In simplest terms, diabetes is heightened insulin resistance. All humans have some level of reaction to insulin, but this resistance changes during pregnancy, and sometimes results in a form of diabetes that exists only during the pregnancy. The American Diabetes Association admits that the exact cause of gestational diabetes isn’t fully understood, but estimates that as many as 9% of all pregnant women will develop it.
Most doctors believe that gestational diabetes is a hormone problem that begins with the placenta. The placenta is an organ developed by the body for the sole purpose of creating hormones that will help grow a human baby. Hormones like estrogen, progesterone, human growth hormone, and even cortisol (a stress hormone) rise during pregnancy. When these hormones become too high, they can override the hormones in the body that are used to break down insulin. The result is gestational diabetes.
Perhaps more accurately named “gestational insulin resistance,” women who develop gestational diabetes stop being able to respond to insulin. As a result, their cells can’t absorb glucose in the blood, resulting in a buildup of sugar in the bloodstream.
The end result is a pancreas that is working harder than it should be, often to no avail. This means that the glucose build up can, and often will, cross the placenta and work its way into the developing baby’s blood. That will, in turn, cause the newborn’s pancreas to work overtime and create more energy than it needs. As a result, that fetus will store the extra energy as fat. This can lead to a variety of complications including high birth weight, damage to the shoulders as they exit the birth canal, and an increased risk of obesity or type two diabetes later in life.
If your surrogate does wind up with a diabetes diagnosis, it is important to understand that there is nothing your surrogate could have done to prevent this. This is not a lifestyle or diet concern. Unlike type 1 diabetes, which is typically inherited, or type 2 diabetes, which typically is the result of excessive weight and poor diet, gestational diabetes tends to be linked to how the body regulates pregnancy hormones.
In most cases gestational diabetes can be managed by closely monitoring diet and adding a bit of additional exercise. Your surrogate will be asked to monitor her glucose levels with a home testing kit and keep a strict log of her food intake and sugar levels, but may not need to change much about her lifestyle.
However, some women are simply unable to control their blood sugar levels, even with strict adherence to diet and exercise. In these instances she may be asked to begin taking oral medication or injected insulin in order to keep her body’s chemistry in check. If this happens, it is not the reflection of poor diet or failure to follow doctor’s orders. Again, in the case of gestational diabetes, hormone levels are more closely related to a higher level of insulin resistance as the result of pregnancy hormone levels.
For most women gestational diabetes will go away once the child is born. The American Diabetes Association advises women who developed gestational diabetes to have a two hour glucose tolerance test at six weeks postpartum in order to ensure that the diabetes has cleared up.