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Experts Corner

Perinatal Pathology

Gestational Diabetes Concerns
By Carolyn M. Salafia, MD

Carolyn Salafia, MDQ. I was diagnosed last week with Gestational Diabetes. This morning I spent an hour listening to some nutritionist lecture about fat content in foods and why I should be gaining only 1/2 pound a week. She muttered some things about food exchanges and handed me a pamphlet on my way out. It was not the most productive appointment I've ever had. Every time I ask my doctors about Gestational Diabetes, they tell me that they're concerned because the baby and I will put on too much weight. Nothing else. I need to know if there are other problems that come from Gestational Diabetes besides weight gain. I suffered from anorexia for years and years and worked hard to learn to ignore my scale. Unless someone can tell me that Gestational Diabetes is dangerous for something other than my weight, I know that I won't take this seriously.

A. Gestational diabetes can be dangerous for your baby. Gestational diabetes means that your body will be making lots more insulin in order to control higher than standard blood sugar levels. That combination CAN (but may not, especially if well controlled) cause changes in how the placenta grows and develops and can influence how the baby grows and develops. It can in some people also put more stress on the baby's heart. It can end up putting more stress on your blood vessels and possibly change their ability to supply adequate nutrition to the placenta. I'm not trying to scare you, but you sounded like you wanted someone to give you a good reason to care about gestational diabetes, and I consider gestational diabetes to be more of a problem to the pregnancy than necessarily to you and it doesn't sound like that's what you drew from the lecture from the nutritionist.

As far as the baby putting on too much weight, one problem with that is that the baby can have a hard time getting out of you, and this can require an operation (not a trivial operation, a cesarean section!). It also can put stress on the baby as it tries to get out before the doctors make the decision that it needs help getting out by an operation. That again may not have any long-term implications for the baby, but it is something that, if the stress is preventable, your doctors would like to avoid. Being too big before you're born is part of the process that can end up stressing a heart. Most of the time, whether diabetes is only confined to gestation, the biochemical changes are comparatively mild, and the babies do not show the types of very severe changes that can be seen when diabetes is consistent/chronic/present even when you're not pregnant. However diabetes and gestational diabetes are not completely understood, and again, I think your doctors are not wanting to take any chances, which I think is quite appropriate!

Everything that I've said here is something that YOU can manage taking good care of yourself. I know something about body image issues. I have a congenital osteoporosis condition and when I put on 10 pounds, I break bones in my feet walking. I've agonized about weight, and I have been very angry about having to be so careful for years . . . and it wasn't until after I hit 40 that I started just ignoring the scale, so I know what you are going through, and I understand that it is going to be tough for you to give up the games that you've made as far as ignoring the scale. But it is very important for you to take this seriously. The risks are, in my opinion, less to you than to your child. This is the first, of very many, our adopted twins teach me every day, sacrifices you will make for your child. Take it seriously, and take it into fashion that allows you to balance your needs and the pregnancy's needs. I know that this balance can be achieved, and we are to help talk you through the tough times.

I've tried to be very serious about this, and I really don't want you to overreact, or go to an extreme, now worrying about your baby's safety. I urge you to find a balance. It may involve finding a different nutritionist or different local support. That might be very important, for you to have that local connection throughout your pregnancy. Gestational diabetes is something that can come back the next time you're pregnant, so unless this is your only child, you should prepare yourself.

Keep talking to us, as long as we can be helpful to you, interpreting or giving you support. I'm sure that you are in a circumstance where an ounce of prevention will be more than more than a pound of cure. Take care of yourself and keep in touch.

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