Gestational Diabetes – My biggest bugbear

As a midwife with a special interest in Gestational Diabetes, one of my biggest bugbears is the early discussion around having a balanced diet during pregnancy – or should i say the lack of early discussion!  Simply stating ‘you need a balanced diet’ is just not enough, yet i found this is mainly the extent of discussion women had with either their Midwife or GP. Then of course you get to 28 weeks (or thereabouts) and have a glucose tolerance test, results come back high – it’s not easy to undo, not easy to un-diagnose but could this be different with more information/education?  The answer in a lot of cases is simply yes!!

 

The most common phrase i hear following a diagnosis is ‘I’ve cut out/down on all the sugary stuff in my diet’….’Well that’s great, but what about carbohydrates, what changes have you made?’ would be my reply and more often than not a puzzled face would be looking back at me. It’s always at that point my heart would sink.  If only they had remembered that Carbohydrates turn into glucose, if only they had been told to think about their portion sizes, if only they had been shown a visual of a ‘healthy plate’ right from the start of their pregnancy.

 

I ran antenatal classes specifically for people diagnosed with GDM. I would play a game – scales, pasta, rice, cereals.  We all know the recommended portion sizes right? We all know what that portion size looks like right? All the portions sizes for the above mentioned are the same right?…..WRONG! I would get the women and/or their partners to pour out what they thought a portion should be…9 times out of 10 the portions sizes were 2-3 times more than they should have been (sometimes more).  Rarely did someone know the correct portion amount. The first line of ‘treatment’ is diet control – one of the first things i advise is being aware of portion control/size. So many times women go away make small changes to their diet, return within a couple of weeks with normal levels – BUT at this point can i safely say that GDM was misdiagnosed, even if there are no other signs at all, even if baby is within normal ranges on a growth scan?  Sadly not, the evidence is too ‘muddy’. Once diagnosed, consultants are not fans of un-doing and will proceed cautiously, even if levels have improved to normal levels, Baby is a ‘normal size’ (i hate this term) they will still continue to treat you for GDM, IOL (induction of labour) will be recommended according to your trusts policy, rarely will someone question it or look at the bigger clinical picture and question as to whether it is really needed and therefore the IOL rate rises, interventions rates during birth rises, outcomes – both physical and emotional are affected and the ‘plans’ during future pregnancies will be affected.   

 

Now of-course I’m not saying that Gestational diabetes is easy to sort out – it isn’t, it’s tricky and can have serious consequences if not treated/controlled.  But what I am saying is with a little more education in early pregnancy we can change the journey of some women and their families. It isn’t just people with Diabetes or Gestational diabetes that need to be aware of this either, it’s all of us!  Being more aware of the sugars, carbs, fats, proteins in our diets and educating others around us will help in the long term. It will help us reduce the incidence of developing type 2 diabetes and the consequences that can bring later in life, and improve our health generally.  It’s also a matter of fitness and activity, it all works together, but to start we can talk about the basics and start at the very beginning with HEALTHY EATING and understanding our food labels and content of foods we are consuming. In turn this will all have an impact of the rest of your family and the people around – you can influence, take control and have an impact not only on your life but on others around you too.  

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