This pregnancy risk is on the rise and has doctors worried

The rate of pregnant women with gestational diabetes rose 30 percent between 2016 and 2020, according to a new report by the Centers for Disease Control and Prevention (CDC). The rapid increase in cases has obstetricians alarmed because gestational diabetes has negative health effects on both the mother and her baby.

OB/GYN Paul DeMeo, MD, has definitely seen an increase in cases in his practice at Cape Obstetrics & Gynecology in Falmouth and Bourne, and the reason is simple, he said.

“The incidence of gestational diabetes has increased over the years because of the increasing obesity rate in the country,” he said. “So, we’ve seen a large increase in the percent of patients that have gestational diabetes and, subsequently, the complications that can result from that.”

Dr. DeMeo advises women who want to become pregnant to use diet and exercise and even the new weight loss drugs like Wegovy, if necessary, to lose any excess weight before they attempt to become pregnant. He said it’s not unreasonable to spend a year or even two getting your weight down to an appropriate number, but he did caution that pregnant women should not take any weight loss medications once they are actively trying to become pregnant.

“Maintaining a normal body weight and exercising four to five times a week for about 50 minutes can help prevent you from developing gestational diabetes,” Dr. DeMeo said. “But it needs to be done preconception. The time to do that isn’t when you are pregnant, although it’s important to exercise and follow an appropriate diet during pregnancy. But if you are already obese and sedentary going into the pregnancy, it’s going to be difficult for you to manage that risk at that point.”

Other Causes

Although obesity is the main reason for the increase in gestational diabetes, Dr. DeMeo said there are other causes too, including:

• Having gestational diabetes in a previous pregnancy
• Having a family history of diabetes
• Belonging to certain ethnic groups
• Having polycystic ovary syndrome
• Living a sedentary lifestyle
• Having hypertension

The Dangers

Dr. DeMeo listed a multitude of dangers that gestational diabetes poses, including:

• Having a large baby
• Shoulder dystocia, which is an obstetric emergency where the shoulder becomes stuck during birth
• Stillbirth
• Cesarean section or an operative vaginal birth with forceps or a vacuum
• High blood pressure during pregnancy
• Low birth-weight baby
• Neonatal hypoglycemia (low blood sugar), which can cause seizures or neurological injury

Routine Screening

Normally, all pregnant women are screened for gestational diabetes with a 50-gram glucose test between 24 and 28 weeks of pregnancy, Dr. DeMeo said. For the test, the patient drinks 50 grams of a sugary liquid and then gets a blood test an hour later.

Obstetricians will screen patients earlier in the pregnancy if a patient has any of the risk factors. If the value is under 135, it is determined that the patient doesn’t have gestational diabetes. If the number is 135 or higher, they then have a three-hour test to determine if they actually have gestational diabetes.

Treatment

If a patient does have gestational diabetes, changing her diet is the first course of action.

“We have them meet with a diabetes educator who will sit down, review their caloric needs and then prescribe a diet for them to follow,” Dr. DeMeo said. “The patients then check their finger sticks (while) fasting and one hour after breakfast, lunch and dinner, and they keep a log of that. If, after two weeks of doing that, their glucose levels are elevated, then they may get started on insulin.”

Insulin injections are the first choice of medication because it’s easier to control glucose levels with insulin than with oral medications. But if a patient is either unwilling or noncompliant with the use of insulin, some doctors will prescribe Metformin.

“In our practice, probably five percent or so of patients end up needing to go on insulin,” Dr. DeMeo said. “About 95 percent of people are successful at controlling their glucose levels with diet. That’s our population. I think the figure is lower nationally, but on the Cape, it’s better.”

Patients with gestational diabetes, or are at risk for it, are assured they can ward off or address the condition, and go on to have a successful pregnancy and a healthy baby, he said.

“You can’t change your genetics, but you certainly can make an impact on your weight by eating a proper diet and getting plenty of exercise so that you can minimize your risk of developing gestational diabetes.”