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Gestational Diabetes: Plan & Prepare for a Healthy Pregnancy

Melissa Dobbins November 16, 2011 2:30 PM This chat has ended. Thank you for participating.
Angela (Moderator) - 2:15 PM:
Welcome! Today’s chat: Gestational Diabetes: Plan & Prepare for a Healthy Pregnancy will begin shortly. Please start submitting your questions and Melissa Dobbins, CDE, will begin answering them as soon as we get started. While you are waiting for the chat to begin, feel free to visit the Diabetes section to obtain more information. We will do our best to answer all of your questions, but because this is such a popular chat, the physician may not be able to answer all of your questions in the time allowed. Your understanding is greatly appreciated.

Erin (Evanston, IL) - 2:29 PM:
I am 22 weeks pregnant and just found out that I have developed gestational diabetes. Do this mean that I will have diabetes after giving birth? Will my baby and I both be at greater risk for diabetes in the future?

Melissa Dobbins (NorthShore):
Most women will not continue to have high blood glucose after delivery - but about 5-10% will. We recommend a follow up test around 6 weeks after delivery. You and your baby are at risk for developing diabetes in the future. About half of all women will go on to develop diabetes later on after pregnancy.

Diana (Evanston, IL) - 2:32 PM:
Gestational diabetes seems to run in my family. If this is something that I will develop will I need to take diabetes medication or insulin during my pregnancy?

Melissa Dobbins (NorthShore):
Many women can control their blood glucose levels through diet alone during pregnancy. However, if they are eating the right amount and the right kind of carbohydrates throughout the day and their blood glucose levels are too high, then we recommend medication.

Crystal (Evanston, IL) - 2:33 PM:
I just found out I have GD. I don't have a family history of diabetes, am not overweight, eat healthy and exercise often. What causes GD and what are some of the complications?

Melissa Dobbins (NorthShore):
Risk for GDM include family history of Type 2 DM, obesity and high risk ethnic groups such as Indian. During pregnancy, the body's insulin needs double then triple. Some women can make the extra insulin and use it well, others have trouble "keeping up" with those demands or tend to be a little more insulin resistant. Complications of GDM include larger babies which may cause delivery complications. Some babies may also have low blood sugars at delivery because their pancreas is working so hard to put out extra insulin. That is a short term problem. However, those babies are more likely to develop diabetes later in life.

Kate (Chicago, IL) - 2:37 PM:
My mother gave birth to large babies (at least 9 pounds). I do not believe she had gestational diabetes, but I could be wrong. Are larger babies a sign of gestational diabetes? Is this something that I should be concerned about when I'm pregnant?

Melissa Dobbins (NorthShore):
Yes, babies larger than 9 pounds could be a sign or risk for GDM. However, some babies are just large - especially if the parents are tall/large. It's impossible to go back and determine if your mother really did have GDM, so you may want to be more aware of your diet and exercise to help prevent GDM.

Kelly (Evanston, IL) - 2:38 PM:
How will my diet change during my pregnancy? What steps should I take into consideration for a healthy baby?

Melissa Dobbins (NorthShore):
It's very important to meet with a registered dietitian who specializes in diabetes during pregnancy. The diet is different from non-pregnant women. Due to the hormones during pregnancy we pay extra attention to the amount and types of carbohydrates at breakfast, and we choose a bedtime snack that has the right combination of carbs, protein and fat to help stabilize the blood sugars over night and help produce a better fasting blood sugar in the morning. All pregnant women should aim for "nutrient-rich" foods in the diet and make sure to have snacks between meals. A great nutrient-rich food shopping list can be found at www.nutrientrichfoods.org .

Candice (Chicago, IL) - 2:41 PM:
My spouse and I are trying to conceive. I am diabetic and wanted to know what I can expect from my pregnancy. What resources are available?

Melissa Dobbins (NorthShore):
It is especially important for someone with pre-existing diabetes to work with an Endocrinologist and diabetes educators to get their diabetes in very good control prior to conception. High blood glucose during the initial weeks/months of pregnancy can cause serious birth defects that we don't usually see with GDM due to the timing of the high blood glucose and what organs are developing at that time.

Becky (Skokie, IL) - 2:43 PM:
Can anything be done to prevent gestational diabetes?

Melissa Dobbins (NorthShore):
If you have a strong family history of diabetes, you may not be able to prevent it. However, following a healthy, nutrient-rich foods diet and avoiding a lot of "excess" carbs, along with being active every day, can help to decrease your chances. And those are the steps you would be recommended to take once you were diagnosed anyway.

Beatrice (Skokie) - 2:44 PM:
I am a vegetarian and have gestational diabetes. What are some good protein alternatives for me?

