Miami fashion designer Lisu Vega has always been health conscious. Up at 5 a.m. and active throughout the day, Vega, 35, was doing well through her second pregnancy when she learned at 24 weeks that she had gestational diabetes.
Gestational diabetes happens when blood glucose, or blood sugar, levels are too high during pregnancy. While changing hormones and weight gain are part of a normal pregnancy, the changes can sometimes lead to insulin resistance, which brings on high glucose levels.
In a typical person, obesity can lead to insulin resistance, said Dr. Ernesto Bernal-Mizrachi, chief of the Division of Endocrinology, Metabolism and Diabetes at UHealth – University of Miami Health System. “In pregnancy, the hormones that are increased induce a resistance to insulin, so the pancreas has to work harder and produce more insulin.”
This can bring on problems for the mother and child, both during pregnancy and later in life.
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“The risk during pregnancy is primarily hypertension and pre-eclampsia,” said Dr. Anthony Lai, a maternal fetal medicine and obstetric gynecologist with South Miami Hospital Center for Women & Infants. “Also, risk of cesarean section is increased, because of the increased risk of large babies.”
Babies born from gestational diabetic or diabetic mothers tend to be big, Bernal-Mizrachi said. “This happens because during diabetes in pregnancy a woman’s high glucose levels go into the baby,” which causes the baby’s pancreas to produce more insulin, which spurs growth.
In the long term, offspring of gestational diabetics have a higher risk of developing diabetes later in life, and are more prone to obesity. “It could be a genetic predisposition being passed to the baby. As with any patient susceptible to diabetes, they have to be aware of avoiding obesity,” he said.
Gestational diabetes also puts women at a greater risk for developing diabetes as they age.
“One out of four women who develop gestational diabetes will develop Type 2 diabetes,” Bernal-Mizrachi said.
Look at the big picture, said Dr. Adrian Roznowski, an obstetric gynecologist with Mount Sinai Medical Center, and Vega’s physician.
“Family history is very important. If you have diabetes in your family, you are at risk. We look at BMI, body mass index and weight,” he said. “Certain populations — including Latinos — are at a higher risk. The risk also increases as you age, because usually you gain a couple of pounds every year, and you may have other health issues.”
Gestational diabetes in a previous pregnancy also increases risk.
“If someone is at risk, a diabetes test can be done early in the pregnancy, before 24 weeks,” Roznowski said. “Also if someone is obese, if they have had gestational diabetes that wasn’t evaluated after the last pregnancy, we may do a glucose test during the initial visit.”
The mainstay is diet and lifestyle modification, in the form of exercise, Lai said. “Most patients with gestational diabetes, about four out of five, will respond to a change in diet,” he said. “About 10 to 20 percent of patients will need other interventions, such as medication — including insulin.”
One way to alter the diet is control the number of calories taken in. Another is changing the type of calories, by reducing carbohydrates, he said. “It’s best to eat smaller meals — on average three meals and three snacks,” Lai said. “It sounds like a lot, but when the calorie count is reduced, each meal is pretty small.”
Women at higher risk for gestational diabetes are counseled to maintain proper diet, exercise and weight gain, Roznowski said. “It needs to be reinforced a little stronger with women who put themselves at risk, because the risk for gestational diabetes or Type 2 diabetes, aside from the family history, is largely acquired.”
In general, you shouldn’t eat too little or too much, Bernal-Mizrachi said.
“Shoot for balanced nutrition,” he said. “You want to avoid excessive weight gain.”
How an expectant mother eats can have far-reaching effects, Bernal-Mizrachi said. He studied how nutrition in pregnancy can affect a child’s future health, using animal models. “We found changes in nutrition in pregnancy can make permanent changes in genes that will affect susceptibility to diabetes,” he said.
About 6 to 12 weeks after the baby is born, if a woman had gestational diabetes, it is recommended that they be screened for diabetes, Lai said. This would typically happen at the post-partum visit.
“Some women may have had diabetes before pregnancy that was previously undetected,” he said.
Keeping weight under control can help lessen future risk, he said. “Obesity is a big problem that plagues us in the United States, and if the patient does not lose weight between pregnancies then the risk of gestational diabetes in subsequent pregnancies is very high,” he said. “On the other hand, if they meet their goals and maintain a healthy weight, then their risk level will fall.”
When Vega was diagnosed with gestational diabetes, she met with a nutritionist to tweak her diet. “One of the problems when you’re Latin is you eat a lot of carbs. I love bread. I love pasta. I love rice, but I really like to eat healthy, too.”
She began to eat smaller meals, cut down on carbs and sugar, and combine carbs with vegetables and protein.
At 36 weeks in mid-November, she was maintaining her active lifestyle, still working in her fashion studio, exercising an hour a day and closely monitoring her glucose levels.
“I’m feeling so healthy right now,” she said. “When your glucose is high, you always have to be worried, because you don’t know what’s going to happen. But if you control that, everything is good.”