There is controversy in obstetrics about the diagnosis of gestational diabetes and the testing that is done to ascertain which women are at greatest risk. Dr. Michel Odent has written an article GESTATIONAL DIABETES: A DIAGNOSIS STILL LOOKING FOR A DISEASE? which can be viewed online at http://www.gentlebirth.org/archives/gdmodent.html.
Until all the controversy is resolved and a more scientific test can be offered, we are stuck with the glucose tolerance test at 28 weeks gestational age. The mother can look at the list of who is at greatest risk and decide to decline the test if her risk is low.
Women at risk:
– maternal age over 25
– – obese woman prior to pregnancy
– – previous birth of baby weighing over 10# at birth
– – previous unexplained stillbirth at term
– – family history of diabetes (esp. close relatives who became diabetic at a young age
i.e. juvenile onset diabetes)
–previous history of recurrent miscarriages
–extremes of heaviness or thinness
–history of alcohol abuse
–history of anorexia or bulimia
This risk factor screening will only pick up 50% of women who are GD. Therefore, we would be wise to treat everybody “as if” they are GD because the diet and lifestyle changes are good for everyone (preventive health care).
If your client has any of the above factors, urge her to follow a GD diet and exercise program as early as possible and then, if she does take the 28 week test, she will usually sail through it with flying colors.
This doesn’t mean that she can start eating junk food though. I tell my clients that ice cream and chocolate are toxic to unborn babies–there is way too much fat, salt, sugar and caffeine in these products for a baby in utero to cope with.
Whole, organic foods, fresh water, and love are the ingredients to grow a healthy baby.
How can we best serve the health interests of mother and baby?
If you meet your client prior to the 28 week test, you can let her know that she can improve her chances of passing the test by eating healthy, unrefined food for the week preceding the test and exercising every day (a 20 minute brisk walk that elevates her heart rate). You can explain to her that some healthy women who just ate badly (lots of sweet desserts and junk food) prior to the 28 week test have tested positive for risk of GD and then had to undergo the more unpleasant fasting 3 hour blood tests.
If you meet your client after she has been diagnosed as GDM (gestational diabetic mother), I would encourage you to attend with your client at the diabetic clinic where a nurse will give her counseling and nutrition advice. Usually, the woman will be asked to maintain a food diary and daily ‘exercise after meals’ regimen. She will be shown how to test her own blood and may be asked to count the number of times her baby kicks in a 12 hour period.
The philosophy behind the diet is that the GDM needs to control her blood sugar levels at an even rate (also known as staying in the Zone–not getting stuffed or starved) and can do so by “grazing” on small amounts of wholesome food, eaten often.
What foods should your clients avoid?
*sugar (white or brown)
*honey, molasses, syrup, jams, jellies, marmalade
*puddings, Jell-O, fruit yogurts
*desserts—cakes, pies, pastries, iced cookies, etc.
*soft drinks, tonic water
*sweetened condensed milk
*sweet sauces—oyster sauce, teriyaki, plum, sweet & sour, ketchup
Caffeine has been shown to make the body more resistant to the effects of insulin so tea, coffee and all soda pop should be avoided.
Fruit sugar should only be consumed in small portions. ½ a banana, 10 grapes, a small apple are the serving sizes. Milk products are also high in sugar and should be used in moderation according to the advice of a diabetic nutritionist.
Update: June 16, 2015
Nice compilation of articles about Gestational Diabetes by an Australian doula http://www.themoderndoula.com.au/g-is-for-gestational-diabetes/