Aida Kaman Stephens
March 20, 2005, 07:26 PM
Some thoughts on Gestational Diabetes
Recently I was questioned on my statement that gestational diabetes is a an obstetric myth. I do accept that perhaps the statement can come across as somewhat flippant. I do however believe that, gestational diabetes is over prescribed and that the risks associated to it are really obstetric myths.
Just bear with me as I talk this through. Gestational diabetes is really carbohydrate intolerance of pregnancy. The condition is an insulin resistance which presents itself during pregnancy. If anyone is wondering why it was decided that it should be called gestational diabetes, well, Henci Goer explained that in 1979, when the National Diabetes Data Group was updating classification of diabetes type, it was decided that the more neutral term of Carbohydrate intolerance of Pregnancy will not be taken as seriously by pregnant women as a term which has the word ‘diabetes’ in it. Furthermore, insurance companies were more likely to cover treatment for it. Also, the original reason for identifying women with gestational diabetes is to pinpoint those who are more likely to develop type 2 diabetes in years to come. I don’t think fetal wellbeing was ever a major purpose in diagnosing gestational diabetes.
I have also read that because birth defects takes place sometime in the first trimester, gestational diabetes can not be attributed as a cause for this as insulin resistance (contributed by the production of contra-insulin hormones by the placenta) does not usually occur until around the 24th week. It is quite normal for women to have normal blood sugar levels during the first trimester. I suppose if a woman is presenting with high blood sugar levels in the first trimester, I would question if this woman is pre-diabetic or even an undiagnosed type 2 diabetic (I for one was walking around as a pre-diabetic for years until just recently). Someone with more knowledge of diabetes might be able to help clarify this.
Anyway, regardless of what the blood sugar levels state the woman is in, I do truly believe that nutrition should always be discussed with the woman at booking. For instance, if the woman has a high BMI, the need for her to pile on the pounds would be much less, and it would be very beneficial for her to be more aware of ways of improving her diet. Now whether or not this woman then in 10 years develop full blown type 2 diabetes is anyone’s guess, but two of the predisposing factors for type 2 diabetes are obesity and increased age.
So if gestational diabetes is a transient carbohydrate intolerance, it should normally resolve itself after the birth. The fact that a large proportion of these women then go on to develop Diabetes type 2 is probably more indicative of the diet imbalance high in refined food/simple carbohydrates.
The question is, should we then screen women for gestational diabetes in order to identify those who might potentially develop type 2 diabetes, at the cost of medicalising their pregnancy, introducing interventions and increasing their stress levels? The success of such management has been ambiguous.
I know that detection can help with macrosomia but wouldn’t it be cheaper and less stressful if we approached it at a preventative level (thorough discussion about diet, nutrition, exercise) rather than a perceived ‘cure’? Pregnancy is a life changing experience, these women will be responsible for the physical (not to mention spiritual) wellbeing of their child, and surely a better understanding of nutrition and diet would put them in a better position in helping themselves and their families?
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