Misconceptions about Gestational Diabetes
Updated: Apr 15, 2021
*This article is not intended as medical advice*
Almost all pregnant women get screened for gestational diabetes by drinking an overly-sweet drink and having their blood tested for glucose levels an hour later. For most, this is one annoying formality in the pregnancy journey. For others, you get the phone call saying you have to take the three hour blood glucose test. No one enjoys this test. First, you have to fast. Second, you may feel like you are going to throw up or pass out. (I have thrown up and nearly fainted.) Third, your blood gets drawn 3-4 times. Four, you have to stay in the lab for at least three hours. Luckily, many will pass the test and never give it a second thought. However, 6-9% of expecting mothers will be diagnosed with gestational diabetes. (Source) This means they were not diabetic before becoming pregnant, but have now developed the condition in pregnancy. Because less than 10% of women get the condition, there are a lot of misconceptions about it.
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Misconception #1: You only get gestational diabetes (GD) if you are significantly overweight.
It is true that you could be at an increased risk for gestational diabetes if you are overweight prior to pregnancy or rapidly gain over the recommended amount of weight during pregnancy. However, you can get GD at any weight, which is why every pregnant woman is screened, not just "fat" women. In fact, you can be considered obese and not have GD. Hormones are a major factor in GD. The hormones released by your body that help the baby grow make it harder for your body to use insulin the way that it needs to. This causes glucose to rise in the blood. (Source) Below is a picture of me days before I found out I was pregnant with my last son. The same pregnancy which I was diagnosed with GD. I may have been a bit bloated because I was pregnant, but I was not significantly overweight. Read here about a woman who ran 5 days a week and still got the diagnosis.
Misconception #2: I don't eat much sugar so I won't get gestational diabetes.
Eating sugar does not cause gestational diabetes. Having a sweet tooth does not cause GD. In fact, I know plenty of women who downed donuts and all types of baked goods on the regular throughout their pregnancy who had normal blood sugar. As explained above, GD has to do with insulin resistance caused by hormones secreted from the placenta and glucose levels rising in the blood. In fact, I had hyperemesis gravidarum in that same pregnancy, so I could hardly eat anything in the period before I took the blood glucose screening test. So, I definitely was not eating too much of anything. Further, even after I completely cut out sugar and simple carbs, my blood sugar was still high.
Misconception #3: My mom didn't have gestational diabetes, so I won't.
Unfortunately, it doesn't work this way. You may be at an increased likelihood to be diagnosed with GD if your mother had gestational diabetes, but it doesn't mean you will not get GD. Likewise, your mother may not have had GD and you will. In fact, you can be at an increased risk if your father has type 2 diabetes (Source.) My mother did have GD, but her mother did not in any of her 5 pregnancies.
Misconception #4: I feel fine, so I don't need to get the screening. According to the Mayo Clinic, in most women, gestational diabetes doesn't cause noticeable signs or symptoms. (Source) However, keep in mind that doesn't mean you should ignore symptoms you may feel are indicative of GD. Personally, I did experience symptoms like feeling very tired after eating sugar or eating carbs. Excess thirst can be another sign. (Source)
Misconception #5 If you have GD, you just have to cut out dessert. Gestational diabetes diets are very strict. The amount of protein, carbs, fats etc. are strictly laid out for each meal. Always consult your OB and nutritionist before starting any pregnancy diet. For example, for breakfast I was allowed 1 carb, 1-2 proteins and 1 fat. No fruit. No milk. I usually ate 1 piece of whole wheat bread with 1 tablespoon of peanut butter and 1 boiled egg. Don't worry about being hungry though, some plans have pregnant women with GD eating 6 times a day. One plus of the diet is the bedtime snack and sugar free desserts :)
Misconception #6: GD can be cured with diet and exercise. A lot of women can treat GD with diet and exercise. However, the first thing I was told when I sat down with the nutritionist was..."you may do everything perfectly, and you may still have blood sugar levels which may have to be treated with insulin." Of course, I did follow it exactly and I still had to have insulin injections everyday.
Misconception #7: You have to inject yourself in the belly. If you take insulin, you likely do not absolutely have to inject the insulin in your belly. I was allowed to inject into my leg...and my husband did it for me.
Misconception #7: Gestational Diabetes just causes babies to be big and big babies are nice and healthy. It is true that GD can cause babies to be larger than average, which is referred to as fetal macrosomia. The baby may be perfectly healthy, but present safety issues at birth. First, it can be clear the baby is too large to born vaginally and the mother will need a Cesarean, which is a major surgery that necessitates a longer recovery for mother. Second, if a vaginal birth is attempted, it is not an exact science to tell how big the baby is vs how big the birth canal is. If the baby is too big, he/she can unexpectedly experience birth injuries like broken bones, in addition to causing complications for the postpartum mother not limited to genital tract lacerations and excessive bleeding. Or, an emergency C-section could have to take place if the baby gets stuck. An additional concern that was presented to me was that if you induce labor early when the baby is still small, the baby's lungs may not be developed. According to studies, high blood sugar that is not controlled well during pregnancy "may delay fetal pulmonary maturation." (Source)
However, delivering the baby is not the only problem with having a large baby. The baby may be born with low blood sugar, jaundice and be at risk for metabolic syndrome. Still births can also occur with untreated diabetes. Read more about fetal macrosomia here and here.
To conclude, every pregnant woman needs to show up to her glucose screening whether or not you think you have risk factors or symptoms. If you receive a diagnosis of gestational diabetes it does not mean you are overweight or ate too much sugar. It does mean your sugar and carbs are going to be dramatically reduced, but it is a do-able diet. Even if you follow it perfectly, you may still need insulin. You also still may have a larger than average baby, but under the careful watch of your medical providers you can still have a healthy baby and easy delivery. You can see in the pictures below, I had a fairly large baby for my size. He was just two ounces short of 9lbs at birth but his delivery was smooth and uneventful. He did have low blood sugar at birth; it was remedied quickly though with just a few ounces of breastmilk and formula. He also had jaundice for a few weeks, but was otherwise healthy.