Gestational diabetes and pregnancy

Written by
Fuel Your Life

There are many challenges that come with pregnancy, but one of those that is most challenging and relatively common affecting 12-14% of Australian women, is gestational diabetes mellitus (GDM).

Chances are, if you’re here reading this blog, you might be awaiting or even have experienced the infamous oral glucose tolerance test (OGTT). This test is the ultimate decider in determining whether you are diagnosed with GDM or not. Many mothers can dread this test, not only due to the fact you have to drink a very sweet drink after a night’s fast but also what those results may show. But fear no more, today we’re going to delve into what GDM is, who gets it, how it can affect you and your baby during pregnancy, and how a dietitian can help you successfully manage GDM.

What is Gestational Diabetes?

GDM is a form of diabetes that occurs only during pregnancy. This means there is too much glucose (sugar) in the blood. Excess glucose in the blood can have negative effects on both you and your baby. But the good news is successfully managing your GDM can increase your chances of having a normal delivery with no effects on your baby’s long-term health.

The Development of GDM

The food you consume is broken down by the gut into proteins, fats and carbohydrates, along with many vitamins and minerals. The carbohydrate component of these foods is made up of many small parts called glucose, and this is what we refer to as sugar. Glucose is our bodies main source of fuel, powering us with the energy to accomplish every day activates involving muscle contractions and brain function. When pregnant, glucose becomes even more important because it is needed to fuel the growth and development of your baby.

Carbohydrates are found in nearly all foods. However, carbohydrate-rich foods are typically sweet or starchy foods (see table below). During digestion, the glucose in carbohydrates is released into the blood, contributing to our overall blood glucose level. From here, this glucose needs to be transported around the body to our muscles, where it can be used for energy. The hormone insulin is responsible for moving glucose from the blood into the muscles and other organs within the body, and as glucose leaves the blood, that is how the blood glucose levels start to decrease.

Carbohydrates

The below are some of the most common sources of carbohydrates in our diet but don’t forget that all of those sweet and savoury treats also contain a LOT of extra carbohydrate as well as fats and salt.

Cereals and GrainsFruit
(fresh, canned, dried, juice)
Starchy Vegetables and LegumesDairy (but not cheese)
Flours,
Rice, Pasta
Crackers,
Bread, wraps and tortillas
Cereals,
Oats
Bananas
Apples,
Pears,
Pineapple, Watermelon
Juices (fresh or pre-packed)
Potatoes,
sweet potato,
Legumes,
Lentils,
Corn
Milk (fresh,
long life,
powdered, flavoured)
Yoghurt
Custard
Ice cream

Insulin Resistance

Unique hormonal changes during pregnancy naturally reduce the effectiveness of insulin, meaning pregnant mothers usually require 2 to 3 times more insulin than they normally would. When the effectiveness of insulin is reduced, glucose stays in the blood and cannot be transported to the muscles. This is referred to as insulin resistance. This is what is happening to mothers with GDM. Their bodies simply cannot keep up with the insulin demands and does not produce enough insulin to effectively overcome the insulin resistance. Blood glucose levels will continue to rise to unsafe levels as more food is consumed. Some women in particular struggle to produce the extra insulin and have an increased risk of developing GDM, these include those:

  • Aged over 35 years
  • Above the healthy weight range
  • Aboriginal and Torres Strait Islander or Asian decent
  • Having a family history of type 2 diabetes or high blood glucose levels
  • Using anti-psychotic or steroidal medications
  • Already had GDM or a large baby before

If you fit into any of the categories above, you could have GDM without even knowing it. Many mothers do not report any symptoms. But those who do typically notice increased thirst, increased hunger or food consumption and more frequent trips to the toilet. All of which are typical symptoms in someone with diabetes.

The Effects on Pregnancy

When blood glucose levels are uncontrolled and remain too high for too long, the glucose needs to find somewhere to go. The easiest path for this glucose is straight to your baby. Extra glucose means the baby will be getting too much fuel, resulting in too rapid growth. Bigger babies can significantly increase the chances of early delivery, with complications during birth. As a result, C-sections are very common to assist in the delivery.

Testing for Gestational Diabetes

GDM is diagnosed using the OGTT as mentioned above, and although it is challenging and requires a lot of patience it is essential to ensure the health of you and your baby. This test usually occurs around 24-28 weeks into the pregnancy, where you drink a sweet drink after an overnight fast. The pathologist will then test your blood sugar levels at certain time points. If too much glucose remains in the blood, you will be diagnosed with GDM.

Managing Gestational Diabetes

GDM can be successfully managed by monitoring blood glucose levels, and by adopting a controlled eating pattern. Upon diagnosis, you will be referred to a dietitian and diabetes educator.

