Simple steps can prevent diabetes before, during pregnancy

 

By: Dr. Linda Gaudiani | March 4, 2014.

A young woman sat in my office a couple of years ago with a puzzled look on her face. I'm a diabetes specialist; she didn't have diabetes.

"I'm not exactly sure why my doctor referred me to you," she said. "There's nothing wrong with me."

The reason was simple. This young woman was hoping to have a baby and her physician was concerned that she might be at high risk of gestational diabetes mellitus. Her mom, who shares the same primary care physician, suffers from diabetes that has taken a heavy toll. So the doctor had identified her patient's significantly higher risk of developing the condition during pregnancy.

A growing number of pregnant women are developing gestational diabetes mellitus, which first comes on during pregnancy, even if they've never previously been diagnosed with diabetes. In fact, it affects about 7 percent of all pregnancies, and even in our relatively healthy corner of the world, it's a significant problem.

During pregnancy some women develop high blood sugar, or glucose, levels. One reason may be the hormonal changes in pregnancy, but additional factors play a role. Those factors include obesity, inactivity and ethnic, or genetic, backgrounds that place some patients at higher risk. I see more cases of gestational diabetes mellitus every year, and most of the time patients have no symptoms of typical diabetes.

The good news is that gestational diabetes mellitus can be prevented even before a woman becomes pregnant, through diet modification, moderate exercise and stress reduction. And those steps before and during pregnancy can reduce a woman's lifetime risk of developing diabetes - as well as her baby's risk of obesity and more significant health complications.

I'm particularly grateful to the primary care doctor who recognized both a potential threat to his patient, and an opportunity to help her and her family develop healthier habits that will reap long-term rewards. That doctor understood that the desire to become pregnant can be a huge motivator for patients who previously found it hard to listen to advice about adopting healthier lifestyles. Women are often far more likely to take action when they realize they can positively affect the health of their babies.

One thing I've found, however, is that it is important for the entire family to be onboard. The first thing I did was encourage the patient's whole family - husband, parents and siblings - to take classes to help them understand the benefits of regular exercise and healthy eating. This helped them support the patient when she became pregnant six months later, and also benefited them directly through encouraging a healthier lifestyle.

I've found that many people don't realize the seriousness of gestational diabetes mellitus. Undiagnosed and uncontrolled early gestational diabetes can cause heart or other birth defects in the baby, or even a miscarriage. Later in pregnancy, babies exposed to high glucose levels can gain excess size and body fat which may result in a C-section delivery and increase post-delivery complications. And after delivery, a third to a half of mothers with gestational diabetes mellitus will go on to develop Type II diabetes. Their babies also may have a significantly increased lifetime risk of becoming overweight, obese or developing diabetes.

Fortunately, this story has a happy ending.

My patient had a healthy pregnancy with no complications, thanks to the steps she took before and during pregnancy. She took my advice and consulted our nutritionist, and also began walking with her husband 30 minutes most days. Now, they take those walks pushing a stroller containing their beautiful little girl.

Dr. Linda Gaudiani is an endocrinologist and diabetes specialist who has practiced in Marin for 28 years. She is medical director of the Braden Diabetes Center at Marin General Hospital.

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