gestational diabetes
Gestational Diabetes: A Particular Problem for Mamas on Bed Rest
January 29th, 2010
Gestational Diabetes (GD) can be particularly problematic for mamas on prescribed bed rest. Previously a common indication for bed rest, with all of the medical advances and therapies most pregnant women who develop GD are easily managed as out patients. Unfortunately, women who are prescribed bed rest for another medical condition are at increased risk for developing GD as a result of inactivity and weight gain. Women who develop GD are at increased risk of developing Type II diabetes later in life as well as Metabolic Syndrome.*
Gestational Diabetes is defined as impaired (improper) glucose metabolism during pregnancy. Some women become insulin resistant, meaning that the insulin their bodies produce does not properly carry glucose from the bloodstream into the body’s cells as it should. Sometimes GD develops because a woman has gained too much weight, a common cause of insulin resistance. Other times the increased hormones of pregnancy interfere with glucose metabolism. Finally, a woman with a genetic predisposition to diabetes may manifest her first symptoms during her pregnancy. This woman is at increased risk of developing Type II diabetes later in her life.
Testing for gestational diabetes is typically done between 20 and 28 weeks of pregnancy. The normal ranges of blood glucose are:
- 70-95 mg/dL Before breakfast (fasting)
- 70-140 mg/dL 1 hour after eating a meal
- 70-120 mg/dL 2 hours after eating a meal
Women who have blood sugars that fall above these ranges during testing will be diagnosed with GD. It is essential that women diagnosed with Gestational Diabetes are treated aggressively and that they achieve and maintain tight blood sugar control. Blood sugar control is essential to ensure the health of both mother and baby. When blood sugars are not controlled during pregnancy, Some unfortunate complications can result such as:
- High blood pressure in the mother caused by preeclampsia
- Excessive birth weight (exceeding 9 pounds, 14 ounces)or Macrosomia
- C-section delivery
- Hypoglycemia (low blood sugar) in the baby at birth
- Jaundice (yellow skin) in the baby at birth
- Respiratory distress syndrome (breathing difficulties) in the baby at birth
- Low blood calcium levels in the baby at birth
- Red blood cell disorders in the baby at birth
- In very rare cases, stillbirth of the baby at 28+ of pregnancy
- In very rare cases, death of the baby in infancy
- Increased risk for type 2 diabetes in both mother and baby later in life
Treatment of Gestational Diabetes is actually quite simple. From many women, adherence to a “diabetic diet”, a regular exercise regimen and regular blood sugar testing are all that is needed. However, for many other women, blood sugar cannot be adequately regulated and controlled with diet and exercise alone, so they are prescribed oral medications or Insulin injections.
Unfortunately most pregnant women on prescribed bed aren’t able to exercise enough reduce insulin resistance with diet and exercise alone. However it is still very important, perhaps even more so, that they follow the dietary instructions from their OB or a nutritionist and that they stretch and do some muscle strengthening and toning while in bed. If women on bed rest are diagnosed with gestational diabetes, they should request a referral to a physical therapist or exercise specialist** so that they can learn safe exercises that they can do while on bed rest.
It may seem unfair to be diagnosed with gestational diabetes while on bed rest for another condition. Try not to become too discouraged. Gestational Diabetes is easily managed and with careful adherence to your obstetrician’s directions, you and your baby can be just fine.
*Metabolic Syndrome is a group of symptoms that occur together and promote the development of coronary artery disease, stroke, and type 2 diabetes. An individual is diagnosed with Metabolic syndrome if they have:
- Extra weight around the waist (central or abdominal obesity)
- High blood pressure
- High triglycerides
- Insulin resistance
- Low HDL (“good”) cholesterol
**Bedrest Fitness is a set of simple yet effective modified prenatal exercises that a pregnant woman on prescribed bed rest can do from her bed with her obstetrician’s approval. Order Bedrest Fitness here.
Please share your comments or questions on this post below.
