Gestational Diabetes Mellitus
While Today is April Fool’s Day, the news below is certainly no joke. Yet another study has reported that low levels of Vitamin D in pregnant women is associated with adverse pregnancy outcomes.
Fariba Aghajafari, MD, CCFP, and colleagues from the University of Calgary in Alberta, Canada, published their findings after performing a systematic review and meta-analysis of the available data online March 26 in in the British Medical Journal. Reviewing data from studies published on MEDLINE, PubMed, Embase, CINAHL, the Cochrane Database of Systematic Reviews and the Cochrane database of registered clinical trials, the researchers reviewed 31 studies and found the following results:
- Low levels of 25-OHD Vitamin D (the best indicator of Vitamin D status in Humans) is associated with increased risk of Gestational Diabetes
- Low levels of 25-OHD Vitamin D is associated with increased risk of pre-eclampsia
- Low levels of 25-OHD Vitamin D is associated with small for gestational age infants.
And these findings are only from this one study! We here at Mamas on Bedrest & Beyond have reported in several of our blog posts the effects of low levels of Vitamin D and adverse pregnancy outcomes. Here is what we have found in the literature to date:
- Low levels of Vitamin D are associated with Post Partum Depression.
- Low levels of Vitamin D are associated with Gestational Diabetes
- Low levels of Vitamin D are associated with Pre-Eclampsia
- Low levels of Vitamin D are associated Low Birth Weight and Asthma in the Baby
We have also found that while current medical recommendations are only 200-400 IU of Vitamin D for daily supplementation, Studies we have seen recommend far more for optimum function (upwards of 2000-4000IU daily).
So what should you do with all of this information? Talk To Your Doctor!! While you may initially experience a bit of push back from your OB, if you bring in these citations, they will take you seriously. Leading medical experts are recognizing the importance of Vitamin D supplementation and noting that the vast majority of individuals in the United States are deficient. Interestingly enough, darker skinned people are at increased risk of Vitamin D Deficiency because Vitamin D is absorbed through the skin from the sun and darker skin protects against penetration from the sun’s rays, so less Vitamin D is absorbed by darker skinned individuals.
Personally, I think that there is a growing body of evidence to support Vitamin D supplementation. The question becomes, at what dose? You will have to discuss this with your doctor. My guess is that optimum dosage may have to be done individually and for that, you may need to have blood levels of Vitamin D assessed in order to figure out how much (if any) supplementation you need.
I warn you now that not all OB’s have jumped on the Vitamin D bandwagon. Many are content to simply prescribe a prenatal vitamin and leave it at that as they, “Don’t believe the hype”. But I suggest to you that if you are at increased risk for any of he aforementioned conditions for which low vitamin D levels increase the risk, then at the very least a discussion with your physician is in order. It may not be the ultimate cure for what ails you, but if it can help you decrease your risk of pregnancy complications and adverse outcomes, a simple pill or 2 a days seems easy enough for your OB to prescribe and for you to take, and there is little to no risk of toxicity or overdose.
Talk with your doctor about your Vitamin D levels and see if you need supplementation. It’s easy, and it may well vastly improve your health, the health of your baby and your ability to have a healthy, full term infant.
A mama with gestational diabetes posed this question to the mama community on a pregnancy website:
Q: Hey all, do any of you have any tips for how I can make my labor and delivery more natural? I have always wanted a water home birth, but with each of my pregnancies (this is my third) I developed gestational diabetes. My first two labors and deliveries were very cold and sterile and highly mechanical. My doctor has already told me that I have to deliver in the hospital, have internal fetal monitoring and if the baby gets too big, that I’ll have to be induced. I called several midwives around town, but because I am on insulin (my blood sugars would soar in the early morning so I take a shot at bedtime).
I really want to avoid as much intervention as possible. I have hired a doula. What else can I do to make my delivery more natural and comforting?
The mamas on this particular website came up with some awesome ideas and I am going to share them here.
You Call the Shots! I was really heartened to hear the mamas in this community encouraging and empowering this mama to stand her ground for as natural a birth as possible. Many suggested that she find a midwife, but when “mama” shared her complicated course and her need for insulin, the mamas agreed that she should deliver in the hospital. However, they gave her sage advice to be very clear on her desires for her birth and to make sure that everyone knows what she wants and is on board to provide that care. One must always remember that the health care staff works for YOU! And while in our current paradigm health care providers often act as if they know what is best for us, in the end, we have the final say as to what treatments we receive.
Make sure that you understand each and every medication, treatment and procedure that is proposed. If you have questions, make sure they are answered to your satisfaction BEFORE you sign any consent form. (Truly make informed consent!)
Have an advocate. This mama was on this, she had already hired a doula. Having someone who knows what you want and who can express your desires if/when you cannot express them yourself is critical. Also, having someone there who is “all for you” is a tremendous emotional boost. This person has to be strong, knowledgeable, able to speak up to hospital personnel and yet someone who will first and foremost have your best health interest in mind, someone who may be able to help translate difficult information so you can make informed health care decisions if necessary. A doula is an excellent option if you don’t have a family member or friend who can take this stand for you, or if you prefer someone without the emotional ties and has some training in this area.
