Gestational diabetes, a condition affecting between 2 to 10% of pregnancies in the United States, poses significant health concerns not only during the gestational period but also well into the future. Astonishingly, women who have faced gestational diabetes are at a heightened 35 to 60% risk of developing diabetes mellitus in the subsequent 10 to 20 years post-pregnancy.

Despite these statistics, GDM is able to be treated through lifestyle and medication changes. In this article, we will discuss what GDM is, what causes it, the best functional medicine testing for the condition, and holistic ways to treat the disease beyond the limitations of conventional treatment. 

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What is Gestational Diabetes?

Gestational diabetes mellitus also referred to as gestational diabetes or GDM, is a condition characterized by glucose intolerance that becomes apparent or is first diagnosed during pregnancy. There are two main types of GDM based on its management and severity. The first type, known as A1GDM, is gestational diabetes which can be managed solely through dietary adjustments without the need for medication. The second type, A2GDM, is more severe and requires medications to control blood sugar levels effectively (1). 

On the physiological side, GDM typically arises between the 24th to 28th weeks of pregnancy. This onset is often due to changes in placental hormones. These changes can either strain the body's capacity to release insulin or make insulin less effective, a phenomenon known as insulin resistance. When insulin doesn't function properly, sugar struggles to enter the body's cells, leading to higher levels of sugar in the bloodstream. Elevated blood sugar can pose risks to both the mother and the fetus. Fortunately, this condition can be managed through a combination of diet, lifestyle changes, and, if needed, medications. For most women, the condition is temporary, with blood sugar levels returning to normal after giving birth (1,2).  

What is The Impact of Gestational Diabetes on Pregnancy?

Gestational diabetes mellitus is a condition that any pregnant woman can develop, though certain factors can heighten its likelihood. Pre-existing conditions like heart disease, high blood pressure, obesity, and polycystic ovarian syndrome are some common contributors. Additionally, having a personal or family history of GDM, being pre-diabetic, living a sedentary lifestyle, or having previously delivered a baby weighing nine pounds or more can further increase the risk. Mothers who develop GDM in the latter stages of their pregnancy face heightened risks, including the need for a cesarean section due to increased fetal size, the possibility of developing type 2 diabetes postpartum, and preeclampsia, a condition characterized by elevated blood pressure and potential organ damage (2). 

For the baby, the implications of the mother's unmanaged or fluctuating blood sugar levels can be multifaceted. There's an increased likelihood of premature birth, hypoglycemia at birth which can lead to seizures, respiratory challenges, and a substantially elevated birth weight. In some severe cases, GDM can even be a factor in stillbirth (2). 

It's vital to understand that GDM doesn't lead to the kinds of birth defects sometimes associated with babies of mothers with pre-existing diabetes. However, untreated GDM poses significant risks. When a mother has GDM, her body struggles to manage blood sugar, leading her pancreas to produce more insulin, which, unfortunately, cannot regulate her glucose levels effectively (2). 

While insulin doesn't cross the placenta, glucose does. This means the baby gets an excess of glucose, causing the baby's pancreas to overcompensate by producing additional insulin. Consequently, the baby absorbs more energy, which gets stored as fat, potentially leading to macrosomia or a "fat" baby. These babies are at risk for complications like shoulder damage during birth, extremely low blood glucose levels, and, later in life, a heightened propensity for obesity and type 2 diabetes (2). 

Gestational Diabetes Signs & Symptoms

Gestational diabetes often presents itself discreetly, with many women experiencing no noticeable symptoms. In cases where symptoms do emerge, they tend to be relatively mild. Some of these subtle indicators might include an increased thirst beyond one's typical level, a more frequent need to urinate, and disproportionate weight gain during pregnancy (1). 

Gestational Diabetes Underlying Causes And Risk Factors

The causes of GDM are multifaceted. A core contributor is the dysfunction of the pancreatic beta-cells or their delayed response to changing glycemic levels. This dysfunction leads to insulin imbalances essential for regulating blood sugar levels. Additionally, the marked insulin resistance seen in GDM is a result of the hormonal output from the placenta. Specifically, the human placental lactogen is chiefly linked to the heightened insulin resistance observed in GDM. Other hormones, such as growth hormone, prolactin, corticotropin-releasing hormone, and progesterone, play a role in fostering insulin resistance and hyperglycemia during pregnancy (1).