If you are looking or an Accredited Practising Dietitian the team at Fuel Your Life can assist you and your GP can refer you straight to them. Fuel Your Life dietitians will always provide you with advice that is tailored to your lifestyle.

The bottom line is that GDM is a condition that can be successfully managed with a proactive approach. Fuel Your Life dietitians are here to help, so get in touch today.

Can I get a rebate for seeing a dietitian?

To find out how you might be able to claim the costs of seeing a dietitian with your health insurance speak with a member of the Care To Compare team on 1300 76 76 00.

Care To Compare can help you find a health insurance policy that covers you for what you need. When you compare and buy a policy through Care To Compare, 100% of profits are donated to charities like the Australasian Birth Trauma Association who provide a peer-led community dedicated to helping Australian and New Zealanders prevent and heal from birth-related trauma.

Support for new dads

“When you welcome a new baby into the world, there is so much emphasis on self care, support and love for mums (and babies). Rightly so. Mums have birthed this human being, experienced profound changes to their bodies, have had a huge shift in their sense of self and most often are primary carer to this new little human.

Unfortunately, partners slide a little under the radar and don’t always receive the care, support and attention they need and crave during this time of transition to parenthood.”

Jasmin Kostov, Let’s Sleep

Up to 1 in 10 Dads experience postnatal anxiety and depression in the first year after their baby is born. Up to 1 in 5 new Mum’s will experience postnatal anxiety and depression. Whilst the prevalence is lower for Dad’s (or so the statistics show anyway…), we know that men in general are not as likely to talk about how they are feeling and may ‘bottle up’ their emotions.

This highlights the importance of supporting partners during pregnancy and postnatally.

Providing opportunities to debrief after the birth experience they have witnessed, having support and education in those early newborn days and empowering Dad’s to build confidence and be as involved as possible are a few key factors that can REALLY help the transition to parenthood for partners.

Here are my suggestions for how to support our partners in the transition to parenthood.

Antenatal education

Knowledge is power. Getting educated about birth and beyond makes a world of difference for parents. I honestly believe that if partners can receive some education about the birthing process, how to support their partner during labour, see a birth video, understand some different scenarios that can happen during labour and birth – this can empower partners and remove some of the unknown and ‘fear’ leading up to to birth of baby.

Often this is where the education stops.

I wish that all parents had some education around caring for a newborn, sleep basics, feeding, how important self care is (and how to fit it in!) and what to expect in those first months as a parent. This knowledge can make the world of difference for partners that are supporting a new Mum and baby.

My antenatal/newborn package was designed just for that reason.

Debrief after the birth

All parents should be provided with the opportunity to debrief after the birthing process. It is a HUGE experience no matter how your birth unfolds. A partners experience of the birth of their baby is completely different from Mums. A partner witnesses the love of their life in quite immense discomfort and can feel helpless as they can’t take that pain away for them. If there is an unexpected turn in the labour such as needing an emergency caesarean, this can create some additional stress for partners and is often a completely unknown environment for them.

Debriefing with a health professional or a trusted friend or family member after the birth of baby can help partners to begin to understand what happened in the birthing process, discuss how they felt and what they saw. This simple chat can prevent those emotions from bubbling under the surface.

Get your partner involved early on

When baby is born, quite naturally the baby and mother spend majority of their time together – especially if baby is breastfeeding. Baby is feeding frequently and having lots of cuddles with Mum. In the moment, it’s not always easy to step back and reflect on how your partner is feeling and adjusting.

Providing opportunities for your partner to build his or her confidence with baby from those early days will help to strengthen and nurture that Mum, partner and baby triad. Involving your partner as much as possible is not only wonderful for their relationship with baby but also provides Mum with some time to herself (even if its just 20-30 minutes a day to begin with). Try your best to allow your partner some space alone with baby, make small suggestions if they need some help but try not to hover (after all, we all learn by trial and error!)

Some ideas for how your partner can be involved regularly from those first few days and beyond.
  • Skin to skin
  • Settling baby for a sleep while Mum has a shower/dinner
  • Offering a bottle of expressed breastmilk or formula (if breastfeeding, always express with a hand or electric pump if your baby is having a bottle, this will help to protect your breast milk supply)
  • Take baby out for an assisted nap in the pram, carrier or car
  • Change nappy and dress baby
  • Bath baby or have a shower with baby skin to skin

Words of encouragement

Those first few months with your new baby can be tiring, stressful and amazing all at the same time. Every day, I challenge all new Mum’s to reflect on something that your partner has done to support you and baby. I then would highly encourage you to share that with your partner. These small comments each day can help to build confidence for partners, make them feel appreciated, involved and needed. Positivity and kindness go a long way.

