Nearly every pregnant woman is tested for gestational diabetes (GD) (or gestational glucose intolerance - GGI) at some point during her second trimester. But what constitutes a "normal" blood glucose level during pregnancy and when maternal or fetal morbidity occurs is controversial.

What is evident in cases of confirmed gestational diabetes is that babies grow larger, weighing over 4000g at birth (fetal macrosomia) or are in the 90th percentile for large-for gestational-age (LGA). And that often increases the likelihood of a surgical delivery and newborn monitoring for hypoglycemia. In the long term, these elevated levels appear to contribute to obesity and diabetes later in the child's life and an increase in the risk of the mother developing type 2 diabetes. On average, however, the rate of confirmed glucose intolerance is small and varies among different ethnic groups. Caucasian women are affected 1% to 2%, Afro-Caribbeans 2% to 3%, and Asians 4% to 5%.

The etiology of defining GD as a medical condition began in the 1950s with a study on women with high sugar values during pregnancy. It was "validated" in 1964 when Drs. O'Sullivan and Mahan, medical researchers, performed a 100g 3-hour oral glucose tolerance test on more than 700 pregnant women who were already hyperglycemic. Their study was to determine if these women were at greater risk of developing diabetes in the future. To no one's surprise, they were. And that led these two men to conclude that the "metabolic stress of pregnancy" exposed women to a "pre-diabetic status." But keep in mind, their research subjects had preexisting high blood glucose levels.

They also made an erroneous correlation that since insulin-dependent diabetes is a known risk to developing babies, this "pre-diabetic status" was as well. But their theory is unfounded. Diabetes types 1 and 2 are completely different in their manifestations and dangers than GD (GGI). For instance, both type 1 and 2 may result in blood vessel and kidney damage, the sequelae of which could be hypertension, insufficient circulation to the lower extremities, possible limb amputation and kidney disease. GD carries none of these risks.

Vacillating levels of high and low blood sugar during early pregnancy in type 1 diabetes might cause congenital malformations or miscarriage. Again, none of these serious complications are caused by GD. The only thing diabetes 1 and 2 share with GD is that the excess glucose goes directly to the babies, making them larger than they would be without the elevated blood sugar levels.

During pregnancy, the pancreas usually produces adequate amounts of insulin to regulate blood sugar levels. However, the hormone HPL (human placental lactogen) inhibits the maternal body's ability to transport the insulin properly out of the bloodstream and into cells, where it is used as fuel, resulting in elevated levels of glucose in the blood - or GD. So, in essence, there is more circulating blood sugar which the baby uses to grow and develop. And as pregnancy progresses, this delicate balance between adequate insulin levels and circulating blood sugar becomes trickier. After eating, blood sugar levels rise and by the time the third trimester comes, blood glucose levels are higher after eating than a woman who is not pregnant. (After a night's sleep, excess insulin goes to work to balance out the extra blood sugar, so morning levels of glucose are actually lower during pregnancy than in nonpregnant women - hypoglycemia.)

But there is a difference between elevated blood sugar levels and diabetes. And current research has not determined when high blood glucose levels, just shy of diabetes, cause harm to mothers and their babies. So screening for GD should come with an understanding, by both mother and her care provider, that the results may or may not be an indication of a serious problem.

Women can actively participate in their health during pregnancy by eating healthy, wholesome foods. They can avoid or control GD by consuming a diet rich in whole foods, high protein and high complex carbohydrates. They can start by eliminating empty calories - soda, white flour, white sugar, fructose and limit sweet desserts. Any food with a sugar content of more than 6 grams (read the label) should be accompanied by a protein source. Milk, often recommended by care providers for the necessary calcium it provides, and yogurt are filled with (milk) sugar and lactose is known to increase blood sugar levels. So consuming excessive dairy products might be contributing to high glucose values.

When eating cereals, the protein and fiber content should be more than 5g per serving and there should be less than 10g of sugar. One third of protein should come from complex carbohydrates. A glycemic index will help some women make healthier choices. And think color when it comes to food choices - the more varied and deeper the pallet, the healthier meals will be.

Clients with GD can still enjoy the benefits of massage. However, it is important to remember that massage, in general, lowers glucose levels. So you have to make sure your client's blood sugar level doesn't get too low, which can lead to impaired judgment and potential accidents. By providing your clients with a nourishing snack, it will raise their blood glucose level enough to get home safely where they can enjoy a healthful, wholesome meal.

Resources

1. Fraser DM, Cooper MA, Myles Textbook for Midwives, 14th Edition, Churchill Livingstone, Edinburgh, 2003.
2. Goer H, "Gestational Diabetes", www.ivillage.com/gestational-diabetes, 1999.
3. Goer H, "Gestational Diabetes: A Common Sense Approach", www.ivillage.com/gestational-diabetes-common-sense-approach, 1999.
4. Goer H, "Gestational Diabetes: The Emperor Has No Clothes", The Birth Gazette, Spring 1996, Vol. 12 No.2.
5. Haas AV, "Don't Risk Yourself Out of a Homebirth - Prevent Gestational Diabetes", Midwifery Today, No. 93: 43, Spring, 2010.
6. Lowy C. "Diabetes and pregnancy", Medicine:25(7): 57-58, 1997.
7. Mitchell M. "Gestational diabetes: a controversial concept", British Journal of Midwifery, 91:26-34, 2001.
8. Stillerman E, Prenatal Massage: A Textbook of Pregnancy, Labor, and Postpartum Bodywork, St. Louis, Mosby, 2008.
9. Virjee S, Robinson S, Johnston D G, "Screening for diabetes in pregnancy", Journal of the Royal Society of Medicine 94:502-509, 2001.