7 Ways Exercise Benefits Pregnant Women and Their Babies
January 18th, 2010After rereading my last post I realized it’s unfair of me to bash a study and not state my reasons why. I came out strongly against the Madrid study which found that low resistance exercise in previously sedentary women didn’t affect the type of delivery that they had. Essentially these researchers took a a group of sedentary pregnant women with uncomplicated pregnancies, set them up with a very low intensity work out for the second and third trimesters of their pregnancies and then looked at modes of delivery.
While the study seems to be carried out properly, my objections are that the women had not been adequately challenged, i.e. made to exercise with enough intensity, to be able to reap the benefits of prenatal exercise. As I mentioned in the last post, the exercise parameters that I use are those put forth by James Clapp, III, MD and Ann Cowlin, MA a Dance and Movement Therapist who have both done extensive research in exercise during pregnancy. They both advocate moderate intensity exercise 3-5 times a week for 20-30 minutes per session. By exercising at this frequency and intensity they both observed less maternal weight gain, lower incidences of gestational diabetes and hypertension, fewer aches and pains of pregnancy, shorter times in active labor (dilation from 4cm to 10 cm) , fewer interventions in delivery (i.e. forceps, vacuum, c-sections) a quicker return to pre-pregnancy weight.
But how exactly does moderate intensity exercise create these benefits? Let’s look at the effects of moderate intensity exercise on a pregnant woman’s anatomy and physiology. I promise not to get too geeky on you, just bear with me because this is important information.
Increased Muscle Tone
Just as in the non-pregnant state, exercise that includes strength training exercises maintain and/or increase endurance and muscle tone, creating more stamina, lean muscle and less body fat. For a pregnant mama, this means increased metabolism (muscle burns more calories than fat) and increased energy to perform the her activities of daily life. Most mamas who have engaged in regular, moderate exercise during pregnancy experience fewer of the common aches and pains of pregnancy, have shortened durations of active labor and subsequently need fewer pushes to deliver their babies. Post partum, they return to their pre-pregnancy weights sooner.
Increased Skeletal Stabilization
This goes hand in hand with increased endurance and muscle tone. A mama with well toned muscles will have more stability in her frame. Strength training enables Mamas to have better posture; a straighter back, less rounded shoulders and less neck strain. More skeletal stabilization leads to more hip and pelvic stability and less pain. Overall Mama will be less uncomfortable as her pregnancy progresses.
Improved Metabolism
Just as in the non-pregnant state, exercise increases metabolism by increasing the number of energy centers within muscles to utilize the nutrients we eat to create energy. Food mama eats will be used more fully for energy and development of her baby and less will be stored as fat. As a result, mama will be less likely to develop gestational diabetes or high blood pressure (hypertension).
Improved Circulation
Mamas who exercise also increase their blood circulation despite the increase in overall body fluid volume. Blood and body fluids are well circulated and don’t readily pool leading to swelling and increased of blood clot formation. For pregnant mamas who exercise, this means less swelling in the hands and feet and a lower risk of developing a blood clot in one of her legs that could dislodge and travel to her heart, lungs or brain and be potentially fatal.
Better Sleep
Ever notice that you sleep better when you exercise regularly? Well, exercising during pregnancy has the same effect. Some women note difficulty sleeping while pregnant. If this is the case, try adding a brisk daily walk or some strength training to your daily routine and see if you are able to get a better night’s sleep.
Improved Placental Growth and Functional Capacity
This was an unexpected finding that Dr. Clapp found in his research. Prior to Dr. Clapp’s research obstetricians and researchers believed that exercising during pregnancy would somehow impair the growth and development of the placenta. Dr. Clapp and his associates, using a special ultrasound machine, measured placental growth in his study subjects. Dr Clapp found that exercise didn’t stunt growth of the placenta, it actually increased its growth rate during the mid portion of pregnancy. Additionally, these larger placentas had more functional capacity, i.e. increased ability to nourish the babies, because they had more blood vessel development. This was a fantastic finding because at the end of pregnancy, when babies are growing rapidly, the larger, more vascular placenta is able to deliver more nutrients to the baby.
