So I will admit right now that I am a bit of a Geek*.  Love, Love, Love to read. I have a favorite book of all time (Jane Eyre). A favorite modern fiction (The Time Travelers Wife). Favorite text books (tie Speroff and Gabbe).  I have also have a favorite journal: the Journal of American Congress of Obstetrics and Gynecology (ACOG) which is fondly nick-named the “Green Journal” by OB/GYNs (because its green… hey we’re not the most creative bunch out there).  ACOG  sets the standard of care for OB/GYN in the United States, so when my Green Journal comes each month I always get a little excited, tearing off the plastic wrapper to see what new studies or recommendations have come out this month.  I must admit though, these last several months I have been approaching the Green Journal with trepidation, for I fear change is a comin’ in the field of gestational diabetes and I know it will not be a easy transition.

One of the issues with studying gestational diabetes (GDM) is that there has been no global standard on how to diagnose it.  Each country uses a different test to diagnose it, therefor studies done in one country could not be applied to patients in another.  However, last year results from a huge study  involving 25,000 women in 8 different countries was released that looked at GDM and had them all use the same diagnostic criteria: a fasting 2 hour 75 g glucose load, requiring 3 blood draws.  The study was excellent and showed that by implementing this different diagnostic protocol, there was a significant reduction of bad outcomes such as preeclampsia, shoulder dystocia and neonatal admissions to the NICU.  That was very exciting.  But then when you read the fine print, it revealed that under these new criteria the number of people who would have the diagnosis of GDM would be doubled, approaching  17% . Ouch.  I realized this was not going to make my patients happy: to make them all do a more annoying test and to tell twice as many of them that they have gestational diabetes.

When I read these statistics initially, my first thought was, “How can 17% of the population have gestational diabetes?” One of the biggest risk factors for gestational diabetes, though, is obesity.  In American 30% of the population fall in the obese category with 1 in 10 Americans being diabetic or pre-diabetic.  Since gestational diabetes is often a precursor to overt diabetes, perhaps these numbers are not so surprising after all. The good news in the study was that the majority of these patients were able to control their diabetes with diet and exercise instead of insulin, which is encouraging.

Currently several national organizations have endorsed the guidelines, however so far ACOG has remained silent.   I’m pretty sure it just a matter of time until I open up a Green Journal and read a committee opinion that recommends changing to the new more stringent criteria.  Though I will most likely hear some grumbling at first from both patients and staff, I think once implemented, the new criteria should help improve the health of both mother and baby. And that’s what matters most.

*This is perhaps a good quality for a doctor to have

Dr. Rupe

I went into my first pregnancy about 30 pounds overweight. I remember being so afraid the effects of pregnancy would tip the scales (literally) to obesity and utter misery. I made it through the first trimester only gaining a couple of pounds but I figured the worst was yet to come.

I have a condition called PCOS (Polycystic Ovarian Syndrome) which makes me insulin resistant. Ironically, it’s one of the reasons I’ve struggled with weight (that and the fact that I love sweets).  The placenta takes over at around 12 weeks in pregnancy so PCOS patients get tested for Gestational Diabetes at the end of their first trimester because the placenta releases a hormone that makes the pregnant woman even more insulin resistant.

Testing for Gestational Diabetes involves the patient drinking a sugary drink (Glucola) and then having their blood drawn an hour later. This typically happens at around 27 weeks. Again, for PCOS patients the test is done much earlier in their pregnancy due to their already being insulin resistant. If you fail the initial test, a 3-hour confirmatory test is then completed. It involves a fasting blood draw, then drinking the Glucola drink and then a blood draw 1, 2 and 3 hours after you finish the drink (I know this process intimately because I participated in it just this morning).

I can remember the day of my first pregnancy that I received the dreaded call with my glucose screen results. I hung up the phone and cried. Then I called a girlfriend and she said the most amazing thing, “Jess, I think this is going to be a gift from the Lord.” I had no idea how right she was. I visited with a nutritionist and she put me on an eating plan. If I followed the plan and monitored my blood sugar (by pricking my finger 4 times a day), I could avoid insulin shots.

My plan was simple. Normally, people should have around 20 servings of carbs per day (a serving = 15 grams). For those of us with gestational diabetes (GD) we could have 13 servings. In addition to limiting my servings, it was important that I had them at certain times of the day (to spread things out) as well as cutting out fruit before noon as fruit sugars are harder to process in the morning.

So my eating plan looked like this:

Breakfast – 2 servings of carbs, protein, no fruit

Snack – 1 serving of carbs, protein

Lunch – 4 servings of carbs, protein, veggies (some veggies are carbs)

Snack – 1 serving of carbs (fruit)

Dinner – 4 servings of carbs, protein, veggies, maybe fruit

Snack – 1 serving of carbs

After 6 months on this regimented, yet doable plan I felt better than I had felt in years (even 9 months pregnant). One of the dangers of GD is how it effects the baby’s size so Dr. Rupe kept close watch on our little one throughout those months and she seemed to be growing just fine. Dr. Rupe also assured me that the decrease in calories would not have a negative effect on the baby if I focused on eating the right things and kept taking my prenatal vitamins.

In May 2008 right before I delivered Hope I weighed exactly what I weighed when we conceived her. I had not gained a pound. Hope was born a very healthy 6 pounds, 11 ounces. After the delivery (ok, a few days later when I braved the scale), I weighed 20 pounds less than when I got pregnant. This truly was a gift from the Lord for me.

I am sorry to say that I went back to my old ways shortly after I delivered (what with the stress of being a new mom and all) so I’ve gained most of that weight back. As I await the results of my screening this time, I am filled with mixed emotions. I would love the chance to lose the weight again. Not that I couldn’t have done it on my own in the past 2 years but some of us just need a little incentive for these things. But I also want nothing more than to make sure my baby is safely growing inside of me. I know the Lord is holding this baby together in his hands and I trust him no matter what comes my way. If I have GD (which I most likely will), then I will count it as the grace of God giving me a second chance to get healthier. If I do not have it, then I will thank the Lord for not allowing something that could possibly effect the baby and I will ask him for the grace to be purposeful and disciplined to get healthier.

If you find that you do have GD, I hope that you can look at it as an opportunity to finish your pregnancy well so that both you and your baby will be as healthy as possible after delivery. {Most women will not actually lose weight due to GD. That was most likely due to the fact that I was diagnosed so early on and stayed on the plan for 6 months.}

I would love to hear from you if you have had GD in the past or you have it now. How did you deal with thediagnosis? What worked for you?

{Update: March 19, 2012 I did not have GD with my second pregnancy. I even passed the initial screen! Which supports the fact that every pregnancy is unique.}