Running Head: THE BURDEN OF GESTATIONAL DIABETES

The Burden of Gestational Diabetes

Abigail E. Floyd
James Madison University

THE BURDEN OF GESTATIONAL DIABETES

Abstract
This essay examines the extensity of the burden of gestational diabetes on women who develop
the disease. It begins with a brief overview of what exactly gestational diabetes is including the
physiology and prevalence of the disease. The essay then goes on to highlight the risk factors of
someone likely to develop gestational diabetes, such obesity and family history of the disease.
Next, the concept that gestational diabetes often displays no symptoms is discussed and
analyzed. Also, complications of the disease, for both mother and infant, are examined.
Treatments for gestational diabetes are described next including lifestyle changes and
medications. Finally, the essay stresses the notion that those with gestational diabetes are more
likely to contract type 2 diabetes in the future. The essay concludes that gestational diabetes is a
large burden for a pregnant woman to carry due to the many lifestyle changes of treatment,
immediate complications and risk of future diabetes development.

THE BURDEN OF GESTATIONAL DIABETES

Pregnancy, without any complications, is difficult enough for any woman to adapt to. A
pregnant womans body becomes something she is completely unaccustomed to, making her
nauseous, emotional, and lethargic. Occasionally however, a woman may experience other, less
common symptoms of pregnancy. These symptoms are that of gestational diabetes. Due to the
many unpleasant symptoms and possible complications, gestational diabetes is an enormous
burden upon any pregnant woman who is unfortunate enough to develop it.
Gestational diabetes is a condition involving diabetes mellitus that arises during
pregnancy in women. This bout of sudden diabetes arises due to pancreatic hormones causing
insulin resistance, and insufficient amounts of insulin in the body (Mertig, 2012, p.6). This
insulin resistance is reminiscent of the insulin resistance found in type 2 diabetes. Insulin in these
women is usually over-produced to compensate for the inability of the body to take in the insulin
(Mertig, 2012, p.6). Of course, this increase in insulin production is futile, due to the insulin
resistance. Blood sugar levels inevitably become very high. Gestational diabetes is fairly
common and affects a large number of pregnant women. This disease is found in roughly 2%10% of total U.S. pregnancies, which is about 135,000 gestational diabetes cases per year
(Mertig, 2012, p.8). As proven by these statistics, gestational diabetes is not a rare condition.
Many U.S. women are faced with and must cope with this troublesome complication of
pregnancy. Insulin resistance is a symptom contracted by every pregnant woman (Mertig, 2012,
p.8). This resistance stems from certain placental hormones (Mertig, 2012, p. 208). However,
those without gestational diabetes have the pancreatic capacity to compensate for the resistance
by producing more insulin. Those with gestational diabetes have pancreases that cannot keep up
with the increased demand for insulin (Mertig, 2012, p.8). The body is therefore, unable to meet
its glucose needs. Another cause of gestational diabetes is an increased hepatic glucose

THE BURDEN OF GESTATIONAL DIABETES

production (Mertig, 2012, p. 209). This puts additional stress on the bodys ability to regulate
glucose. After pregnancy, when the placenta is delivered, gestational diabetes usually subsides
(Mertig, 2012, p. 209). Anti-insulin hormones are no longer being produced because pregnancy
has concluded. However, women with gestational diabetes should be screened for type 2 diabetes
post-pregnancy to rule out the possibility of their gestational diabetes actually being type 2
diabetes.
Certain genetic and environmental factors can make some women more prone to
gestational diabetes than other women. Individuals with an extensive family history of type 2
diabetes have a higher risk of developing the disease during pregnancy. Also, women who are
severely obese or have previously had a baby with an abnormally high birth weight are at an
increased risk for the disease to arise. Other risk factors include prior history of GDM, presence
of glucose in the urine, and diagnosis of PCOS (Mertig, 2012, p. 209). Women exhibiting these
characteristics should be especially cautious of contracting gestational diabetes. However,
women with diabetes before pregnancy are no longer discouraged from getting pregnant because
of an increase in technology in the field of diabetes management (Mertig, 2012, p. 206). The
burden of contracting gestational diabetes or even the fear of contracting the disease due to the
knowledge of possessing certain risk factors is an enormous burden of anxiety on any pregnant
woman. The imminent possibility of no longer being able to regulate blood glucose is an
immensely ominous outcome.
Another burden of gestational diabetes is the fact that it is difficult for the pregnant
woman to become aware of it. Gestational diabetes does not usually come with any symptoms
that would indicate to the pregnant individual that something is wrong (Understanding the
Symptoms, 2014). Any change in overall wellbeing would most likely be attributed to normal

