Everything you need to know for a safe and healthy pregnancy
The Vegan Doctor is a UK GP, a practicing vegan and health writer. She is a medical advocate for the vegan lifestyle, breaking down barriers between vegans and the medical profession.
Gestational Diabetes Mellitus ( GDM) is a type of diabetes that either develops or becomes apparent during pregnancy. Before we get into the finer details of GDM, let’s take a quick tour of diabetes in general, to give you a better understanding.
Diabetes Mellitus ( DM) is a group of conditions where there is either reduced insulin production, reduced efficacy of insulin in the tissues, or a combination of the two. Insulin is a hormone produced by the pancreas in response to an increase in blood sugar levels. It works by allowing glucose ( a type of sugar) to enter cells so they can provide energy for the normal functions of those cells. Type 1 diabetes is usually diagnosed early in life, and is a failure of the pancreas to produce insulin, whereas type 2 diabetes results from insulin resistance; insulin is produced but the body’s tissues don’t respond adequately to it. If insulin is either not being produced or not being responded to, then blood glucose levels rise. Raised blood sugar levels are concerning for several reasons; in the short term they can result in severe dehydration, and, when chronically raised, they may cause damage to organs, such as the eyes and kidneys, and to the nervous and cardiovascular systems. Depending on which type of diabetes has been diagnosed, it can be treated with dietary changes, oral medications, or injections of insulin.
GDM is diagnosed in pregnancy, but some who are diagnosed during their gestational period will actually have been diabetic, or at least pre- diabetic, beforehand, but not yet diagnosed. Rates of GDM are on the rise with the increasing rates of obesity. The reason pregnancy puts people at higher risk of diabetes is that some of the hormones that are released have anti- insulin effects in order to make glucose more available to the developing fetus. Most pregnant people will be able to deal with these effects, however, around 5% will either develop GDM or be diagnosed with pre- existing diabetes during their pregnancy. There are certain factors that can increase the risk of being in this 5%, including: a BMI of over 30kg/ m ² , a prior history of GDM or family history of DM, a previous delivery where the baby weighed 4.5kg ( 9.92 lbs) or more, and ethnic origin from a country with a high prevalence of DM, including some African and South Asian countries. In the US, it is recommended to take a glucose tolerance test with all pregnancies, however, in the UK, the test is generally only administered to those considered to be high- risk. The glucose tolerance test involves having one’s blood sugar level checked before and after consuming a glucose- rich drink. This test is carried out between 24 and 28 weeks of pregnancy. If diagnosed with GDM, the mother might be at risk of pre- eclampsia, polyhydramnios ( too much amniotic fluid around the baby) and premature labor. The baby might be at risk of congenital abnormalities, being too large and stillbirth. There are also some complications that can affect both mom and baby during delivery such as failure to progress because baby is too big, and shoulder dystocia, where the baby’s shoulders get stuck in the birth canal, again, because they are too big. This is why it is so important to test for and appropriately manage GDM. Even if the individual is not at risk of GDM, they will still have some screening for it when their urine sample is checked at regular intervals during the pregnancy.
After diagnosis, if the blood sugar is only marginally raised, GDM can be managed with diet and exercise. However, if blood sugars remain high, then a medication called Metformin might be prescribed; there are multiple formulations of this drug that do not contain any animal products. If blood sugar levels are high at diagnosis, or remain high after the above measures have been taken, then insulin will be prescribed. The insulin is injected with a very fine needle into the layer of fat under the skin, and this can be done at home. Most insulin prescribed today is not derived from animals, but make sure to double check.
In the same way that a healthy, plant- based diet can lower the risk of type 2 diabetes, it can also have protective factors for GDM. Healthy, non- overweight vegans will be at a lower risk of GDM, but regular antenatal checks are extremely important in case you develop this condition, so that it can be properly managed to keep mom and baby safe during pregnancy and delivery. It is also important to remember that anyone who is diagnosed with GDM during their pregnancy will be at a higher risk of developing type 2 diabetes later in life, so yearly blood tests should be carried out to screen for it.