Question:
know there was a thread about this recently but my news server is only
letting me see new threads so I can't access it - sorry.
I've just been told that I have GD, I'm 28 wks.
I'm not freaking out (yet) but should I be?
Is this serious?
I've made an appointment to see the nurse and discuss diet and learn how
to test blood sugar. I'm not a fan of unnecessary medical intervention
so if there's an alternative treatment that somoen knows about please
enlighten me.
Answer:
If you don't like unnecessary medical intervention,
my advice would have been to refuse testing ;-)
Basically, there's a lot of controversy over GD.
Just about every major medical group admits that there is
no high quality medical evidence that screening improves
outcomes. The two things that tend to be associated with
GD are macrosomic babies (big babies, where "big" is most
often defined as over 8 lbs 13 oz, even though most women
with GD will not have macrosomic babies and most macrosomic
babies are born to women without GD) and neonatal hypoglycemia
(though at least one study suggests that NH is more
strongly associated with blood glucose levels during
labor than during pregnancy).
Beyond that, there's the question of whether
treatment for GD improves outcomes. There is precious
little evidence that it does. Diet and/or insulin
sometimes make the babies a little smaller, but they
don't reduce the complications typically associated
with macrosomia (e.g., shoulder dystocia, c-section).
So, if treatment doesn't improve outcomes, why do it?
The one thing that *is* consistently reported
by research is that if you are diagnosed with GD, you
are at higher risk for developing type 2 diabetes
later in life. This should therefore be a wakeup
call to get control of lifestyle factors that increase
the risk of type 2 diabetes. The other thing to consider
is whether there's a possibility that rather than having
GD, you're an undiagnosed true diabetic. If you are,
there are greater risks to the pregnancy, though 28
weeks is later than ideal to be finding out about that.
As far as the diet goes, there's not much wrong
with the usual diets recommended for GD as long as they
are not calorie restrictive (some are, so watch out for
that!). The downside, however, is that despite the
fact that there's no evidence to support them, now that
your caregivers know that you have GD, they may start
pushing unwarranted interventions that in themselves
increase risks (like pushing for induction for suspected
large baby).
Personally, given the lack of evidence showing
that screening or treament improve outcomes significantly,
I refuse to be tested (though I encourage women to be
screened while *not* pregnant if they have any risk factors
for diabetes so that they know if they're diabetic and
can get good glycemic control in the FIRST trimester if
they become pregnant).