You Can Refuse to be Induced. Now this is a bit sticky. In Gestational Diabetes, there is always the risk of having a larger baby. However, if neither you nor the baby is in distress, there are no complications and you are not post dates, there really is no medically necessary reason to induce. You have the right to a trial of labor. Discuss this you situation with your OB and get the exact, specific reason he/she wants to induce your labor. If you have questions, you have the right to consult with another OB for a second opinion. Just be sure that an induction is truly indicated as it carries with it increased discomfort, the increased likelihood of an epidural, the increased likelihood of you having a c-section and an increased risk of your baby needing intensive care in the neonatal ICU (NICU).
You don’t have to have an epidural. You don’t have to have an epidural. Again, if every thing is progressing without complications or distress, and you feel comfortable and competent to manage your pain, you are well within your right to refuse an epidural.
You don’t have to have an episiotomy. An episiotomy, a surgical cut in the perineum is not necessary. Many OB’s perform this to “prevent tearing”. However, there are methods of perineal massage that allow for natural stretching of the tissue in this area. Most Midwives know these techniques and most OB’s do not. Ask a midwife or doula if they can share methods of perineum softening/stretching to ease delivery.
Make Friends with the L & D staff. If you can, visit the Labor and Delivery floor at the hospital at which you intend to deliver. Chat with the staff. If you can, get a feel for how the nurses care for the patients. The more you know up front, in terms of how the floor is laid out, how the nurses work with the patients and the nurses themselves, the better will be your experience.
Bring things from home to make your surrounds more comfortable and “homey”. Most of the mamas advised that mama bring her own gowns, robes and slippers, candles, music, pillows-anything that she finds soothing and that will make her surroundings feel more like home and less like a hospital room.
We are all well aware that eating too much red meat puts you at increased for cardiovascular disease, strokes, increased long term weight gain and type II diabetes. But now researchers have note that high red meat consumption is also detrimental to pregnant women, putting them at increased risk for gestational diabetes. But there is some good news in all of this. Researchers at the Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Rockville, Maryland report that pregnant women who eat a primarily plant based protein diet have a significantly lower risk for developing gestational diabetes. This study data was published in the February 1, 2013 edition of Diabetes Care.
The researchers analyzed pre-pregnancy food questionnaires for 15,294 women, which resulted in a total of 21,457 singleton pregnancies, including 870 first time gestational diabetics. After adjusting for such confounding factors such as Body Mass Index (BMI), age, number of pregnancies and dietary history (including cholesterol history) they found that red meat intake was associated with a significantly higher risk for development of gestational diabetes when compared with diets high in plant based protein consumption. The authors also looked at alternative animal proteins such as poultry and fish consumption. Diets rich in these proteins also resulted in lower risk of developing gestational diabetes, but even their risks were higher when compared with plant based protein intake.
So how big a deal is red meat versus plant protein intake on the development of Gestational Diabetes? Here is what the researchers actually found:
The substitution of 5% energy (food intake) from vegetable protein for animal protein was associated with a 51% lower risk of GDM . The substitution of red meat with poultry, fish, nuts, or legumes showed a significantly lower risk of GDM.
In plain English, that means that women who ate diets high in red meat had a 29% higher risk of developing Gestational Diabetes. On the other hand, if they decreased their red meat consumption by 5% and substituted nuts for the red meat, they lowered their risk for developing Gestational Diabetes by 51%. This is HUGE!! This risk reduction is even greater than what is seen when red meat is substituted with poultry or fish (which both significantly reduce the risk of gestational diabetes, just not as dramatically as replacing red meat with nuts.)
The researchers also found:
Substituting 1 serving per day of total red meat with a more healthful protein source was associated with a 29% lower risk for GDM for poultry, 33% for fish, 51% for nuts, and 33% for legumes (beans).
These numbers are staggering. Yet they also clearly indicate that small dietary changes can have significant impact on our health. If you have a history of Gestational Diabetes (in a previous pregnancy) or have been diagnosed with Gestational Diabetes, you may want to discuss dietary changes with your doctor and consider exchanging your intake of red meat for other animal proteins (poultry or fish) or for vegetable sources of protein if you consume large amounts of red meat. Even if you don’t consume large amounts of red meat, if you have developed Gestational Diabetes and do eat red meat, you may want to consult with your doctor or a nutritionist about making changes to your diet to improve your sugar metabolism and to stabilize your blood sugars.
Wei Bao, MD, PHD, Katherine Bowers, PHD, Deirdre K. Tobias, SCD, Frank B. Hu, MD, PHD, and Cuilin Zhang, MD, PHD Pre-regnancy Dietary Protein Intake, Major Dietary Protein Sources, and the Risk of Gestational Diabetes Mellitus: A prospective cohort study. Diabetes Care, February 1, 2013