COMEDIAN Julie Jay loves being a mammy and she can’t believe she and husband Fred Cooke are getting to do it again, with their second baby expected next month.
“We really can’t wait. We’re super-excited — and very excited for Ted that he’ll have somebody else to play with,” she says of her toddler who turns three in September.
When Julie was pregnant with Ted she was “really shocked” to be diagnosed with gestational diabetes. A common medical disorder in pregnancy and sometimes called GDM (gestational diabetes mellitus), it happens when too much glucose (sugar) stays in the blood instead of being used for energy.
Pregnant women are prone because higher levels of pregnancy hormones can interfere with insulin, which is responsible for keeping blood sugar levels in the normal range.
And while usually the body makes more insulin during pregnancy to keep blood glucose normal, in some women it doesn’t.
Gestational diabetes “is caused by a combination of insulin deficiency and insulin resistance”, says Professor Fidelma Dunne at the School of Medicine, University of Galway, who cites some common risk factors: being overweight/obese, maternal age (mums aged 40 and above) and a sedentary lifestyle.
For Julie, the diagnosis came out of left field. “Absolutely nobody in my family has diabetes. I was very healthy and I wasn’t at a high weight. I’d assumed that you were at higher risk if your weight was high. And since I got it, I’ve met so many women who had it too and who were of average weight.”
GDM is most likely to occur in the second half of pregnancy and Prof Dunne explains that at-risk women are usually screened at weeks 24-28. “However, in women with previous GDM or those very overweight, it can occur earlier in pregnancy and practitioners — suspecting its existence — will screen prior to 24 weeks.”
Treatment starts with dietary changes and increasing exercise levels — a big aim is to prevent women gaining excessive weight. “About 40-50% [of women] need additional treatment. Insulin by injection is commonly used and it is effective,” says Prof Dunne.
Considerations and risks
Because Julie had GDM when pregnant with Ted, she was expecting it this time too. Her diagnosis came at 16 weeks.
“Any bit of bread or pasta would really set my sugar levels very high. I started taking insulin about six weeks earlier this time. It was inevitable I’d have to go on it. It didn’t bother me — the insulin helps me process carbohydrates.
“The main thing I don’t like about it is — not that the diet is restrictive, but that I’m having to think about what I’m eating all the time. For example, I really can’t have much carbs in the morning because pregnancy hormones are high then. So if I’m having carbs it has to be afternoon or evening. All that planning does take up a lot of mental space.”
Julie finds exercise really effective at bringing down her sugar levels. “I was doing that (exercising) when I was pregnant with Ted. It was during covid and I wasn’t working so I had time — things were more flexible. This time around, with a toddler, it’s not always doable to go for a walk after a meal.”
A study carried out over a dozen years ago in the West of Ireland found a prevalence of 12% for GDM in the overall pregnant population when universal screening is implemented. “In high-risk women, the prevalence is much higher,” says Prof Dunne, who explains the concerns GDM brings for the health of mothers and their babies.
“The mother is at increased risk of delivery by Caesarean section, or of developing blood pressure issues or pre-eclampsia. Cholestasis of pregnancy is also more common, a liver condition that results in the build-up of bile. It occurs in late pregnancy and usually presents with a very bad itch, particularly on hands and feet, but with no rash.”
When it comes to the baby, Prof Dunne says excessive sugar in the mother can lead to excessive growth of the baby due to an increase in fat tissue. “Large babies may suffer birth injuries and require treatment in Nicu. These babies are also more likely to have low sugar levels post-delivery and have breathing problems that may require ventilator assistance.”
Julie describes being quite upset when Ted was found to have low blood sugars at birth. “I’d been so strict on myself that I really felt I’d done everything I possibly could. I was upset to be told he had low blood sugars, but it just meant he had to spend a few days in the neonatal unit. Thankfully, this time around the baby’s average size, so it’s not inevitable a baby’s blood sugars would be low.”
Gestational diabetes usually goes away after the baby is born (though there is a 50% higher risk of developing type 2 diabetes later in life) and Julie was no exception.
“My blood sugars went back to normal pretty much straight after the birth,” she says, adding that she has found the diabetes clinic in Tralee very supportive. “They’re so amazing and helpful, I couldn’t praise them enough.”
Treating GDM
GDM doesn’t usually come with warning signs, though women sometimes report thirst, tiredness, and passing urine a lot.
“These are also common symptoms in pregnancy,” says Prof Dunne, adding that women with previous GDM are encouraged to get a sugar check prior to getting pregnant again.
About 60-70% of the Irish obstetric population have some risk factor for GDM. Both Prof Dunne’s research, and that of others, have shown risk factor screening misses some women with GDM. This is because not everyone has the classic risk factors. Prof Dunne would like to see universal screening for all women. “Because the stakes are so high for the current pregnancy — and the future health of mother and infant — it’s best if cases aren’t missed.”
She points out that the screening test (oral glucose tolerance test) is not expensive — but space in hospitals to perform the test is limited.
“Performing screening seven days a week would spread the load more evenly and may be more patient-focused [because] many women work Monday to Friday. Also, testing in alternative community locations would develop capacity — and be more patient-focused too.”
Prof Dunne has just completed a trial on tablet metformin for treatment of GDM. “The results are positive. It appears very effective at controlling sugar levels in the mother.” She believes tablet treatment may become the norm, with insulin reserved for cases where the tablet is not enough to maintain normal sugar levels.
Prof Dunne would like more resources for follow-up of mother/infant pairs from GDM pregnancies, so as to prevent long-term chronic health conditions.
“We’ve just completed a multi-professional model of care document for diabetes in pregnancy. Implementing this with appropriate resources [would] ensure we work to enhance maternal health. Healthy mothers have healthy babies and healthy families, [which] translates into enormous social and economic gains for the country.”
Meanwhile, in West Kerry, Julie doesn’t mind the insulin injections that much. “But taking the blood before and after every meal to check my sugars, that’s the bit I don’t like. It can be sore because sometimes I have to do it a few times to get enough blood for the reading. And it’s quite time-consuming.”
Overall though, she says GDM isn’t as limiting as you might initially think. “It’s a bit of a lifestyle change in pregnancy, but it’s totally doable.”
- See exa.mn/HSEGDM
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