Most people are familiar with the two main types of diabetes — Type 1, where patients cannot make insulin and need insulin injections for life; and Type 2, where patients have insulin resistance and cannot use insulin properly. There is another kind of diabetes that occurs only in pregnancy, known as gestational diabetes mellitus.
GDM occurs in pregnancy in someone who was never diagnosed with diabetes before, and it usually resolves after delivery. But women with GDM are at risk for GDM with future pregnancies, and an increased chance of developing Type 2 diabetes later on. In GDM, babies may be too big and there is risk for early delivery and complications during delivery.
OGTT should be done during the first prenatal visit.
GDM is diagnosed with an oral glucose tolerance test, where blood samples are drawn before and after drinking 75 grams of glucose. This is usually done around the sixth month of pregnancy, but Filipino women have been found to have an increased risk for GDM and the OGTT should be done at the first prenatal visit, especially if you are 25 years old or older and have a first-degree relative with Type 2 diabetes. Testing should also be done in women with a history of irregular menstrual periods and polycystic ovary syndrome, who are overweight or obese before pregnancy, or who have previously delivered a baby weighing eight pounds or more.
In GDM, it will also be necessary to check your blood glucose levels by using either a traditional glucometer and pricking your finger to test, or with continuous glucose monitoring. If you have GDM, consult with an endocrinologist who can help you decide on which method is best for you and how often you need to check.
The cornerstone of managing GDM is a proper diet. It turns out that “eating for two” when you’re pregnant is not true. With a proper diet and some exercise, most women will be able to control their blood glucose without medication. About 10 to 20 percent of women with GDM however will need medication, and this includes injecting insulin, which is effective and safe to take in pregnancy. As GDM usually resolves after delivery, mothers will not need insulin after delivery.
Also remember to get an OGTT again six weeks after delivery to make sure that your blood glucose levels have indeed returned to normal. Half of the women who have GDM develop diabetes in the next five to 10 years, and annual testing is recommended to catch this early. To remember that you have to do this test once a year you should do it during the month of your birthday, as a birthday gift to yourself.
Having GDM can be stressful — monitoring, counting calories, and worrying about how this could all affect your unborn baby’s health. Consult with your doctors regularly, ask questions, and educate yourself, because the more you know, the more in control you’ll feel. Don’t be afraid of the diet and all the testing. You are taking the proper steps toward taking care of yourself and your baby.