Moreover, during pregnancy, the body undergoes various transformations, including the production of specific hormones and weight gain. These alterations can cause the body's cells to exhibit reduced efficacy in utilizing insulin, a condition known as insulin resistance. While this form of resistance is somewhat standard in the latter stages of pregnancy, some women's bodies fail to produce sufficient insulin to counteract it, leading to GDM (8).

Several clinical risk factors are associated with the development of GDM. Increased body weight, specifically a body mass index (BMI) exceeding 25, is a substantial risk. Physical inactivity, having a first-degree relative with diabetes mellitus, or a previous experience with GDM can increase susceptibility. Additional factors like having a newborn with macrosomia (large baby for gestational age), existing metabolic comorbidities like hypertension, low HDL levels, triglyceride levels surpassing 250, the presence of polycystic ovarian syndrome, hemoglobin A1C levels over 5.7, an abnormal oral glucose tolerance test result, and any significant markers of insulin resistance (such as acanthosis nigricans) are worth noting. A past medical history inclusive of cardiovascular diseases is another factor that heightens the risk (1).

To explain further, being overweight or having obesity, even before pregnancy, is intrinsically linked to GDM due to existing insulin resistance. Excessive weight gain during pregnancy can compound this risk. Genetics also appear to play a part, as having a family history of diabetes increases the likelihood of developing GDM during pregnancy (8).

Functional Medicine Labs to Test For The Root Cause Of Gestational Diabetes

Functional medicine labs offer a variety of tests that can help tailor treatment to patients, allowing providers to optimize management strategies.

Cardiovascular Health Testing

This test is geared toward evaluating various cardiac health markers. Given the connection between GDM and cardiovascular diseases, it is important to evaluate and monitor cardiac health. Additionally, factors like hypertension and abnormal lipid profiles (such as low HDL and triglycerides greater than 250) which are risk factors for GDM, are also associated with cardiovascular diseases. Evaluating these markers can provide insights into the patient's cardiovascular health and any associated risk of GDM (1). 

Diabetes Panel

Since GDM is a form of diabetes that arises during pregnancy, it's essential to test blood glucose levels and other diabetes-associated markers. This test can evaluate the presence of diabetes and help in monitoring glycemic control. Specific indicators that underscore the need for this test include a history of GDM, an abnormal oral glucose tolerance test, hemoglobin A1C greater than 5.7, and having a first-degree relative with diabetes mellitus. Additionally, this panel would be beneficial for women who previously had newborns with macrosomia, as elevated blood sugar levels in the mother can lead to excessive growth and fat storage in the fetus (1,11). 

Hormone Testing

Hormonal changes and imbalances play a pivotal role in the onset of GDM. As mentioned above, hormones like human placental lactogen, growth hormone, prolactin, corticotropin-releasing hormone, and progesterone stimulate insulin resistance and hyperglycemia during pregnancy. Additionally, it's notable that some of these hormones, specifically estrogen, cortisol, and human placental lactogen, can obstruct insulin's effects. Given that these hormones influence the body's response to insulin, it becomes vital to monitor and assess their levels throughout pregnancy. This comprehensive hormone profile tests for progesterone, estrogen, and cortisol levels (1).

Additional Lab Tests 

The oral glucose tolerance test is typically performed as a screening test for GDM at 24 to 28 weeks of pregnancy (1). 

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Conventional Treatment for Gestational Diabetes

Gestational diabetes management primarily starts with nonpharmacologic approaches, including dietary changes, exercise, and glucose monitoring, with the ADA emphasizing personalized nutrition plans based on a patient's BMI. When lifestyle modifications don't yield satisfactory glycemic control, insulin becomes the preferred treatment, adjusted based on blood glucose levels and the pregnancy trimester, with certain insulins, such as Lispro, Aspart, and detemir, approved for pregnancy due to their benefits and reduced hypoglycemic risk. Alternatively, oral hypoglycemic agents like metformin and glyburide are growing in usage for GDM management, even without FDA approval (1).

Functional Medicine Treatment for Gestational Diabetes

Functional medicine treatment for GDM focuses on dietary changes, supplements, incorporating physical activity, and reducing stress. 

