hi everyone we are the doctors bjorkman i am a pediatrician and i am an ob gyn and this week
we are talking all about gestational diabetes what is it what's a glucola how do i know if i have it
yeah so if you're pregnant be sure to stay tuned for the rest of this episode as we're
gonna be talking about some testing that you will be sure to go through during the second trimester
right after this thanks for joining us if this is your first time meeting us i'm sarah and i'm
an ob gyn and i am also 27 weeks pregnant and i'm kurt her husband and i'm a pediatrician
and we thought it would be fun and also just great for everyone if we could share
all the advice we've been giving to patients over the past few years as
well as what we're learning or going through pregnancy the very first time ourselves yes
so there's a couple you know big appointments that happen during your prenatal care and that first
one is kind of around 11 to 13 weeks when you have that first ultrasound for your genetic screening
um at the 20-week mark you have your anatomy scan and then somewhere between 24 and 28 weeks you are
going to have that dreaded glucola test where they screen for gestational diabetes this is
going to be a really big episode where we dive into diabetes in pregnancy which is incredibly
common we're going to talk about the testing for that um what that means for you as mom
and stay tuned to the end too because we're gonna talk about all how this changes kind of weight
management in pregnancy with extra screening needed for baby late in that third trimester
so what is gestational diabetes so gestational diabetes is diabetes that develops during
pregnancy the placenta produces some different hormones like placental lactogen prolactin
progesterone and some others that cause some moms to become carbohydrate intolerant during pregnancy
those hormones are very important for the fetus to make sure they're getting enough nutrients
but sometimes it can cause issues for mom gotcha as it is about six percent of pregnant women in
the us will get gestational diabetes and just like as is true in kind of non-gestational diabetes
the rates of gestational diabetes are higher in certain ethnic populations notably it's more
likely to be higher in women who are of african american descent hispanic american native american
pacific islander or even east and south asian women more so than in women of caucasian descent
and the numbers are increasing which we suspect is because moms are getting older as well as the
increasing rates of obesity in the us so why do we care about gestational diabetes there are a lot
of reasons actually women who have gestational diabetes are more likely to get pre-eclampsia
and are more likely to end up with a c-section importantly studies have shown that women who have
gestational diabetes are at an extremely increased risk of getting diabetes in the future
predominantly type 2. studies have shown that up to 70 of women who have gestational diabetes
will go on to get regular diabetes within 30 years of their pregnancy i think it's also important to
note that gestational diabetes or diabetes of any kind in mom can also put baby at risk it's
been associated with increased risk of baby being too big or macrosomic having issues with low blood
sugar after birth having issues with birth trauma getting stuck in the birth canal shoulder dystocia
congenital birth defects and even increased risk of still burning yes and studies have
shown that fetuses that are exposed to a mom in utero who has diabetes is at an increased risk
as a child of being obese and getting diabetes themselves and that is independent of their weight
or other risk factors because of all of these potential complications to mom and baby with
gestational diabetes your ob gyn is going to want to know do you have diabetes because it's been
shown that really good control of blood sugar can reduce the risk of all of these potential
consequences to mom and baby right and so that is where the screening with the glucolates is going
to come in so most women are going to undergo screening sometime before between 24 and 28
weeks however acog recommends earlier screening if you are overweight or obese and have at least
one of these risk factors shown here some of those being physical inactivity first degree
relative with diabetes hypertension pcos a history of cardiovascular disease all reasons your doc may
screen you earlier in pregnancy if you don't have any of those extra risk factors you will
likely be screened between weeks 24 and 28 weeks of pregnancy as is a standard for all pregnancies
and so that is done with the glucola test glucola is a 50 gram glucose solution that you drink one
hour after you drink it your blood is drawn to test your blood glucose level and if you are if
your blood glucose is under a certain number you usually don't want 130 to 140 depending on your
hospital then you pass you don't have gestational diabetes if your blood sugar is above 130 to 140
then you have to do another test it's called the three hour glucose tolerance test to see if you
in fact have gestational diabetes alright so 27 weeks and it was officially time
for my glucola um i'm a real weirdo and like the glucola throughout my time as an ob gyn i have
tried the variety of flavors and the lemon lime is my favorite the orange is totally gross um
so if you get the orange i'm sorry um but i looked out and i got lemon lime
shot that delicious little cocktail down and one hour later they drew my blood sugar and i
was under 140. i did have an attending in residency who always told us that you should
