Diabetic Pregnancy: Macrosomia Dangers complicated by Insulin as a Growth Hormone
Pregnancy Tracker: 22 weeks
Size of the Baby: The size of a small doll.
Biggest Obstacle: Staying comfortable in this heat wave!
I'd venture to say that all pregnant women are concerned with weight during their pregnancy. Whether they take the "I can eat anything I want now!" attitude, try to maintain a healthy level of weight gain, or fall somewhere in between, pregnancy puts pounds on the brain.
For pregnant women with preexisting diabetes, the topic of weight takes on another aspect entirely -- that is the weight of your baby. The most common complication for diabetic pregnancies is macrosomia, or a heavier-than-average fetal weight at birth. Besides the health concerns for the baby, macrosomia contributes to more difficult labors and thus the increased likelihood of needing to deliver via cesarean.
Babies of diabetic mothers become large because the baby receives additional nutrition whenever the mother's blood sugar is high. The surplus glucose that the mother cannot efficiently metabolize passes onto the baby, who metabolizes it by making their own insulin.
I have been operating under the assumption that by maintaining a low A1c throughout my pregnancy, I would avoid the complication of having a large baby. However, further research led me to the basic error in this assumption. I realized that many diabetic women had very low A1c scores throughout their pregnancies and still delivered babies who weighed upwards of 11 pounds. This stumped me for awhile until I realized that a low A1c result can be achieved in many ways. If a diabetic mother eats a diet high in carbohydrates (or even just a typical amount of carbs), and then boluses accurately for their food, they can achieve a very low A1c score. Thus, a low A1c does not guarantee a healthy weight for your baby, or yourself.
Most diabetics went through a period of weight gain once they started insulin therapy because insulin is a growth hormone that allows the body to access the glucose consumed through food. Eating large quantities of carbohydrate and thus administering large doses of insulin to control blood sugar is a vicious cycle. When we think of pregnancy, however, weight gain seems natural, thus many women may not think to control their carbohydrate or caloric intake.
On the other hand, if a pregnant woman with diabetes chooses to limit her carbohydrate intake, she can achieve excellent blood glucose control without having to take extremely large doses of insulin. Keeping insulin doses as low as possible (remembering that insulin resistance will cause insulin requirements to rise) will help both mother and child to maintain a healthy weight.
Last week I spoke with my Certified Diabetes Educator, who confirmed the basic principle that eating a low carbohydrate diet while pregnant will benefit both me and my baby. However, as with all things diabetes-related, she explained that a mother can do everything "right" with her diabetes, and still have a large baby. All we can do is try our best and leave the rest up to God.
I'll be sure to follow up my high protein lunch with a little prayer!