Some examples might include:
  • ’it was so great when you gave Max his bottle today and had cuddles with him afterward’
  • ‘thank you for cooking us dinner tonight’
  • ‘it was so helpful that you brought the washing in off the line today’
  • ‘Max loved having a nice warm shower with you tonight’

I hope that these suggestions resonate with you and positively impact transition to parenthood. Our partners are so important. There is something pretty special about seeing your partner with your baby and nurturing that relationship.

About the author

Jasmin Kostov is a Registered Midwife, Registered Nurse, Maternal & Child Health Nurse, Infant & Child Sleep Coach and the Director of Let’s Sleep.

SUPPORT FOR POSTNATAL DEPRESSION

Care To Compare is proud to support the Australasian Birth Trauma Association who provide a peer-led community dedicated to helping Australian and New Zealanders prevent and heal from birth-related trauma.

DID YOU KNOW?

Asking your private health insurer to remove pregnancy cover can reduce your monthly premiums?

10 tips to help your newborn baby sleep

“Each child and each family is different. Simple, holistic and family centred sleep solutions can provide positive and significant changes in the lives of families.”

Jasmin Kostov, Let’s Sleep

The newborn period is from birth right through to 3 months of age. Arguably, this is one of the biggest periods of adjustment for parents whether it’s your first child or not. You might be surprised to learn that there is plenty you can do in that newborn period to set up great healthy sleep habits.

Read my top 10 tips below to help your newborn sleep as well as possible in the first 12 weeks.

1. Awake windows

When a newborn is overtired they are much more challenging to settle off to sleep. Having a rough idea of how long your baby should be awake before having another sleep is so important. This single piece of knowledge can make for a much easier first 12 weeks. Sadly, most parents are not informed about awake windows. I wish all parents were provided with this knowledge immediately after having their baby. This knowledge can make the difference between your baby fighting sleep or going off to sleep quite easily. Look for your baby’s tired signs and and offer them sleep when you see these signs.

  • Birth – 3 weeks: 40-60 minutes
  • 4 – 7 weeks: 60-90 minutes
  • 8 – 12 weeks: 75-105 minutes

2. Darkness

From 3 weeks of age or earlier if you wish, I recommend offering your baby their day naps and night time sleep in a very dark room. Before 3 weeks of age babies are naturally quite sleepy and don’t seem to phased by darkness or light for sleep. After 3 weeks of age your baby will start to ‘awaken’. The production and secretion of melatonin (the sleepy hormone) is blocked by light and therefore, providing a dark sleep environment works with your baby’s natural hormones to help promote sleep.

A dark room will help your baby settle off to sleep and connect their sleep cycles much easier plus will prevent them waking up early in the morning when the sun comes up. When they’re napping on the go in the car, carrier or pram – don’t stress about a dark environment!

3. Swaddle

From birth right through to 4 months or when showing signs of rolling, I recommend swaddling your baby for all day sleep and night sleep. You can use a muslin/jersey wrap, love to dream, ergo bag or something similar. There are a few reasons for this recommendation.

Your baby has the Moro Reflex (otherwise know as the ‘startle reflex’) that is present until it starts to fade around 3 months and is generally gone by 5-6 months at the latest. Swaddling helps prevent your baby ‘startling’ themselves awake during sleep.

Your baby is used to a cozy, comfy space in your tummy and would have had limited space in their to move around at the end of pregnancy. Swaddling recreates this womb like environment.

Swaddling for every nap and night sleep is a positive sleep association and each time you swaddle them, they will start to associate this with sleep

4. Rough routine from 6-8 weeks of age

I regularly receive questions on what age is the right time to introduce a routine. Around 6- 8 weeks of age your baby will start to develop natural circadian rhythms and their biological clock becomes more established. Food, light and social interaction all entrain or set your baby’s biological clock. For these reasons, 6-8 weeks is a great time to start a loose routine to follow each day. This might include:

  • the same wake up time each day of 7am
  • aiming for 3-5 naps across the day and a bed time of between 6-7.30pm after a nice warm bath and massage.
  • rough times for feeds (3-4 hourly) and fit these in around your babies nap times.

5. Offer your baby sleep in their bassinet from the beginning

You might have heard the saying, start as you intend to finish. If your goal is for your baby to be sleeping in their bassinet or cot for all sleep in a few months time – then it is never too early to get started. In those first 12 weeks you might find your baby sleeps really well in their bassinet or cot for naps and night sleep (yay for you!).

If your baby isn’t as content in their own bed, just start off with settling them for 1 day nap in their cot or bassinet per day. This will help them slowly get used to their sleep environment and before long, it will be totally normal for them. Don’t stress if your baby is enjoying sleeps in the pram, car, carrier, your chest and anywhere other than their bed. This is quite normal and you can work on encouraging them to sleep in their own bed as they get past 3-4 months of age.