“Lean Mean Babies”
After establishing that exercise is good for mothers, Clapp set out to see what effect moderate exercise had on the growing babies. Clapp found that babies born to mothers who exercise are not at risk of being of low birth weight. They may weigh less than babies born to non-exercising mothers, but they are still of normal, acceptable birth weights and sizes. These babies also had less body fat than their counterparts. (Remember, they were being well fed by a highly functional placenta!) These babies also adapt well to stimuli and if there are complications during labor and delivery, they are better able to adapt and compensate giving clinicians a bit more time to assist if necessary.
This research has significant implications for women who exercise during pregnancy. But what happens if a woman stops exercising late in her pregnancy? Clapp found that women who stopped exercising late in pregnancy, say at 32 weeks lost all the benefits they had developed. They began gaining weight, experiencing the aches and pains of pregnancy, swelling in their hands and feet and they tended to have larger babies.
If women are going to exercise during pregnancy, they need to exercise at a moderate intensity (12-14 out of 20 on Borg’s Scale of Perceived Exertion) 3-5 times a week for 20-30 minutes and, as much as possible, they should continue exercising as close to delivery as possible.
Do you exercise or did you exercise while you were pregnant? Share your experience in the comment section below.
Mamas on bed rest, you may not be able to engage in cardiovascular exercise, but you can strength train using exercise bands. A simple, yet effective set of exercises is waiting for you in Bedrest Fitness. Even if you are unable to do all of the exercises, your body will appreciate the movement. Get your copy of Bedrest Fitness Here
Indications for Bed Rest
September 22nd, 2009Each year some 700,000 (about one in five) pregnant women will be prescribed bed rest, either modified activity or complete inactivity and confinement to bed. While bed rest has been a part of obstetrics for years, there is still controversy as to whether or not bed rest actually helps or is effective against any of the conditions for which it is prescribed.
Bed rest is commonly prescribed for women who:
- Have a multiple gestation; twins, triplets or higher order multiples
- Have an “incompetent cervix”; a cervix that begins to open prior to 37 weeks pregnancy endangering the life of the fetus and/or mother
- Preterm labor or a history of preterm labor; labor that begins before 37 weeks gestation
- History of prior miscarriage, still birth (death in utero) or premature birth (prior to 37 weeks gestation)
- intrauterine growth restriction/retardation (impaired growth)
- Placenta Previa; The placenta presenting first at the cervical opening
- Gestational Hypertension; with or without Pre-Eclampsia(toxemia)
- Gestational Diabetes
- Vaginal bleeding
- Too little amniotic fluid (oligoamnios)
While all of these conditions certainly put mama and baby at risk, to date there is no solid evidence that prescribed bed rest is effective at stopping or improving any of these conditions. In fact, studies to date show that prolonged bed rest and inactivity actually cause a worse overall physical condition to pregnant women-even those considered “high risk”. Women on prescribed bed rest may develop muscle weakness, cardiovascular deconditioning, blood clots, fatigue, drops in blood pressure when standing up, backache, bone loss, changes in metabolism, muscle aches, joint pain, difficulty walking (particularly stairs), difficulty concentrating, dizziness, shortness of breath, insomnia, and weight loss.
What has always struck me is the lack of attention to the emotional and psychological effects that prescribed bed rest has on pregnant women. When I have raised this concern to obstetricians their response typically is many of the psychosocial stressors can be dealt with once mother and baby are physically safe. However, studies have shown that maternal stress and anxiety prenatally can result in significant depression (perhaps leading to post partum depression) as well as mood changes a sense of confinement and loss of control. These psychological stressors can have significant impact on the course of the pregnancy and the health of both mother and baby. Additionally prescribed bed rest affects a pregnant woman’s entire family an can lead to child care problems, strained relationships and financial difficulties.
The next several blog posts will examine the common conditions for which bed rest is prescribed and the “proposed” benefit of bed rest on the condition. We’ll also look at what some research is revealing about bed rest in these situations and how many clinicians are rethinking how and when they prescribe bed rest for their patients.
