably don’t have gestational diabetes. If it is high, you may be retested after fasting.

What are the causes?
Hormones produced by the placenta to sustain pregnancy can make cells throughout the body more resistant to insulin. The placenta produces more and more of these hormones as pregnancy progresses making it harder for insulin to “unlock” cells so that glucose can enter. Gestational diabetes is most likely to develop during the last three months of pregnancy when hormone production by the placenta is at its highest.

Risk factors for gestational diabetes (besides being pregnant) include being overweight (the more overweight you are, the higher your risk), a family history of diabetes, your age (women over 25 have a higher risk), having had gestational diabetes during a previous pregnancy, having had a stillbirth or a very large baby with a previous pregnancy, or a history of abnormal glucose tolerance. In addition, the following ethnic groups are at high risk for diabetes of all types: Hispanic, African-American, Native American and Pacific Islander.

What is the conventional treatment?
Treatment involves dietary measures, exercise and, in some cases, insulin injections. Your doctor may refer you to a dietician or diabetes educator who will design a meal plan to help keep blood sugar in your target range. This may involve:

• limiting sweets and other carbohydrate-rich foods.
• eating three small meals and one to three snacks daily.
• making sure that you get fiber with your meals in the form of fruits, vegetables and whole-grain cereals, crackers and breads.

Your doctor may also recommend walking, swimming or other form of aerobic activity to help bring maintain glucose levels within your goal range. You may also have to give yourself insulin injections and to monitor and record your blood glucose levels four or five times a day with the aid of device called a blood glucose meter.

What therapies does Dr. Weil recommend for gestational diabetes?

• Dietary changes: Since being overweight can cause cells to become resistant to insulin, not gaining excessive weight during pregnancy can make a big difference. In addition, try to keep your blood sugar in a healthy range by eating small frequent meals. Learn about the glycemic index of carbohydrate foods and choose foods that are low on that scale. Mostly that means avoiding refined and processed carbohydrates. Also learn about glycemic load.
• Exercise: Regular physical activity is the single most important thing you can do to support a healthy pregnancy. Every pregnancy is unique, and there are stages of pregnancy when particular exercises will be especially helpful, and when some types should be avoided. Talk with your OB-GYN about his or her recommendations and any restrictions.
• Supplements: All pregnant women should be taking a prescribed pre-natal vitamin, and should also supplement with fish oil or another source of omega-3 fatty acids to help support the nervous system of their developing child. In addition, if you are at risk for, or develop gestational diabetes, you should speak to your OB-GYN about using the following, all of which are helpful for control of blood sugar.
  • GTF (glucose tolerance factor) chromium: This trace element plays a role in blood sugar regulation by working with insulin to help transport glucose into cells. Take 1,000 mcg daily.
  • Alpha-lipoic acid: This antioxidant can enhance glucose uptake, inhibit glycosylation (the abnormal attachment of sugar to protein), and help promote and maintain eye and nerve health. Start with 100 mg a day. Higher doses (600 mg a day) help treat and prevent diabetic neuropathy (nerve damage from impaired microcirculation).
  • Magnesium: To help promote healthy insulin production, take 400 mg daily. Magnesium glycinate is a good form with less of a laxative effect than other forms of magnesium.
  • Coenzyme Q10: This is a powerful antioxidant that may help maintain a healthy heart. Take 60-100 mg of a softgel form with your largest meal.
• Botanicals:
  • Bitter melon (Momordica charantia)
  • Gurmar (Gymnema sylvestre)
  • Prickly-pear cactus (Opuntia spp)
• Also: Insulin may be used when appropriate in cases of gestational diabetes.