Melissa Dobbins (NorthShore):
It can be a little more challenging to control blood sugars on a vegetarian diet since many of the protein sources are also carbohydrates (such as beans, dairy). However, it certainly can be done. Being a lacto-ovo vegetarian helps because you include dairy and eggs. Strict vegans have a little more challenge. Great non-meat protein sources are: eggs, milk, cheese, yogurt, beans, lentils, nuts, seeds, tofu, soy beverages, cottage cheese. Grains also provide some protein - breads, rice, etc.

Matthew (Evanston, IL) - 2:47 PM:
My wife has gestational diabetes. What do I need to know about caring and helping her?

Melissa Dobbins (NorthShore):
Many of my patients bring their husbands along to their appointments - so you may want to consider this as a way to show your support. There is a lot to juggle sometimes, especially if there is medication involved. Just the diet alone, along with monitoring blood sugars can sometimes be overwhelming. You can help your wife by offering to do the grocery shopping (and following what is on the list!) and helping to prepare some meals. Also, if you're so inclined - go on the diet "with" her - only you may need more calories than she is eating. Simply asking her what you can do to support her is a huge step.

Rebeka (Chicago) - 2:50 PM:
At what point do I need to get my doctor involved if I think I have gestational diabetes? Are there varying treatment options?

Melissa Dobbins (NorthShore):
You should always be working with your doctor if you have questions or concerns. If you think you have GDM - discuss your concerns and your history with your doctor and maybe he/she will decide not to wait until the typical glucose tolerance test around 24 weeks. The treatment is pretty much the same for all - try diet and monitoring blood sugars first - if that doesn't work, add medication.

Christy (Evanston, IL) - 2:52 PM:
What screening is necessary to determine if I have gestational diabetes?

Melissa Dobbins (NorthShore):
Around 24-28 weeks, most women will take an oral glucose tolerance test. Depending on the results, further testing may be required. The testing criteria may be changing in some facilities due to new research study called the HAPO study.

Jason (Little Rock) - 2:54 PM:
On the topic of vegetarian. Is it considered healthy to be on a freshly juiced vegetable/fruit diet for most meals when pregnant?

Melissa Dobbins (NorthShore):
We recommend that our pregnant patients avoid fruit juice during pregnancy. We find that our patients can more easily control their blood sugars if they do. Certainly, you would want to include more than just veg/fruit juice such as whole grains, protein and calcium-rich foods such as milk or yogurt.

Allie (Glenview, IL) - 2:56 PM:
What are the best ways to count my carbohydrates when planning for meals? How often do you recommend I check my blood sugar?

Melissa Dobbins (NorthShore):
Counting carbs is a very useful tool. First you need to know what foods contain carbs and what foods do not (i.e. eggs). Then you need to know how much you're aiming for at a meal or snack. The best way to count carbs accurately is to look at the food label. First check the serving size and then check "total carbohydrates" NOT the "sugars" (because that does not include all the carbs). If you are only on the diet and no medication, we typically recommend checking your blood sugars 4 times a day (before breakfast and one or two hours after meals). If you're on insulin we would typically recommend checking 6 times a day (before meals and after meals).

Deb (Lincolnwood, IL) - 2:58 PM:
Will I be able to breast feed if I have gestational diabetes?

Melissa Dobbins (NorthShore):
Absolutely - diabetes does not affect the ability to breastfeed.

Meg (Highland Park, IL) - 2:59 PM:
What tests are done to monitor my baby and to make sure that she is safe despite my GD?

Melissa Dobbins (NorthShore):
You should talk with your doctor to find out what tests, such as non-stress tests, they want to do. They will measure the baby's growth as they do in all pregnancies, too.

Liz (Chicago, IL) - 3:02 PM:
When does gestational diabetes develop? Why is it something that doesn’t happen on the onset of pregnancy?

Melissa Dobbins (NorthShore):
GDM doesn't usually develop until around the 24-28th week of pregnancy because that is when the insulin needs have double or tripled. Earlier in the pregnancy, the insulin needs are not as high, and in fact, go down around the 12-14th week. However, any diabetes that develops during pregnancy is called "GDM" even though it may mean someone has Type 2 DM if it develops early enough.

Kim (Evanston, IL) - 3:05 PM:
What resources are available? Are there any community groups that meet about this topic?

Melissa Dobbins (NorthShore) - 3:10 PM:
For more information about GDM and resources, check out my TV segment from last weekend on ABC 7 Chicago. You can view the website article below the video which includes links to resources. http://abclocal.go.com/wls/story?section=resources&id=8429482

Carmen (Chicago, IL) - 3:11 PM:
Once you have gestational diabetes, will you have it with all future pregnancies as well? I had it with my first child.

Melissa Dobbins (NorthShore):
We do usually see GDM come back in all subsequent pregnancies, but not 100% of the time.

