Helen Dandurand (Host): Welcome back to the Well Within Reach podcast. I'm your host, Helen Dandurand. And today, I'm going to be joined by Dr. Clementina Asamoah, OB-GYN with Riverside Women's Health, to shed some light on the topic of gestational diabetes.

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Host: And we are back. Thank you so much for joining me today.

Dr. Clementina Asamoah: Thank you for having me.

Host: Of course. So to get started, could you tell us a little bit about your background?

Dr. Clementina Asamoah: . , so again, I'm Clementina Asamoah. I'm an OB-GYN at Riverside Medical Center. I joined the group about a couple months ago. I grew up and trained in Michigan, did my medical school at Michigan State University. Go Green, go White! And then, did my residency in Detroit.

Host: Awesome. Great. So, can you start? I guess we'll jump into the topic here, gestational diabetes, by telling us exactly what gestational diabetes is and how it differs from other types of diabetes.

Dr. Clementina Asamoah: Yes. So, gestational diabetes is a condition that specifically occurs in pregnancy in which the body becomes resistant to insulin. Specifically, the body can't break down carbohydrates and this is often called carbohydrate intolerance. This is different from type 1 or type 2 diabetes because they're often diagnosed outside of pregnancy.

Specifically, type 1 diabetes occurs most of the time earlier in life, and it's characterized by basically actually the immune system attacking the cells that release insulin. So, insulin is actually required as a treatment and needs to be given. And then, type 2 diabetes often occurs later on in life. And it's also characterized by basically resistance. The body becomes resistant to the insulin that's being released from the body.

Host: Got it. That makes sense. So, could you tell us, what are some of the primary risk factors that increase a woman's likelihood of developing gestational diabetes during pregnancy then?

Dr. Clementina Asamoah: Definitely. So, some risk factors include having a first-degree relative with diabetes, specifically mother, father, brother, and sister with diabetes. Also, a personal history of hypertension, high cholesterol levels, even PCOS, a personal history of coronary artery disease, specifically heart disease, or being obese or having a sedentary lifestyle, meaning you're not that active. All of those can be risk factors for developing gestational diabetes.

Host: Got it. The first thing you mentioned was having a close relative is that, does it matter if it's type 1 or type 2 that they have or no?

Dr. Clementina Asamoah: No. If either type 1 or type 2 or even if they know their mother had gestational diabetes, then that could also

Host: Got it. Got it. Okay. How is gestational diabetes then diagnosed? And what roles does screening play during pregnancy?

Dr. Clementina Asamoah: Yes. So, gestational diabetes is diagnosed in pregnancy. Every single pregnant woman is screened between 24 and 28 weeks with a one-hour glucose test. If the test is normal, then we can rule out gestational diabetes. However, if that one-hour test is abnormal, then we move on to the three-hour test. And in the three-hour test, we basically will check fasting, then we do a one-hour, two-hour, three-hour. If two of the four values are elevated, then we can say you have gestational diabetes.

Another way we can diagnose it is, if the one-hour level is very, very high, then we don't even go ahead and move on to the three-hour. We can safely say you have gestational diabetes.

Host: Got it. What are the potential risk factors if someone is diagnosed with gestational diabetes for like the mother and for the baby?

Dr. Clementina Asamoah: Yes. So for the mother specifically, a woman with gestational diabetes, they actually have a higher risk of developing preeclampsia, which is a very severe form of high blood pressure in pregnancy that often necessitates early delivery. They also have a risk of developing diabetes later on in life, and they're actually more likely to undergo a C section at the time of labor and delivery.

Yeah. And in addition for the babies, they're more likely to develop hypoglycemia, which is low blood sugar after birth. They're also more likely to have stillbirth, unfortunately, where the baby passes away while still in the uterus. And they're more likely to also develop birth trauma, specifically shoulder distortion.

Host: Got it. We are going to take a quick break to talk about primary care at Riverside.

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All right, and we are back. So, what kind of lifestyle changes or interventions are most effective in managing gestational diabetes particularly in terms of like diet and exercise?

Dr. Clementina Asamoah: Yes. So once gestational diabetes is diagnosed, the first step is lifestyle modifications, specifically diet and exercise. In regards to diet, we usually refer to nutrition counseling where they meet with a licensed dietitian and they come up with a nutrition plan that works for them.

The goal is to limit carbohydrates to at least 30-40% and then the rest to 30% of protein and fat to include also in the diet. And also, exercise is really important. We recommend at least two hours and a half a week of moderate intensity exercise. Even something simple as taking a 20-minute walk after a meal will is beneficial.

