It’s not your fault. 

Mother’s guilt: the inevitable, foreboding, innate reaction to the otherwise rapturous state that is parenthood. For many, pregnancy is a foray into mother’s guilt: especially if you are amongst the 3-14% of women globally ^[1]Whitelaw B, Gayle C. Gestational diabetes. Obs, Gyn Rep Med. 2010;21:2 who are diagnosed with gestational diabetes mellitus (GDM) in their 28th week of pregnancy. A diagnosis of gestational diabetes can come as a major shake up during what is usually the pinnacle of joy in many women’s lives. Ultimately, it can leave one wondering what will become of their pregnancy and birth, what will happen to their unborn child and all too commonly, did they do something to cause it?

Gestational diabetes mellitus is similar in its mechanism to type 2 diabetes, only its onset occurs during pregnancy^[1]Whitelaw B, Gayle C. Gestational diabetes. Obs, Gyn Rep Med. 2010;21:2. It is characterised by generalised insulin resistance, leading to elevated blood sugar levels in the pregnant mother^[1]Whitelaw B, Gayle C. Gestational diabetes. Obs, Gyn Rep Med. 2010;21:2^[2]Halse RE, Wallman KE, Nenham JP, and Guelfi KJ. Home-Based Exercise Training Improves Capillary Glucose Profile in Women with Gestational Diabetes. Med & Sci in Sport & Ex. 2014;0195-9131. Evidence demonstrates a marked increase in the mother and neonate’s future risk of developing type 2 diabetes, poor birth outcomes, increased risk of obesity in the child ^[1]Whitelaw B, Gayle C. Gestational diabetes. Obs, Gyn Rep Med. 2010;21:2 and decreased neonatal breastfeeding rates^[3]Jagiello KP, Azulay Chertok IR. Women’s Experiences With Early Breastfeeding After Gestational Diabetes. JOGNN, 2014;44:500-509. It is recommended that all pregnant Australian women undergo a standard oral glucose tolerance test at 28 weeks gestation in order to diagnose it.  

As dietitians, it is important that we are attuned to the extrinsic emotional needs of women with gestational diabetes, in order to reassure them that their baby will be healthy and that their pregnancy can be stress, insulin and restrictive diet-free. A woman with gestational diabetes needs to hear firstly that it is not her fault because self-blame is often inevitable. Reassurance that she won’t have to spend the remainder of her pregnancy feeling hungry, insulin therapy is not a forgone conclusion and that her baby will probably not be large can alleviate some of the fear and guilt that comes with the diagnosis. 

Beyond a woman’s prenatal caregiver/s and the phlebotomist who took what felt like three thousand blood samples during her oral glucose tolerance test, a dietitian is pretty much the first port of call for the newly diagnosed woman. The majority of gestational diabetes is controlled by diet and monitored via peripheral blood samples, therefore the dietitian plays a critical part in the management of the disease. It is important to remember that, as dietitians, we are dealing with a woman who is trying to cope with the magnitude of impending parenthood and the diagnosis of a disease which is known in popular culture as being a major contributor to morbidity and mortality on a global scale. So what things are helpful for a woman who is partnering with you in managing her newly diagnosed gestational diabetes, to hear? 

1. It’s really not your fault…

There is no single specific reason for a woman to develop gestational diabetes. What is known is that age, heridity, race, BMI, Polycystic Ovary Syndrome and previous history of a large baby are risk factors^[1]Whitelaw B, Gayle C. Gestational diabetes. Obs, Gyn Rep Med. 2010;21:2. It wasn’t the mud-cake-a-day habit during the first 27 weeks of pregnancy, nor was it the copious amounts of ice-cream in the first 12 weeks, because it was all that would stay down. Women who have just been diagnosed with gestational diabetes need to hear this, pronto. Because even if they don’t say it, there is a good chance they are blaming themselves.

2. You can still eat carbs…

In fact, low GI carbs are the cornerstone of gestational diabetes management^[4]Diabetes Australia. Managing gestational diabetes https://www.diabetesaustralia.com.au/managing-gestational-diabetes. 2015. Getting a pregnant woman to fast overnight and  front up to a blood collection centre for the oral glucose tolerance test is a larger-than-life ask in itself. The thought that she may also have to go on a restrictive diet for the remainder of her pregnancy is simply mortifying. Snacks are also central to maintaining normoglycaemia^[4]Diabetes Australia. Managing gestational diabetes https://www.diabetesaustralia.com.au/managing-gestational-diabetes. 2015. Telling a pregnant woman that she will probably need to eat more often than she usually does will get you on her good side and make her feel much less overwhelmed. 

3. You probably won’t need insulin…

Insulin therapy is a very scary thought for most, especially for those who are grasping a recently learnt notion of peripheral blood samples six times daily. It can be reassuring for one to know that the majority of women with gestational diabetes are able to manage their condition purely through diet and exercise^[2]Halse RE, Wallman KE, Nenham JP, and Guelfi KJ. Home-Based Exercise Training Improves Capillary Glucose Profile in Women with Gestational Diabetes. Med & Sci in Sport & Ex. 2014;0195-9131. As dietitians, the obvious focus is on management through diet. However, it is particularly important to stress the effectiveness of exercise in the management of the condition. Regular exercise can have an instant effect in lowering post-prandial glucose levels, obviating the need for insulin^[2]Halse RE, Wallman KE, Nenham JP, and Guelfi KJ. Home-Based Exercise Training Improves Capillary Glucose Profile in Women with Gestational Diabetes. Med & Sci in Sport & Ex. 2014;0195-9131. 

4. Your baby will most likely be of normal size…

The Pederson Hypothesis is the accepted theory that elevated maternal blood glucose crosses the placenta and the foetal pancreas responds by producing more insulin, which can lead to increased birthweight, given that insulin is a growth factor ^[1]Whitelaw B, Gayle C. Gestational diabetes. Obs, Gyn Rep Med. 2010;21:2. The overwhelming body of literature, however, shows that when the condition is managed, large babies and increased birth intervention such as cesarean and forceps delivery is greatly reduced^[1]Whitelaw B, Gayle C. Gestational diabetes. Obs, Gyn Rep Med. 2010;21:2. 

Serious perinatal complications can occur in unmanaged gestational diabetes, however simple dietary changes and moderate exercise can often be sufficient to negate any requirement for insulin therapy. It is essential to be cognisant of the fact that pregnant women with gestational diabetes are unlike most other dietetic patients, in that they don’t only have their own health to consider but also that of their baby. This and some insight into what these women might be feeling can go a long way in building a practitioner-patient relationship which is crucial in the effective management of the condition.   

Should you need assistance in managing gestational diabetes, please contact your health care provider, GP, or an Accredited Practising Dietitian