Recovering the Sacred: Understanding gestational diabetes |

Recovering the Sacred: Understanding gestational diabetes

Rebecca Chavez
Special to First Nation’s Focus
Studies show that 7% of Native women will develop gestational diabetes during pregnancy.
Photo: Getty Images | iStockphoto

Sugar is the source of energy that makes our bodies run. All the cells in our bodies need sugar to work normally.

This sugar comes from the foods we eat. Our bodies digest the food by mixing it with enzymes in the stomach, breaking it down into sugar or glucose. This glucose is then absorbed by the small intestine into the bloodstream where it can be moved to the cells for immediate energy or stored for later use.

Rebecca Chavez

Insulin is the hormone that is needed to move glucose into the body’s cells. If there is not enough insulin, or if the body stops responding to insulin, sugar builds up in the blood and diabetes develops.

According to the Indian Health Service, more than 16% of Native people have diagnosed Type 2 diabetes and another 30% have pre-diabetes. This data indicates that Native people are twice as likely to develop Type 2 diabetes than non-natives.

Furthermore, Natives are 4 times more likely to experience an amputation due to complications with diabetes and 6 times more likely to experience kidney failure leading to dialysis than their white counterparts.

This information is important to indigenous women in their child-bearing years for several reasons: during pregnancy the growing baby and the placenta produce hormones that make the mother resistant to her own insulin.

Most women will produce more insulin to compensate and keep their blood sugar levels low. However if a women cannot compensate for the increasing levels of blood sugar, she will develop gestational diabetes.

Studies show that 7% of Native women will develop gestational diabetes during pregnancy.

The risk factors that can lead to women developing diabetes during pregnancy also place a young woman at risk of developing Type 2 diabetes later in life. Studies show that 50% of women who develop gestational diabetes in pregnancy will develop Type 2 diabetes.

Complications of gestational diabetes

If a woman develops diabetes in pregnancy, complications can occur for both mother and baby including:

• Giving birth to a baby with macrosomia (weighing more than 8 pounds, 13 ounces), which can increase the risk of injury to the mother or baby during delivery. A shoulder dystocia may occur: a situation where a large baby gets “stuck” in the mother’s pelvis. Complications for the mother can include tearing down into the rectum and postpartum hemorrhage. For babies, common complications can include fractures to the collarbone or arm, and nerve damage.

• Mothers with large babies are more likely to have a cesarean section.

• Preeclampsia may develop. This is a dangerous condition that usually develops during the second half of pregnancy. High blood pressure develops, protein is present in the mothers urine, and organs such as liver, kidneys, heart, brain and placenta begin to malfunction. For these reasons, the baby may not develop or grow normally.

• If the mothers diabetes is not in good control or if complications such as macrosomia or hypertension develop, a baby might need to be born prematurely.

Further, gestational diabetes can cause complications in newborns following birth as well: breathing and eating problems due to prematurity, low blood sugar (hypoglycemia) and jaundice.

Children born to diabetic mothers alsoare at higher risk for developing obesity and diabetes later in life.

Who is at risk?

It is hard to predict which women will develop gestational. However, there are risk factors that can make some women more likely to get it than others.

A woman is more likely to get gestational diabetes if she:

• is overweight or obese

• have diabetes in her family

• had gestational diabetes before

• had a larger baby (9 pounds or more) in a previous pregnancy

• has had elevated blood sugar tests before

• is Hispanic, Black, Asian, South Pacific Islander or Native American.

• is older than 25 years old

• has a diet heavy in carbohydrates, processed sugar or fast foods.

Testing procedure

Even women without any of these risk factors can develop gestational diabetes. This is why getting good prenatal care is so important. Testing for gestational diabetes is usually done around 24 to 28 weeks of pregnancy. However, if a woman has risk factors, testing may be done earlier.

The most common test is a one hour glucose test: on the day of the test, a woman can eat and drink normally. She will be given 50 grams of glucose, usually in the form of an orange flavored drink.

She will be asked to drink the whole amount within a few minutes. After on hour has passed, she will have her blood drawn to measure her blood sugar level. If her blood sugar is normal, no other tests are needed. If her blood sugar is extremely elevated (200 or greater) a diagnosis of gestational debates is made.

If her blood sugar level is greater than 140 but less than 200, a 3 hour glucose test is done. This test requires her to fast for 8 hours before. Her blood will be drawn to determine a fasting glucose level, then again 1, 2, and 3 hours after the glucose drink. If there are 2 elevated levels, gestational diabetes is diagnosed.

Treating gestational diabetes

If a woman is diagnosed with gestational diabetes, she will need to make changes in her diet and she will have to check her blood sugar regularly. In some cases she will have to give herself insulin injections or take a pill to lower her blood sugar levels. The main goal of treatment is to prevent complications.

Things a woman can do to manage gestational diabetes:

• Eat healthy-eat 3 regular meals and 2 snacks every day. Don’t skip meals. Avoid sweet desserts and sweetened beverages (this includes juices). Include protein with meals: trimmed red meat and pork, chicken, and fish. Other good sources of protein are cheese, eggs, nuts, and peanut butter. Eat natural carbohydrates (fresh fruits and vegetables) and starches (pasta, rice and breads) in moderate portions.

• Meet with a nutritionist to design a healthy eating plan.

• Follow the doctor or midwife’s directions on how often to check blood sugar levels and what to do if a level is too high or too low. Keep a log of these levels to share with the provider at prenatal visits.

• Get regular exercise during pregnancy. A 30 minutes daily walk is recommended.

• Take all medicine as prescribed.

• Keep all prenatal care checkups, even if you are feeling fine.

If blood sugars are close to normal during the pregnancy and no complications develop, a woman can expect to deliver vaginally at around 39 to 40 weeks gestation. Women with gestational diabetes can and do have healthy pregnancies and healthy babies.

“Recovering the Sacred” is a monthly women’s health-focused column from Rebecca Chavez (Western Shoshone), who is a certified nurse-midwife, women’s healthcare provider and a mother of two. If you have any questions or ideas for future topics, email her at

Health & Wellness

Recovering the Sacred: Understanding gestational diabetes

November 25, 2019

According to the Indian Health Service, more than 16% of Native people have diagnosed Type 2 diabetes and another 30% have pre-diabetes. This data indicates that Native people are twice as likely to develop Type 2 diabetes than non-natives.

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