Diet And Nutrition in Gestational Diabetes Management

For women diagnosed with GDM, maintaining a balanced diet is an important part of treatment. Such a diet should be abundant in nutrient-dense foods, including vegetables, fruits, whole grains, lean proteins, and healthy fats while minimizing the intake of processed foods, sugary treats, and sugar-laden beverages. Carbohydrate consumption should be monitored diligently to regulate blood sugar levels, with a preference for complex carbohydrates that have a low glycemic index. It's beneficial to spread these carbs throughout meals during the day and combine them with proteins and healthy fats to slow digestion and curb blood sugar spikes (2). 

On the other hand, the Mediterranean-style diet, enriched with lean proteins, seafood, antioxidant-rich fruits and vegetables, and healthy fats like olive oil, is gaining traction for its potential benefits in managing GDM. This diet aligns with a low-glycemic way of eating, proving ideal for individuals with GDM (2). 

While the significance of staying adequately hydrated can't be overstated, it's equally vital for women with GDM to opt for individualized nutrition therapy, preferably with guidance from a registered dietitian. Customized diet plans based on individual needs can help in optimizing maternal and infant health outcomes, given that no single diet has proven universally effective for GDM (13,17). 

The Role of Nutritional Supplements in Gestational Diabetes

Several supplements may play a role in the symptomatology and disease process of GDM (13): 

Impact of Myo-Inositol 

Intake of Myo-Inositol has been linked to a decreased occurrence of GDM. This compound acts as an agent enhancing insulin response, thereby facilitating better insulin activity and sugar processing. Research indicates that using Myo-Inositol can diminish GDM onset risks and optimize blood sugar levels (13).

Role of Vitamin D 

A lack of vitamin D can heighten the likelihood of GDM. Introducing vitamin D supplements during pregnancy has demonstrated benefits in sugar metabolism and in lowering fasting blood sugar metrics among GDM-afflicted women. It's vital to gauge Vitamin D levels early in pregnancy for tailored preventive measures (13).

Benefits of Probiotics 

Probiotics alter gut flora composition, which in turn enhances sugar and fat metabolism. Numerous pieces of research point to probiotics as potential agents in lowering GDM risks and bettering blood sugar regulation. They may also play a role in curbing inflammation and oxidative challenges in GDM-diagnosed pregnant women (13).

Omega-3 Fatty Acids 

The potential therapeutic properties of omega-3 fatty acids in the context of GDM are under investigation. Early findings suggest that omega-3 supplements can refine insulin function, lipid balance, and inflammation indicators in GDM patients (13).

Physical Activity and Exercise Recommendations For Gestational Diabetes

Physical activity has been shown to significantly influence the management and control of GDM in pregnant women. Studies have found a positive correlation between engaging in physical activity and better GDM control. Specifically, resistance training, aerobic exercises, or a mix of both have demonstrated effectiveness in managing blood glucose levels, HbA1c, and insulin requirements (2). 

While the studies analyzed did not pinpoint a singular best type of exercise due to varying conditions and individual differences, it's evident that any physical activity, if done with adequate intensity and duration, is beneficial. Pregnant women with GDM are advised to engage in physical activity for a duration of 20-50 minutes, with at least moderate intensity, a minimum of two times per week (2). 

Stress Management and Mental Wellbeing

Studies indicate a connection between GDM and increased risks of anxiety and depression, especially in women who had anxiety prior to pregnancy. Stress is associated with reversible severe insulin resistance, making stress management essential for those diagnosed with GDM. Leveraging a robust support system, practicing deep breathing, allowing emotional expression, and incorporating meditation can greatly assist in fostering relaxation and combatting stress during pregnancy (2). 

Collaborating With Healthcare Professionals

Collaborating with healthcare professionals is crucial for patients with GDM to ensure optimal prenatal care and safeguard both maternal and fetal health. Through regular consultations, patients can receive tailored advice on diet, exercise, and medication, which can significantly reduce potential complications. Moreover, continuous interaction with healthcare experts ensures timely intervention, up-to-date monitoring, and comprehensive support throughout the pregnancy journey (2).

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Summary

Gestational diabetes mellitus is a temporary condition characterized by glucose intolerance during pregnancy, with potential risks for both the mother and fetus. While many factors, such as genetic predisposition, hormonal changes, and pre-existing conditions, can contribute to its onset, early diagnosis, and intervention are vital for managing this condition. Various approaches, from dietary changes and physical activity to pharmacological interventions, play crucial roles in managing GDM, aiming for balanced blood glucose levels and optimal pregnancy outcomes.