Gestational Diabetes Mellitus or GDM and a child's health.
March 7th, 2022
What is the latest research on the effects of diet, gestational diabetes and inflammation on a newborn and child?
Gestational diabetes mellitus (GDM) is a growing national problem during pregnancy. It is diagnosed when a woman without previously diagnosed diabetes develops chronic elevated blood glucose levels after becoming pregnant. This is usually the result of chronic insulin resistance from sedentary behavior and poor quality macronutrient food choices over a long time pre pregnancy.
Consequences of GDM for the pregnant female include increased risk of maternal cardiovascular disease, type 2 diabetes mellitus and birth complications including failure to progress and eclampsia/hypertension.
One recent study from Pediatric Allergy Immunology noted an almost doubling of asthma risk in children born to mothers with gestational diabetes. The study group had a 62% ethnic make up as African American. (Adgent et. al. 2021)
Children born to mothers with GDM have a 2x risk of developing diabetes. (Blotsky et. al. 2019)
There is solid evidence that GDM drives epigenetic changes in the pathways of macronutrient metabolism. (Ruchat et. al. 2013)
Non alcoholic fatty liver disease is associated with maternal GDM. (Weselowski et. al. 2016)
We are going to take a deeper dive here with Dr. Rick Johnson in the summer after his new research is published on the association of fructose and preeclampsia.
The modifiable factors for a pregnant or prepregnant woman are centered around reducing insulin dysfunction, inflammation and hormonal balance:
1) increased movement to reduce blood glucose levels in the blood stream
2) eliminate fructose based beverages and processed foods
3) avoid dehydration
4) avoid all alcohol while trying to get pregnant and during pregnancy/ breastfeeding stages
5) avoid excess salt intake
6) reduce mental stress which drives cortisol excess
7) increase fiber intake and avoid drugs and chemicals that disrupt the microbiome
8) increase dramatically your consumption of vegetables and fruits with a high ORAC scale for antioxidants which in turn quenches the effects of the survival switch
9) Avoid high glycemic load foods that spike your blood glucose level
10) Avoid eating out at chains or fast food as the food choices are less healthy and promote insulin dysregulation in general
Preventing the risk to one's offspring is prudent,
Pathophysiology of GDM: One important metabolic adaptation is in insulin sensitivity. Over the course of gestation, insulin sensitivity shifts depending on the requirements of pregnancy. During early gestation, insulin sensitivity increases, promoting the uptake of glucose into adipose stores in preparation for the energy demands of later pregnancy. However, as pregnancy progresses, a surge of local and placental hormones, including estrogen, progesterone, leptin, cortisol, placental lactogen, and placental growth hormone together promote a state of insulin resistance. As a result, blood glucose is slightly elevated, and this glucose is readily transported across the placenta to fuel the growth of the fetus. This mild state of insulin resistance also promotes endogenous glucose production and the breakdown of fat stores, resulting in a further increase in blood glucose and free fatty acid (FFA) concentrations. Evidence in animals suggests that, in order to maintain glucose homeostasis, pregnant women compensate for these changes through hypertrophy and hyperplasia of pancreatic β-cells, as well as increased glucose-stimulated insulin secretion (GSIS). The importance of placental hormones in this process is exemplified by the fact that maternal insulin sensitivity returns to pre-pregnancy levels within a few days of delivery. For reasons that will be explored in this review, the normal metabolic adaptations to pregnancy do not adequately occur in all pregnancies, resulting in GDM.