Gestational Diabetes: A Particular Problem for Mamas on Bed Rest

January 29th, 2010

Gestational Diabetes (GD) can be particularly problematic for mamas on prescribed bed rest. Previously a common indication for bed rest, with all of the medical advances and therapies most pregnant women who develop GD are easily managed as out patients. Unfortunately, women who are prescribed bed rest for another medical condition are at increased risk for developing GD as a result of inactivity and weight gain. Women who develop GD are at increased risk of developing Type II diabetes later in life as well as Metabolic Syndrome.*

Gestational Diabetes is defined as impaired (improper) glucose metabolism during pregnancy. Some women become insulin resistant, meaning that the insulin their bodies produce does not properly carry glucose from the bloodstream into the body’s cells as it should. Sometimes GD develops  because a woman has gained too much weight, a common cause of insulin resistance. Other times the increased hormones of pregnancy interfere with glucose metabolism.  Finally, a woman with a genetic predisposition to diabetes may manifest her first symptoms during her pregnancy. This woman is at increased risk of developing Type II diabetes later in her life.

Testing for gestational diabetes is typically done between 20 and 28 weeks of pregnancy. The normal ranges of blood glucose are:

  • 70-95 mg/dL  Before breakfast (fasting)
  • 70-140 mg/dL  1 hour after eating a meal
  • 70-120 mg/dL  2 hours after eating a meal

Women who have blood sugars that fall above these ranges during testing will be diagnosed with GD. It is essential that women diagnosed with Gestational Diabetes are treated aggressively and that they achieve and maintain tight blood sugar control. Blood sugar control is essential to ensure the health of both mother and baby. When blood sugars are not controlled during pregnancy, Some unfortunate complications can result such as:

  • High blood pressure in the mother caused by preeclampsia
  • Excessive birth weight  (exceeding 9 pounds, 14 ounces)or Macrosomia
  • C-section delivery
  • Hypoglycemia (low blood sugar) in the baby at birth
  • Jaundice (yellow skin) in the baby at birth
  • Respiratory distress syndrome (breathing difficulties) in the baby at birth
  • Low blood calcium levels in the baby at birth
  • Red blood cell disorders in the baby at birth
  • In very rare cases, stillbirth of the baby at 28+ of pregnancy
  • In very rare cases, death of the baby in infancy
  • Increased risk for type 2 diabetes in both mother and baby later in life

Treatment of Gestational Diabetes is actually quite simple. From many women, adherence to a “diabetic diet”,  a regular exercise regimen and regular blood sugar testing are all that is needed. However, for many other women, blood sugar cannot be adequately regulated and controlled with diet and exercise alone, so they are prescribed oral medications or Insulin injections.

Unfortunately most pregnant women on prescribed bed aren’t able to exercise enough reduce insulin resistance with diet and exercise alone. However it is still very important, perhaps even more so, that they follow the dietary instructions from their OB or a nutritionist and that they stretch and do some muscle strengthening and toning while in bed. If women on bed rest are diagnosed with gestational diabetes, they should request a referral to a physical therapist or exercise specialist** so that they can learn safe exercises that they can do while on bed rest.

It may seem unfair to be diagnosed with gestational diabetes while on bed rest for another condition. Try not to become too discouraged. Gestational Diabetes is easily managed and with careful adherence to your obstetrician’s directions, you and your baby can be just fine.

**Bedrest Fitness is a set of simple yet effective modified prenatal exercises that a pregnant woman on prescribed bed rest can do from her bed with her obstetrician’s approval. Order Bedrest Fitness here.

Please share your comments or questions on this post below.

3 responses to “Gestational Diabetes: A Particular Problem for Mamas on Bed Rest”

  1. Amy Romano says:

    This is an important issue, and I’d like to add just one anecdote from my friend’s personal experience. She was prescribed strict bedrest for bleeding placenta previa. After a week or so of being stable in the hospital, she was discharged home for more strict bedrest. A few days after that, she had her first office visit with her OB and it was at this visit that she had the one hour glucose test. This was literally the first time she had been out of bed except to go to the bathroom in nearly two weeks and she was sweating bullets with absolute terror that she was going to bleed. Plus, since she had been cared for by midwives up to the initial bleeding episode, she was entering an unfamiliar office setting. She failed the 1hour test miserably (nearly reaching the cut-off to not even bother with the 3-hour test). We know that acute distress mobilizes glucose and I suggested to her that her fear and anxiety may have contributed to her test result. Indeed, she retook the 1 hour test under better circumstances several days later and got a normal finding.

    The screening tests for gestational diabetes have high false-positive rates in the first place, and I suspect that this may be exacerbated in women experiencing bedrest, especially if they have to “break the rules” of the bedrest prescription in order to obtain the test. I think women on home bedrest should be able to get home care for routine things like blood draws.

  2. Darline says:

    I couldn’t agree with you more. I think that this scenario further drives home the point that women on bed rest are forced into artificial circumstances and as a result their entire anatomy and physiology will be thrown off. Thus, trying to apply “standard” tests in an unconventional situation is just asking for their results to be abnormal, thus inviting in even more “drama”. The literature is still controversial regarding the benefit of prescribed bed rest, but since we have no other alternative therapies, it will still be prescribed. Hopefully, now that more physicians and researchers are beginning to really look at the efficacy of bed rest and alternative therapies, more suitable and effective therapies will emerge.

  3. I couldn’t agree with you more. I think that this scenario further drives home the point that women on bed rest are forced into artificial circumstances and as a result their entire anatomy and physiology will be thrown off. Thus, trying to apply “standard” tests in an unconventional situation is just asking for their results to be abnormal, thus inviting in even more “drama”. The literature is still controversial regarding the benefit of prescribed bed rest, but since we have no other alternative therapies, it will still be prescribed. Hopefully, now that more physicians and researchers are beginning to really look at the efficacy of bed rest and alternative therapies, more suitable and effective therapies will emerge.

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