Nov 29, 2022, 12:20
by
GoodHealth Magazine
Expert Medical Care for Women: Obstetrics & Gynecology and Diabetes Education
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