THE BURDEN OF GESTATIONAL DIABETES

pregnancy symptoms. Occasionally however, a woman with gestational diabetes may notice
increased urination, hunger, and thirst (Understanding the Symptoms, 2014). However, this is
only in rampant cases of gestational diabetes, where the glucose regulation is highly out of
control. With symptoms rarely arising, women are highly unlikely to detect the gestational
diabetes on their own. For this reason, all pregnant women are advised to be screened for the
disease. Most of gestational diabetes cases are diagnosed through examinations for diabetes at
physicians offices (Understanding the Symptoms, 2014). An undiagnosed case of gestational
diabetes would be an extraordinary burden on a pregnant woman, making it very necessary to
check for this disease during scheduled doctors appointments.
One of the major reasons that gestational diabetes is such a huge burden on a pregnant
woman is the many risks and complications of exhibiting the disease during pregnancy. Fetal
and maternal morbidity can be affected by gestational diabetes (Webb, 2013, p.16). Whether a
mother and child survive pregnancy and delivery can be attributed to displaying gestational
diabetes, which is the most massive complication of all. The emotional burden linked to the loss
of a wife or child is utterly devastating. Possible complications for the fetus are macrosomia,
neonatal hypoglycemia, respiratory distress syndrome, shoulder dystocia, polycythemia, and
hypocalcaemia (Webb, 2013, p.16). This abundance of possible complications regarding the
infant is extremely distressing to parents and mothers with gestational diabetes. Macrosomia is
especially concerning when considering that 20-30% of infants born of mothers with gestational
diabetes exhibit it (Webb, 2013, p.16). Maternal risks of having gestational diabetes include
hyperglycemia, obesity and caesarean section delivery. In addition, the mother is at an increased
risk for developing type 2 diabetes later on in life (Webb, 2013, p.16). With so many possible
complications for both mother and child, parents are likely to feel uneasy about the outcome of

THE BURDEN OF GESTATIONAL DIABETES

the pregnancy. In addition, if any of these complications do arise for either the mother or child,
the burden and stress of coping with these conditions is immense for new parents. Not only do
they have to take care of a helpless infant, but they must also cater to the demands of the
complication. Also, if the mother unfortunately contracts one of these possible complications,
her health needs will have to be provided for as well.
Gestational diabetes must be treated properly in order to ensure the health of both mother
and child, which is an additional burden upon the mother who is already adjusting to the
demands of pregnancy. This treatment includes diet and lifestyle alteration as well as possibly
the introduction of insulin supplements, which are given if the former changes do not suffice
(Webb, 2013, p. 17). Mothers with gestational diabetes are advised to restrict their calorie
consumption and to keep up with a regular exercise routine (Webb, 2013, p.17). Drugs can also
be prescribed in order to regulate blood glucose levels. Metformin and glibenclamide are often
the drugs of choice regarding gestational diabetes (Webb, 2013, p.17). Insulin supplements,
rapid-acting and human derived, are often given in addition to the anti-diabetes drugs (Webb,
2013, p.17). Adjusting to a new lifestyle routine in addition to having the enormous lifestyle
change of pregnancy, can be a huge burden to a pregnant woman. Physicians attempt to target
the blood sugars of gestational diabetics to be similar to those with pre-gestational diabetes
(Webb, 2013, p.17). To observe these levels, women are required to calculate their blood glucose
levels before a meal and one hour after (Webb, 2013, p.17). This frequent checking of glucose
levels can be a hassle for women with busy schedules. Treatment for gestational diabetes does
not include use of oral hypoglycemic agents, principally owing to concerns in relation to
transplacental passage and risk of neonatal hypoglycemia (Webb, 2013, p.18). The oral route
for receiving treatment is therefore, removed from consideration. With regard to diet changes,

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gestational diabetics are advised not to consume any foods with added sugars (Webb, 2013, p.
18). Women who are accustomed to frequent intake of food items with added sugars are highly
inconvenienced by this recommendation. It may be very difficult for them to alter their diet in
this manner, due to their reliance upon foods with added sugars. Overall, the necessity of
lifestyle alterations to cater to gestational diabetes can be an enormous burden for the mother
with gestational diabetes.
Possibly one of the most concerning elements of gestational diabetes is the threat of the
woman developing type 2 diabetes later in life. The development of type 2 diabetes is a
permanent condition, unlike the temporary gestational form, making it of great concern. The
risk of developing type 2 diabetes after gestational diabetes increases over time, from 4.9% at 15
months post-partum, 13.1% at 5 years post-partum, and 18.9% at 9 years post-partum (Webb,
2013, p.16). Due to this increasing risk over time, the mother with gestational diabetes is never
placated. She is consistently, increasingly in fear of developing the condition. There is never a
moment where she can relax and be sure that her gestational diabetes has not led to type 2
diabetes. This is a heavy load to bear for the rest of a lifetime. Additionally, there is a high risk
of developing type 2 for gestational diabetics after 10 years. Those who have had gestational
diabetes during pregnancy can look forward to a 35-60% risk of contracting type 2 diabetes at
10-20 years after delivery (Mertig, 2012, p. 208). Therefore, not only is there an increasing risk
of developing the disease over time during the first few years, but also a disturbingly high risk of
developing it after 10 years. The gestational diabetic has ominous possibilities in her future that
are bound to weigh heavy on her mind.
Gestational diabetes is a condition that coincides with enormous emotional, physical, and
psychological burden for those who experience it. A woman with gestational diabetes must

THE BURDEN OF GESTATIONAL DIABETES

completely alter her lifestyle, worry about impending complications for both she and her baby,
and wrestle with the possibility of type 2 diabetes in her future. No woman wants to experience
such hardships when preparing for and experiencing the birth of her child.

THE BURDEN OF GESTATIONAL DIABETES

References
Mertig, R. G. (2012). Nurses' Guide to Teaching Diabetes Self-Management Second Edition..
New York: Springer Publishing Company.
Understanding the Symptoms of Gestational Diabetes. (2014, March 21). WebMD. Retrieved
April 27, 2014, from http://www.webmd.com/baby/understanding-gestational-diabetessymptoms
Webb, J. (2013). Diagnosis and treatment of gestational diabetes. Nurse Prescribing, 11(1), 14.