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Complete Pregnancy Care Addresses Gestational Diabetes

Nov 29, 2022, 12:20 PM by GoodHealth Magazine


Expert Medical Care for Women: Obstetrics & Gynecology and Diabetes Education

Doctor with woman and new baby

Meg Parker first learned she had gestational diabetes at her visit with  OB/GYN physician Meghan Wallman, MD during her 24th week of pregnancy.  Spiked numbers on her glucose tolerance test identified the need for a closer  look, and subsequent tests revealed the diagnosis. This news surprised Meg since  neither she nor anyone in her family ever had diabetes. The only possible red  flag was perhaps her frequent thirst. ”Naturally it felt a bit alarming at first. I wondered if this condition could have been prevented, but I learned that I had done nothing wrong, and that we  could manage it,” says the 35 year-old.  Gestational diabetes does not generally cause noticeable signs other than weight  change, fatigue, excessive thirst or more-frequent urination. Symptoms usually  dissipate after delivery. Dr. Wallman tests all of her patients for gestational diabetes  between their 24th and 28th week of pregnancy, following a recommendation  from the American College of Obstetricians and Gynecologists  (ACOG) because the symptoms marking  this type of diabetes are quite common.

Gestational diabetes occurs when hormones from a woman’s placenta  decrease her response to insulin. Women  who are African American, American  Indian, Asian American, Hispanic  or Latino, or Pacific Islander are at a  higher risk. Women who have diabetes,  prediabetes, a family history of diabetes,  polycystic ovary syndrome (PCOS,) are  overweight, are inactive, over age 35, or  have previously delivered a baby over  9 pounds are also at a higher risk for  gestational diabetes. Left unchecked,  the condition can increase the risk of  hypertension, preeclampsia and type 2  diabetes. It can also increase the possibility  of a C-section delivery, yet most women  with the condition are able to deliver their  babies vaginally. The growing infant can  be affected as well, since the condition  can elevate the risk of breathing problems,  obesity, premature birth and type 2  diabetes. There is also a risk of stillbirth  in women whose gestational diabetes is  poorly-controlled. For this reason, Dr.  Wallman will sometimes recommend  additional ultrasounds or antenatal testing  close to the due date to monitor the well- being of the baby.

A study published this summer by the Centers for Disease Control and  Prevention (CDC) showed gestational  diabetes in pregnant women is on the  rise, with cases increasing 30% between  2016 and 2020. Some obstetricians link  the sharp increase during COVID-19 to  people’s more sedentary lifestyle, and  added physical and emotional stress. “I  agree this could be a factor,” remarks Dr.  Wallman. “While we do not know exactly  why some women get gestational diabetes  and some don’t, being pregnant early in the pandemic was scary and stressful  for many women. Many of my patients  started working from home or were not  able to exercise the same way as before.”

OB/GYN Physician Assistant Heather Merrick explained to Meg how this  condition might impact the rest of her pregnancy. Heather regularly encourages  those with gestational diabetes to first try diet and lifestyle changes to regulate  insulin levels before medications or injections are considered. The OB/GYN  staff connects patients to Sansum Clinic’s  diabetes education team right away, and  to Clinic endocrinologists when needed.

“We know this can be difficult for patients to navigate and we have limited time to get control of it, so having a plan in place early is helpful,” comments Dr. Wallman. Heather invited Meg to join Sansum Clinic’s health education class for those with gestational diabetes. The expectant mother began using a home glucose monitor to test her blood sugar after every meal, recording the results on her cell phone. She also attended a virtual class for patients with gestational diabetes led by diabetes educator and dietitian Nicole Almanza, RD, CDCES.  In these sessions, Nicole explains what’s happening in the body, and how to test,  track and record blood sugar readings  from many types of monitors. She offers support on exercise, reading nutrition fact labels and managing diet changes  amidst regular pregnancy ailments like nausea and vomiting. Nicole also tailors her recommendations for each patient  using guidelines from leading diabetes, nutrition and clinical endocrinology associations. “Every person entering this program starts with an abundance of information,” describes the educator. “I try and promote a sense of reassurance and calm, and encourage them to reach out if they find themselves struggling.”

Meg’s subsequent one-on-one visits with Nicole taught her to fine-tune her meal  plans, and to handle her blood sugar elevations with more confidence. “I thought of myself as someone who eats  healthy, but in pregnancy, it’s hard in the  first trimester. I felt like I only wanted  cereal and mac ‘n’ cheese. What was helpful  was understanding that I needed to keep  a certain level of protein and carbs per  meal,” she explains. Diligent habits led  Meg to successfully manage her diabetes  and in the end, she delivered a healthy  8 pound, 12 ounce baby boy with her  husband, Matt, and Dr. Wallman by her  side. “My experience with Dr. Wallman has been extremely positive. She told me exactly what I needed to know and I trust  her,” shares the new mother. Meg intends  to carry her healthy awareness and good  eating habits with her during her maternity  leave, and when she returns to her job  as an attorney at a small, local law firm  where she handles complex employment  litigation. “It is good to be mindful in this  stage of life,” she admits. Meg’s persistence  paid off, according to Nicole. “Though I am the provider of support and knowledge, it’s the patients who do the hard work, and they amaze me with what they are  capable of,” says Nicole. Dr. Wallman and  her staff are always working to streamline  and improve the relationships between the  Clinic departments caring for women with  gestational diabetes so everyone shares  information and is on the same page. “I am lucky to work with so many amazing people dedicated to helping women have  the healthiest pregnancies possible,”  concludes the obstetrician.


**Sansum Clinic patients who have been diagnosed with gestational diabetes can request  information on these free health education  classes from their OB/GYN provider.

Photo caption: (left to right) Nicole Almanza, RD, CDCES, Meg Parker,  son, Paul Hofer, and Meghan Wallman, MD, FACOG