eat scrambled eggs before you did your glucola it's voodoo but i followed that recommendation
um and passed so that was fun i do want to say um i know lots of thin people who fail their glucola
um it isn't about how skinny you are the placenta just affects those placental hormones just affect
some women differently um and i've seen many skinny minis fail their glucola if you
fail you have to do the three hour glucose challenge glucose tolerance test which is
really miserable you have to go in fasting drink an even bigger drink and then they check your
blood sugar at one hour two hours and three hours and so there's four values and if two of those are
off then you fail and you have gestational diabetes so i hope for you that you
pass the first time with flying colors but know that it's common and it can be treated
and i hope you get the lemon lime so if you fail this three hour glucose tolerance test then you
are diagnosed with gestational diabetes but if you get this diagnosis it is not the end of the world
it does mean though that your ob gyn is going to want you to get treatment to help reduce the
risk for all those complications of mom and baby that we've talked about already it has been shown
again that with good glucose control blood sugar control that you can drastically reduce the risk
of complications for mom like hypertensive disorders preeclampsia the risk of c-section
risk of shoulder dystrophia and decreased risk for babies and things like macrosomia or big baby and
birth trauma along the way with good treatment so now you're wondering what is the treatment for gdm
and the answer is specific diet changes as well as exercise if diet and exercise are not enough
then we add medication but what are the diet and exercise recommendations well the first step
is going to be glucose monitoring so your doctor provider is going to want you to check
your blood sugar at home four times a day the first time being in the morning when you wake
up before you've eaten anything or fasting and then again one to two hours after breakfast
lunch and dinner yeah and this can seem like a lot but there's actually some good logs or apps that
you can use for this something called glucose body can be really helpful and if you're scared
don't be worried like this is something that your ob gyn deals with all the time they likely have
a nurse educator or even a diabetes educator that can help you kind of learn the ropes of
this very new testing and thing for you once your blood sugar control is under a bit better stable
control you may be able to reduce some of your testing from that four times a day to less often
if diet exercise is working well for you but you should count on at least needing to test
at least twice a day once you have that diagnosis of gdm the american diabetes association and acog
recommend specific values for your glucose levels and so fasting levels in the morning before you
wake up we want to be under 95. if you're testing one hour after your eat we want it to be under 140
and if you're testing two hours after you eat then you want it under 120. your provider is
probably going to want to see the values in your log about once a week if those numbers are
up abnormal or above that range we're looking for they might want to be reviewing it more frequently
it's safe to assume that with a diagnosis of gestational diabetes you're way more comfortable
checking your blood sugar levels but once you have that down and with having that down there's going
to be all the other changes that happen too yeah so we know that women with gestational diabetes
have a carbohydrate intolerance so the mainstay of treatment is diet changes as well as exercise
the goal of these diet changes is still to make sure that you know mom is getting an adequate
amount of nutrition as well as baby growing and developing appropriately there are specific
nutritional recommendations for meals that we will cover right here so studies have shown that
if your diet is composed of as 50 to 60 carbs that you are more likely to have an increased
weight gain as well as postprandial hyperglycemia or your blood sugar being high after you eat so we
the recommendation is to bring your carbohydrates down to 40 percent of your total calories
your protein is 20 percent of your calories and then fat is about 40 percent of your calories
it's also recommended that you get your carbohydrates from complex carbs
as opposed to simple carbs and complex carbs are things like vegetables and whole grains
additionally this is recommended that you do three meals and two snacks to divide that up
and your total calories that you should be consuming is going to be based on how tall you are
your current weight and your current bmi and that is something that the diabetes nurse educator or
nutritionist will go over with you when you're kind of making this new meal plan for women who
are overweight or obese with gestational diabetes moderate intensity activity is recommended
to help improve blood sugar control and so these recommendations are 30 minutes of moderate
intensity aerobic exercise at least five days a week or 150 minutes per week in total you can also
walk for 10 to 15 minutes after each meal can help bring down some of that postprandial post-meal
high blood sugar levels so the big takeaways for exercise are walk for 10 to 15 minutes after each
meal and get 150 minutes of exercise moderate intensity every week yeah and that 150 minutes
a week goal may sound really familiar to you as we talked about exercise in pregnancy back in
