When Amy Abramowitz was 28 weeks pregnant with her second son, her doctor performed a routine glucose test and discovered she had gestational diabetes.
Once, this might have been an alarming diagnosis, fraught with potential risks. Mothers who suffer from the condition, triggered by hormones that make the body resistant to insulin, have a 35 to 60 percent chance of developing lifelong diabetes within 10 to 20 years, according to the National Institutes of Health. And babies born to untreated moms can suffer major birth defects to the brain, heart and spine.
But through universal screening and new knowledge about aggressive treatment, moms and babies can all end up healthy.
“It’s all about patient compliance,” said Abramowitz’s doctor, Dr. Larry Spiegelman, an obstetrician with Baptist Hospital in Kendall.
Surprisingly, gestational diabetes has bucked the national trend. Among the general population, the rate of diabetes has become epidemic with the increasing rate of obesity, climbing from 0.95 percent in 1958 to 6.95 percent in 2010, according to the Centers for Disease Control and Prevention. Type 2, the most common form, usually strikes adults and is often the result of fat in the body preventing it from properly using insulin to convert sugar to energy. Less prevalent is Type 1 diabetes, in which the body makes too little or no insulin, which typically develops in childhood.
In 2008, researchers from Kaiser Permanente found that the rate of pre-existing diabetes in pregnant women increased from 1.3 percent to 1.82 percent for every 100 births.
But gestational diabetes, that is, diabetes triggered by the placenta producing hormones that fight insulin, has remained steady at about 7 percent.
“They’re very different. The disease process is the same, but the ramifications are different and the causes are different,” Spiegelman said.
Until the 1980s, doctors only screened selectively for gestational diabetes, said Dr. Gene Burkett, a University of Miami/Jackson OB/GYN, who specializes in high-risk pregnancies and is a professor at the Miller School of Medicine. Then studies began to surface showing babies being born with the same features as those born to diabetic mothers, he said. That prompted doctors to switch to universal screening, typically between the 24th and 28th week of pregnancy, to ensure that cases were not being missed.
Now the American College of Obstetricians and Gynecologists recommends that all pregnant women be screened using either patient history, risk factors, or by administering a glucose test.
While research has shown that obesity is clearly related to Type 2 diabetes, Burkett said gestational diabetes is more likely handed down in families.
“It is true that it’s accentuated through things like obesity and … high blood pressure,” he said. “But the cause may be very, very genetic.”
Abramowitz, 33, was not completely surprised by the diagnosis. Her mother had gestational diabetes when she was pregnant with her brother. And Abramowitz is hypoglycemic. What surprised her was that she was already on medicine to prevent preterm labor since her first son was born at 23 weeks, 10 days after her water broke. Now 18 months old, he weighed just one pound, three ounces, and spent three and a half months in the neonatal intensive care unit. But Spiegelman said her gestational diabetes was completely unrelated.
“I said why did I get this? Wasn’t that enough?” she said.
Spiegelman immediately referred Abramowitz to a nutritionist to discuss a diet. Hoping to find a diet more in line with what she already eats, Abramowitz then decided to meet with a second nutritionist.
“The nutritionist worked with my lifestyle and tailored the diet around that and helped me with what goes into the diet, rather than just saying eat this amount of proteins and this amount of carbs,” she said.
While she doesn’t mind the food covered by the diet, she has been struggling with the amount: three meals plus two to three snacks.
“When you’re pregnant and getting bigger and bigger, you don’t want to eat so much,” she said.
In addition to testing her sugar throughout the day, every morning she must check her urine to ensure limiting her carbs is not causing her body to literally start attacking itself in search of other sources of energy. Sure enough, Abramowitz developed this condition, called ketosis, but remedied it by changing her carb intake.
Like most women with gestational diabetes, she has been able to control it through diet alone. A small percentage of women will need to take insulin or other medicine that spurs insulin production, Spiegelman said. And of those, anywhere from 20 to 50 percent will end up being diabetic for life, according to the NIH.
Those women need to be retested six weeks after they deliver “to see if they are truly diabetic,” Spiegelman said. “We know being a gestational diabetic is a risk factor for people who will become diabetic. It doesn’t cause it, but it teases out those people a little earlier.”
Babies are also typically born with elevated sugar levels, he said, which can then plunge. So doctors need to monitor that because “if the baby is very, very hypoglycemic, that can cause seizures. And that’s not a good thing.” Neonatal diabetes, a very rare form that afflicts only one in about 100,000 babies, is completely unrelated to gestational diabetes, he said. Researchers have increasingly linked it to a gene mutation.
While diet can help symptoms, there is no preventing gestational diabetes, Burkett said.
“Exercise, proper diet and maintaining your weight are going to be important in allaying the problem, but can you really prevent it? I’m not sure you can,” he said. “So what we have to do is screen patients.”
And because it can be a warning, women who develop gestational diabetes need to take heed and pay extra attention to their weight, diet and exercise. In addition, they need to keep a careful eye on their children: the NIH reports that of the children born to women with gestational diabetes, about 10 percent are overweight in early adolescence.
“It’s something we have to be aware of,” Burkett said. “It also comes back to the question of whether or not we can prevent it. I don’t think we can. I think we can diagnose it and minimize some of it by changing the way people live and by the way they eat and exercise.”