All pregnant women will be tested for gestational diabetes during their pregnancy, and it is no cause for alarm. Even if they’ve had no prior issues with blood sugar levels in their day-to-day life or in previous pregnancies, they will still be tested during a surrogate pregnancy.
While being a surrogate does not raise the odds of developing gestational diabetes, factors such as excessive weight, age, and carrying multiples may contribute to a more significant insulin resistance and the development of this condition.
Glucose tolerance tests monitor the body’s ability to turn sugar into energy. During pregnancy, the additional hormones can confuse the pancreas, rendering it unable to break down glucose properly. When this happens, blood glucose rises and, on occasion, the woman will develop gestational diabetes. Unlike type 2 diabetes, gestational diabetes is purely hormonal. If a diagnosis of gestational diabetes is given, it is not the result of your surrogate’s food and exercise choices. This is not a diagnosis that could have been avoided with different behaviors.
Learning that your surrogate’s initial glucose tolerance test came back elevated is a conversation that no intended parent hopes to have during their journey. Your initial reaction will likely be surprise, which then ignites questions and concerns: “She’s never had THAT in her history! What does this mean for the pregnancy? What did she do to ‘fail’ this test when she’s never failed it before?”
Let’s start by establishing a baseline. Having an elevated one-hour glucose test result is not a “failure.” If the test result is elevated (a “fail”), then there is nothing that could have been done differently by your surrogate to “pass”. Also, many women will have elevated levels in a one-hour standard test and go on to pass a three-hour screening and have no problems. However, an elevated result on a one-hour glucose screening can also be the first indicator that your surrogate has developed gestational diabetes. In either event, it’s important to note that this test result is not the result of any action or inaction on the part of your surrogate.
Understand that your surrogate is likely having an emotional reaction to these results as well. Despite not being able to control the results, she likely feels guilty and perhaps even a bit scared. The kindest thing that you can do for her is to reassure her that she hasn’t lost your trust and that you’re still in this together.
With a buildup of sugar in the bloodstream, a pancreas will work harder than it should, often to no avail. This means that the glucose buildup can, and often will, cross the placenta and work its way into the developing baby’s blood. That will 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.
However, 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.
Women who are unable to control their blood sugar levels, even with strict adherence to diet and exercise, may be asked to begin taking oral medication or injected insulin. 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.
It’s important to understand what gestational diabetes is (a hormone-driven resistance to insulin) and what it is not (poor dietary choices or the inability to follow a diet). Your surrogate will likely feel some level of guilt in the case of a gestational diabetes diagnosis, even though it was induced by pregnancy. This is a great time to show her that you support her and will stand by her side moving forward.