Lower Thresholds for Gestational Diabetes?
I found this article this morning, and I feel torn as to how to interpret the findings. Researchers have proposed that current thresholds for diagnosing a pregnant woman with Gestational Diabetes are too lax. They suggest lowering the upper limits of normal glucose values based on data that suggests a doubling of risk for either mother or baby at levels above this proposed "new" range.
Here is the article: http://wellness.blogs.time.com/2010/02/26/assessing-gestational-dia...
Now, I am a fervent advocate for a healthy diet and regular exercise during pregnancy--many studies have shown that this reduces risk of complications in labor and delivery, even in women without GD. I hope that doctors and midwives would use this data to be more proactive in educating and supporting their pregnant patients to eat and move mindfully.
I suppose my primary concern is that these new guidelines could swell the percentage of pregnant patients with GD from 5-8% to over 16%. This is a HUGE increase, and may needlessly cause OBs to label these women as "high-risk" and increase their likelihood of an interventionalized birth. (Because, let's face it: for doctors to spend the additional time necessary to properly instruct on diet and exercise, they would have to see fewer patients, or work longer hours, or pay for a dietitian full-time on staff. I'm sure you can guess that none of these options would provide a "quick fix". But a scheduled c-section sure would!)
On the other side of the coin, perhaps we should be more concerned that so many American women are so improperly nourished that they fall into this category in the first place. I mean, those are some sobering statistics--a doubling of risk for preeclampsia, for example, is profound, in my opinion. But should we change the threshold? Will this cause normal, physiologic birth to be even harder for women to achieve?
What are your thoughts?
Here is the article: http://wellness.blogs.time.com/2010/02/26/assessing-gestational-dia...
Now, I am a fervent advocate for a healthy diet and regular exercise during pregnancy--many studies have shown that this reduces risk of complications in labor and delivery, even in women without GD. I hope that doctors and midwives would use this data to be more proactive in educating and supporting their pregnant patients to eat and move mindfully.
I suppose my primary concern is that these new guidelines could swell the percentage of pregnant patients with GD from 5-8% to over 16%. This is a HUGE increase, and may needlessly cause OBs to label these women as "high-risk" and increase their likelihood of an interventionalized birth. (Because, let's face it: for doctors to spend the additional time necessary to properly instruct on diet and exercise, they would have to see fewer patients, or work longer hours, or pay for a dietitian full-time on staff. I'm sure you can guess that none of these options would provide a "quick fix". But a scheduled c-section sure would!)
On the other side of the coin, perhaps we should be more concerned that so many American women are so improperly nourished that they fall into this category in the first place. I mean, those are some sobering statistics--a doubling of risk for preeclampsia, for example, is profound, in my opinion. But should we change the threshold? Will this cause normal, physiologic birth to be even harder for women to achieve?
What are your thoughts?
Tags: diabetes, diet, exercise, gestational
Replies to This Discussion
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Permalink Reply by Cherylyn on -
I can understand why the medical community would want to watch these women more closely because of the higher risks involved with even the lower thresholds. I agree with you, however, that it could potentially put more women at risk for interventions. It is very alarming that women in general are so malnourished that these pregnancy complications are becoming so much more common. Doctors are not equipped with the proper tools to support women in eating and living healthy in pregnancy to avoid complications by staying low risk. Doctors aren't trained in nutrition at all, and they don't have the knowledge and resources to advise pregnant women on how to stay low risk. The midwifery model of care is better at this, at least from what I've seen in the midwives I know.
If an expectant mother will eat whole foods and fresh foods and focus on healthy eating and staying active from the beginning of her pregnancy (or before she becomes pregnant), then she will establish a healthy foundation and environment for her baby to grow and be healthy as well. She will avoid infection, as well as complications such as gestational diabetes and preeclampsia. These are serious complications, and we are seeing them become more and more common. I wish I had an easy solution, but I think it starts with educating women on how to truly stay healthy and low risk during pregnant.
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Permalink Reply by EmilyK on -
From what I have recently read about diabetes, heart disease, etc..., many of the thresholds have been lowered across the board. For example healthy blood pressure used to be 120/80. But now, that is considered "pre-hypertension", and a more healthy BP is 110/70. The same is true for diabetes.
The other side of that is a lot of more "natural" practitioners would argue that a woman's body simply functions differently during pregnancy and that we shouldn't have the same standards for pregnant and non-pregnant women. There is even a school of thought that says that a degree of anemia isn't a bad thing during pregnancy, but a natural reaction to the needs of the baby. The same thing can be said for a blood sugar that's a few points up, if it's not related to increased weight gain and other signs of diabetes.
So, those are my thoughts. They aren't really backed up by anything except some remembered reading, but that's what I've got :-).
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