Kathleen (Evanston, IL) - 3:12 PM:
How will gestational diabetes affect my lifestyle? Are there specific changes I will need to make?

Melissa Dobbins (NorthShore):
The amount of change depends on what your current lifestyle is like. If you are active already, no changes there. If you tend to skip meals and drink a lot of sugary beverages, there will be some pretty big changes just in eating 3 meals and 3 snacks and avoiding sugary drinks. Specific changes would be based on what you are already doing. Check out the website article I posted for an idea of where is a good place to start with your diet.

Helen (Evanston) - 3:15 PM:
Are other there conditions that affect gestational diabetes? If so, how?

Melissa Dobbins (NorthShore):
I'm not sure I understand your question. Do you mean risk factors for GDM?

Helen (Evanston) - 3:17 PM:
I meant both GDM risk factors and other health concerns. I have high blood pressure and asthma as well.

Melissa Dobbins (NorthShore):
Risk factors include obesity, family history of Type 2 DM, high risk ethnic groups (african american, hispanic, asian and american indian), history of PCOS, having impaired fasting glucose. Having high blood pressure and asthma do not directly affect the GDM itself, but do affect the mom's health and therefore may impact the baby's health if not well controlled.

Angela (Moderator) - 3:19 PM:
Thank you everyone for your great participation. The chat will be ending in approximately 10 minutes. Please submit your final questions.

Irene (Chicago, IL) - 3:20 PM:
I am overweight and trying to get pregnant. Am I at a greater risk?

Melissa Dobbins (NorthShore):
Being overweight is one risk factor, but if you don't have a family history of diabetes and are not in a high risk ethnic group (see previous answer), you may not have as much of a risk.

Janice (Skokie) - 3:21 PM:
I am having a really hard time sticking to a diet and measuring everything I eat. Do you have any tips?

Melissa Dobbins (NorthShore):
Yes! First of all - you should not have to measure everything you eat. If you measure it once, and use the same dish/plate/bowl/cup, then you can eyeball it instead. You may want to measure from time to time to make sure your portions aren't "growing". People who have a hard time sticking to the diet sometimes are being unneccesarily strict. The more you learn about food choices and carb counting, the more options you have. A registered dietitian can work with you to do some creative problem solving. I just had a patient this morning who has GDM and she's finding it hard to eat more than 2 times a day due to her schedule. We talked for about 5 minutes and came up with easy things she could plan ahead for grab-n-go meals and snacks.

Dawn (Chicago) - 3:25 PM:
Will taking insulin increase my risk for having diabetes after pregnancy?

Melissa Dobbins (NorthShore):
Taking insulin itself does not increase your risk for diabetes. It is merely supplementing the insulin your body is already making (in GDM). However, if you NEED insulin during pregnancy, that may mean you are more insulin resistant in the first place and may have a higher risk of developing Type 2 diabetes after pregnancy.

Lori (Chicago) - 3:27 PM:
How long will it take for the hormones that cause gestational diabetes to leave my system? How long should I wait until being tested for Type 2?

Melissa Dobbins (NorthShore):
We recommend being tested about 6 weeks after delivery.

Melissa Dobbins (NorthShore) - 3:29 PM:
Food safety is very important during pregnancy since you are more susceptible to food borne illness. See this website for information about Listeriosis. One third of all cases are in pregnant women. Make sure you choose pastuerized dairy products and heat all meats until steaming hot. http://www.americanpregnancy.org/pregnancycomplications/listeria.html

Tina (Evanston, IL) - 3:29 PM:
Is my baby at risk for developing diabetes? What can I do after delivery if I have gestational diabetes?

Melissa Dobbins (NorthShore):
Having diabetes during pregnancy does increase your baby's risk of developing diabetes later in life. The goal is to control blood sugars very well during pregnancy to mimic non-diabetic levels and therefore decrease any risks associated with diabetes during pregnancy. After delivery you should make sure to have your glucose levels checked around 6 weeks post partum. If you still have diabetes, it would be Type 2. Diet and exercise after delivery are about the same as during pregnancy, but you may need more calories if you're breastfeeding. You also would have more flexibility at breakfast because you wouldn't have the pregnancy hormones affecting you then.

Angela (Moderator) - 3:32 PM:
Thank you again for participating in our chat today. For more information please visit our Diabetes section . Also, a transcript of this chat will be available shortly.

Melissa Dobbins (NorthShore) - 3:32 PM:
Visit this website to learn more about avoiding mercury during pregnancy: http://www.americanpregnancy.org/pregnancyhealth/fishmercury.htm

Angela (Moderator) - 3:37 PM:
Check out more answers on Gestational Diabetes from NorthShore University HealthSystem on Sharecare.
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