Host: Are there ways if someone is not already pregnant and they want to minimize their risk for that, for having gestational diabetes? What would you recommend they do?

Dr. Clementina Asamoah: Yes. So, minimize the primary risk factors that I talked about. So if you have a history of PCOS, getting that taken care of. If you have a history of coronary artery disease or heart disease, also making sure they may need to be put on medication, they may need to start exercising, lose weight, and incorporate a healthy diet so that they can treat their heart disease.

But also, if there's a family history, there's not much that can be done. But if they are overweight or obese or have a sedentary lifestyle, getting active now, getting their weight under control and eating a healthy diet, healthy nutritious diet, can decrease the risk of gestational diabetes.

Host: Gotcha. So going back, you know, we were talking before that about managing it once you already have it, can it be managed with diet alone or are there medications too that patients might have to take in order to help manage it as well?

Dr. Clementina Asamoah: Yeah. So, our goal is to manage it with diet and exercise. If we see with diet and exercise your blood sugar levels are still elevated, then the next step is medication. The first line in standard therapy is insulin. Insulin has been shown to actually be very beneficial in getting the blood sugars under control in gestational diabetes.

Host: Gotcha. How does gestational diabetes then affect the delivery process? Are there any special considerations for labor and delivery?

Dr. Clementina Asamoah: Yes. So, overall, if you have well-controlled gestational diabetes, the recommendation is that you get delivered between 39 weeks and zero days and 39 and six days. However, if your gestational diabetes is not well controlled and your sugars are very elevated and your OB-GYN has had a difficult time controlling it, for mom and baby's sake, we may need to deliver them early.

In regards to labor and delivery specifically, there's not really any special considerations. The goal is to control blood sugars during labor. Labor is very stressful for the mom and that can cause the sugars to actually spike. So, we'll check your sugars more frequently and give insulin if needed to get them under control.

Host: What steps should women take postpartum, both in terms of monitoring their health and ensuring that gestational diabetes does not develop into type 2 diabetes later in life?

Dr. Clementina Asamoah: That's a good question. So, gestational diabetes often resolves after delivery, that's why it's called gestational because it happens in pregnancy. But the recommendation is any women that have gestational diabetes, postpartum, about four to twelve weeks after, we actually do a diabetes screening where we get a fasting sugar level and we also do a two-hour glucose level. If that's normal, we still do testing every couple of years, because it's been shown that one-third of women who have gestational diabetes will actually end up developing type 2 diabetes later on in life.

Host: Wow, that's crazy. Well, that's all great information, though. Is there anything that you feel like we missed? Like, something that's important around this topic that you want to share

Dr. Clementina Asamoah: Yeah. So, I can talk about early screening. So, sometimes if we notice that you may have risk factors that may increase your risk of diabetes or even gestational diabetes, at the initial OB visit, even if you're in your first trimester, we'll go ahead and do actually early diabetes screening. And if that testing comes back positive, then we know you actually have type 2 diabetes, not gestational.

Host: So, if someone comes in and they are already diagnosed with diabetes, how does that affect the pre-screening or screening process with all of that?

Dr. Clementina Asamoah: Yes, that's a good question. So if they come in already diagnosed with type 1 or type 2 diabetes, there's no screening that needs to be done. They already have type 1 diabetes and that will continue throughout the pregnancy. Most of the time, when they come in already with a diagnosis of type 1 or type 2, they're already on treatment, specifically insulin. So when they're pregnant, those insulin regimens may need to be adjusted, because now the body has a whole human being that is trying to grow, and the body's metabolic changes may necessitate changes in the doses of the insulin needed so that we can get the sugars better controlled during pregnancy.

Host: Okay. What would you say to a patient who's diagnosed or thinks they might be? What kind of advice do you have to give them?

Dr. Clementina Asamoah: So, I would say the most important thing is we need to get your sugars under control. This is not an end of life diagnosis, this is something that can be treated specifically with diet and exercise. That's why usually our first step is lifestyle modification.

If patients get really serious and focus on their diet and watch their carbs and then incorporate actually exercise into the diet, most of the time we can actually control their gestational diabetes and they may not need insulin. Because I know just the thought of poking yourself multiple times a day and injecting yourself with insulin can be daunting. But if we can get your diabetes controlled just with diet and exercise, we may not need to proceed with insulin.

Host: Well, great. I feel like that's all really good information for this podcast, and thank you so much for agreeing to do it.

Dr. Clementina Asamoah: Thanks for having me.

Host: Of course. And thank you listeners for tuning into the Well Within Reach podcast, brought to you by Riverside HealthCare. For more information, visit riversidehealthcare.org.