Bittersweet (Part 1) - Long-term risks to moms and babies

Being diagnosed with gestational diabetes can be a shock, but it cloud also turn out to be a long-term boon for you and your baby

Besides being an “older” mom

Cecilia Paetsch had no risk factors for gestational diabetes mellitus (GDM, or high blood sugar during pregnancy). “I thought it was really only a concern for obese women, and my weight wasn’t an issue,” says the 35-year-old attorney from Northbrook, 111. “I was also pretty conscientious about what I ate, and somewhat consistent about exercise, so I figured I was in the clear.” Paetsch’s preg­nancy was normal and routine—until she was diagnosed last year with GDM at week 25.

Regular exercise can keep GDM in check

Paetsch is one of a growing number of women being diagnosed with GDM, which the U.S. Centers for Disease Control and Prevention reports now affects 2 percent to 10 per­cent of expectant women. In 2011, the American Diabetes Association endorsed lowering the threshold for diagnosis, but most OB-GYNs are still utilizing the old standard. If the proposed new criteria are used, the number of women diagnosed with GDM could jump to 18 percent—nearly 1 in 5, says Mark Landon, M.D., chairman of the department of obstet­rics and gynecology at The Ohio State University Wexner Medical Center in Columbus.

GDM develops when hormones from the placenta compromise a woman’s ability to use the insulin produced by her pancreas. Though most women compensate by produc­ing extra insulin to break down glucose (blood sugar) for energy, some can’t; their excess glucose builds up in their blood and passes through the placenta to the fetus. Recent stud­ies indicate GDM can have long-term consequences for mothers and children and that it poses risks at lower blood-sugar levels than previously thought, says Landon, the lead author of a large 2009 study published in The New England Journal of Medicine that demonstrated clear benefits to treating even mild cases of GDM.

Long-term risks to moms and babies

A GDM diet includes plenty of fresh produce

In many pregnancies affected by GDM, the baby absorbs the moth­er’s glucose and grows bigger than he or she should, and a Cesarean section is often necessary. In others, the baby is underdeveloped and has a low birth weight. Babies born to mothers with GDM may also have problems with breathing, low glucose levels or jaundice. After delivery, the mom’s blood sugar levels typically revert to normal, but according to a study of nearly 10,000 mother-child pairs, this may not be the end of the story for either mom or baby.

Researchers at Kaiser Permanente Center for Health Research in Portland, Ore., and Hawaii found that the higher a mother’s blood sugar was during pregnancy, the more likely her baby would be over­weight by age 7. “Quite a few studies have shown that if you’re over­weight at ages 5 to 7, you’re much more likely to be overweight as an adult,” says endocrinologist Teresa Hillier, M.D., the study’s lead author. Hillier found an increased risk of childhood obesity even among GDM babies who weren’t large at birth. “To me, that suggests something has been metabolically changed that allows the baby to more easily store fat,” she says.

Among women diagnosed with GDM, 50 percent will develop type diabetes within five to eight years, and 70 percent to 85 percent will develop the disease during their lifetimes, says Boyd E. Metzger, M.D., a professor of medicine and endocrinology at Northwestern University Feinberg School of Medicine in Chicago (see “Life After Gestational Diabetes,” pg. 37). The National Diabetes Education Program and the American College of Obstetricians and Gynecologists recently joined together to state that women who have GDM (as well as their chil­dren) should be followed closely after childbirth to monitor—and minimize—their risk of developing diabetes.

In addition, a 2012 study published in the journal Circulation found that having had GDM boosted a 50-year-old woman’s 10-year heart disease risk by 26 percent. Researchers suggest that women with GDM might need to have their blood pressure as well as their blood sugar checked more regularly as they get older.