the first trimester um you can see that video linked here and this we talked about pregnancy
and exercise for all women if your gestational diabetes is able to be controlled with diet and
exercise alone it is called a1 gdm yeah but if diet and exercise aren't enough then it's not
a1 gestational diabetes and you're going to need to be started on a medication and that medication
is insulin so insulin is an injectable medication that is safe for mom and the fetus because it does
not cross the placenta i know the thought of an injectable medication is a little bit
daunting but again your doctor nurse educator diabetes educator is going to sit down with you
and explain all of the equipment and make sure you understand everything that is needed in terms of
how to draw up your dose when you need to take your dose timing all of those things if you need
medication to control your diabetes that is called a2 gdm those are just some terms you may see
a1 versus a2 a1 diet and exercise a2 medications one question you may have is if there's any oral
medications you could take to treat gestational diabetes and the answer technically is yes however
insulin is the first line recommended medication so in addition to all of these things we've
talked about blood sugar control if you have gestational diabetes there's going to be some
other things they're going to play into your care and care of baby during pregnancy starting around
week 32 your ob gyn is likely going to want you to come in for weekly testing and these
are going to be things like an ultrasound and a non-stress test and the ultrasound is to look
at fluid around the baby and then to see how the baby's growing in size yep and for the nst
they your doctor or nurse is going to hook up a monitor to put it on your belly and it watches
the baby's heart rate for about 20 minutes now studies have not shown an increase in stillbirth
in women who have really well controlled a1 gdm so your practice may not require this monitoring
before 40 weeks however it's very practice dependent so just talk to your doctor about what
they prefer another thing you may have heard about or may be questioning is how does gestational
diabetes change the timing of delivery and the answer is it depends on what type of gestational
diabetes you have and how well controlled it is for women who have well controlled a1 diabetes
unless they have some other indication don't need to be delivered before 39 weeks and most providers
will let you go until about 40 weeks and 6 days if you have really well controlled a2 diabetes
so you're taking insulin by your blood sugars are really well controlled the recommendation
is to make sure you're delivered sometime between 39 and 0 and 39 weeks and six days now there is
expert opinion supporting early delivery of baby for women who have poorly controlled gestational
diabetes and this is largely to reduce the risk of stillbirth in these women who have trouble
controlling their blood sugars while pregnant exactly um you know and most of this is thought
to be best between 37 weeks gestation and then 39 weeks reserving earlier delivery between 34
and 36 weeks only for women who fail intensive inpatient management of their blood sugar exactly
it's also very likely that your doctor is going to want to do a growth ultrasound between 34 and 36
weeks just to get an idea of how big your baby is because we know that women with gestational
diabetes are at an increased risk of having bigger babies and having a shoulder dystocia so if that
ultrasound shows that your baby might be bigger than four and a half kilograms or 9.9 pounds
your ob gyn is likely to discuss the possibility of a scheduled c-section as well as kind of the
risks and benefits of choosing that versus doing a normal vaginal delivery it's really important
to know that your carbohydrate intolerance usually will resolve with delivery once that placenta is
gone but studies have shown that between 15 and 70 percent of women who had gestational diabetes
go on to develop diabetes usually type 2 within 30 years because of that the american diabetes
association and acog recommend screening at your postpartum visit and that's going to be a two hour
glucose screening test and then additionally they recommend screening for diabetes every one to
three years in women who had gestational diabetes so that was a really intense in-depth dive into
all things gestational diabetes yes and so if you find yourself with this diagnosis of gestational
diabetes i know it can feel overwhelming but don't panic your ob team is here for you there is a team
of nurses and dietitians and diabetes educators who do this every day and are there to help you
and support you have a healthy pregnancy and learn how to control your blood glucose i know
the finger sticks to check your blood glucose seems like a lot insulin injection seems like
a lot but i promise you you can do it and by the end of pregnancy you are going to be a pro
at all of those things yeah so just hang in there and if you have any other questions for us please
feel free to leave them in the comments below we try to get to those as best as we can and please
don't forget to hit subscribe so you can catch all the great information we've got planned for our
very own third trimester of pregnancy and maybe yours too yes we will see you next week bye guys
we're doctors but not your doctors anything we've said in this video
is for education or entertainment purposes only it is not medical advice
any specific medical questions you have should be directed to your provider