6. Upright time and burping during and after feeds

Offering your baby upright time during and after feeds can help aid digestion and alleviate unsettledness due to wind pain. As the day progresses, trapped wind and gut discomfort can worsen simply due to an accumulation of wind. This can play in to that unsettledness in the late afternoon/early evening that is common for babies from birth to 12 weeks of age.

Offer your baby upright time a couple of times during the feed and some back patting/gentle motion side to side and forward and back. Repeat this at the end of the feed and have an upright cuddle for 5-10 minutes after each feed to allow the milk to settle in their tummy before being laid down horizontal. Don’t stress about getting a set number of burps! Just offer them the upright time, some pats on the back and motion.

7. Combination feed option

You may have heard of the ‘witching hour’ or ‘cluster feeding’ in the late afternoon and early evening that is common for newborns. Babies will often feed on and off during this time of day and naturally this can be quite tiring for Mum. An option here for breastfed babies is to introduce ‘combination feeding’. There is a big push currently to ‘exclusively breastfeed’ and whilst I understand the benefits of breastfeeding, I believe parental wellbeing is equally as important. If you’re finding you’re exhausted by the end of the day and your baby is unsettled, there is a possibility this is due to hunger. Breast milk supply naturally is lower in the later part of the day and therefore baby can become a little frustrated and continue feeding on and off as a result.

An option here is to offer a small bottle top up in the evening to ensure your baby has a nice full tummy and therefore will likely settle for sleep a little easier. You can consider offering a small bottle top up from early on (2 weeks onwards). IF your baby has been breastfeeding well, weight gain is not an issue and you’re connected with a lactation consultant or maternal and child health nurse who has been supporting you with breastfeeding. Offering 1 bottle each day from an early age helps your baby get used to taking a bottle, allows flexibility if you need a little break or aren’t able to be with your baby for some reason and my favourite part – partners can give this bottle to baby and be involved in the feeding process. Win-Win.

This bottle could be expressed breast milk or formula depending on what you are comfortable with. If you are going to offer a bottle to your baby, ALWAYS express with a hand or electric pump whilst your baby has the bottle to signal to your body that it needs to create some additional milk. This protects your milk supply and is crucial for combination feeding to be effective.

8. Use a consistent nap time and bed time wind down routine

From birth you can start using a consistent nap wind down routine thats 2-5 minutes long and a bedtime wind down routine thats 10-20 minutes long before you put them down in their bassinet or cot for sleep. This consistent wind down routine will help signal to your baby that sleep is coming.

  • Nap wind down example: When you see tired signs, head into your baby’s room, change nappy, darken room, hum or sing a quiet song, into swaddle and settle for sleep in their bassinet/cot.
  • Bedtime wind down example: 10-20 minutes before bedtime, head into your baby’s room, change their nappy, offer a feed, read a quiet story or sing a quiet song, darken room, into swaddle and settle for sleep in their bassinet/cot.

9. Massage and skin to skin

Massage and skin to skin are both amazing for bonding and relaxation in the first 12 weeks and beyond. Massage can be a great addition to your baby’s bedtime routine. Here’s a great resource for how to get started with baby massage! You can use a natural oil such as olive, avocado, macadamia or coconut oil. Skin to skin helps to stabilise body temperature, regulate blood sugar, establish breastfeeding, reduce crying and pain, boost parent child bonding and basically just gives you all the warm fuzzies!

10. Parental self care

I know it may seem like a total stretch to think you’d prioritise yourself in those first 12 weeks, however i’m here to tell you that it’s so important! Be kind to yourself, seek support, speak with health care providers (MCHN, LC’s, GP’s, breastfeeding help lines), keep open communication with your partner, family, friends. Laughing, crying, waves of emotion, frustration, sadness and feelings of elation are all SO normal when adjusting to have a little person in your life. The challenging times will come and go and the good times will come again. It’s a marathon, not a sprint and therefore prioritising self care from early on will help prevent you from feeling burnt out.

Start small in those early days. Even a 5-10 minute shower all to yourself whilst your partner watches over the baby (you could be a real dare devil and put on a face mask too!). Within a couple of weeks you might feel okay to get out for a walk on your own for 20-30 minutes or go meet a friend for a coffee for an hour. Those pockets of self care over the weeks and months evolve into being the time that you have to fit in what fuels you and makes you feel good (exercise, hobbies, socialising – whatever it is). That’s not to say that being with your baby doesn’t make you feel good – it’s just so key to have a little time out just for you as well.

About the author

Jasmin Kostov is a Registered Midwife, Registered Nurse, Maternal & Child Health Nurse, Infant & Child Sleep Coach and the Director of Let’s Sleep.

DID YOU KNOW?

Asking your private health insurer to remove pregnancy cover can reduce your monthly premiums?