Integrative Medicine and Gestational Diabetes: A Multidisciplinary Approach to Management

Pregnancy is a monumental time in many women’s lives. They’ll experience the beauty of growing a human life, see the astonishing transformation that a woman’s body can accomplish, and have the honor of birthing a baby. While the majority of pregnancies go without metabolic complications, it’s important to know the conditions that can arise in pregnancy, such as gestational diabetes. In the United States, between 2% to 10% of pregnant women will be diagnosed with gestational diabetes. This condition is typically self-limiting and will resolve after childbirth, but it’s essential that you know what it is, the risk factors associated with it for both you and the fetus, and your options for care. 

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What is Gestational Diabetes?

During pregnancy, dysfunctional blood sugar regulation can occur, resulting in gestational diabetes (GD). This condition arises between weeks 24 to 28 of pregnancy due to placental hormone changes, which can not keep up with the demand for insulin release, or insulin is not working effectively. Malfunctioning insulin response to blood glucose is a result of insulin resistance. When insulin is not functioning properly, blood sugar can not get into the cells, which leads to elevation in the blood. This can negatively impact both the mother and fetus but can also be managed through diet, lifestyle modification, or medication. In the majority of cases, GD is self-limiting to pregnancy, with a return to normal blood sugar functioning after you give birth. 

Risk Factors And Potential Complications For Both The Mother And Baby

While diet and lifestyle matter, any pregnant woman can develop gestational diabetes. There are risk factors that increase your odds of this condition. These include heart disease, high blood pressure, obesity, polycystic ovarian syndrome (PCOS), family history or past medical history of GD, being pre-diabetic, inactivity, or having a previous large birth weight baby of nine pounds or more. If a woman develops diabetes during the last half of pregnancy, it can increase her risk for a cesarean birth due to large fetal development, type 2 diabetes (T2D) that continues after the birth, and preeclampsia. The baby can also have potential complications from unregulated blood sugar during the mother’s pregnancy. This ranges from prematurity to hypoglycemia at birth which can dangerously lead to seizures, breathing difficulty at birth, increased birth weight, increased risk for developing T2D later in life, or a stillbirth. 

Current Standard Medical Interventions For Gestational Diabetes Management

When diagnosed with gestational diabetes, it’s important to treat the mother’s blood sugar dysregulation. Monitoring blood sugar with a glucose meter or continuous glucose monitor (CGM) can help track and regulate blood glucose. This provides insight into foods that you may be adversely responding to in terms of insulin stimulation and processing. With that in mind, constantly elevated blood sugar can be damaging to both the mother and the fetus. Making dietary changes will be the primary mode of blood sugar control in GD. Some straightforward alterations include cutting out all processed and high sugar content junk food, eating smaller meals, and creating consistency in meal times. Recent research indicates that a low glycemic index diet, in comparison to a low-carbohydrate diet or calorie-restricted diet, can lower the need for insulin and decrease the associated risk of a high birth weight infant. In addition to diet, exercise is key and can help your body mobilize glucose. If these lifestyle interventions are not making a positive impact, or your situation is worsening, your doctor may prescribe insulin to help control your blood sugar. 

The Role of a Multidisciplinary Team For Gestational Diabetes Management

Collaboration among healthcare providers that are all working towards optimizing a mother’s health and the well-being of her unborn child is ideal. Pregnancy care starts with an obstetrician or midwife. The standard care of practice is to test for gestational diabetes between weeks 24 to 28 by doing a glucose challenge test. If your blood sugar is high after consuming the testing solutions (a high-sugar drink), you’ll then need to do a glucose tolerance test. It’s essential that you approach this test by fasting. Your blood glucose is measured before the test begins and then again at intervals of one, two, and three hours after you have consumed the high-sugar drink. A positive result on this test is affirmative for gestational diabetes. Your visits with your obstetrician may become more frequent after this point, as they’ll want to monitor you and your growing baby. You may also be referred to a nutritionist who can help you establish a dietary plan. Movement is highly encouraged to help manage blood sugar as well. Evidence shows that by conventional medical standards, there is typically a two-week lifestyle and dietary intervention window to see if that makes a positive impact on blood sugar regulation. If your situation worsens or hyperglycemia becomes more present throughout the day, a referral to an endocrinologist is warranted to discuss pharmaceutical options. Insulin is the primary drug intervention for gestational diabetes, but your doctor may also discuss options such as Metformin or Glyburide, which are medications to lower blood sugar. Even with lifestyle interventions, about 15-30% of women with gestational diabetes may need medication intervention. Additional options for care are adding a naturopathic doctor or functional medicine practitioner to your team who is trained in nutrition counseling and lifestyle modification such as stress management, optimizing sleep, vitamin and nutrient therapy, botanical medicine, and the importance of movement on physiology. 

Functional Medicine Labs to Test That Can Help Individualize Treatment for Patients With Gestational Diabetes

Proactive investigation and assessment through functional labs can help guide your holistic doctor in treatment recommendations. Looking at basic lab values in a CBC, blood sugar markers in a diabetes screen, or even a comprehensive micronutrient panel can provide valuable insight.

Comprehensive Pregnancy Panel

Getting bloodwork early on in pregnancy provides a baseline of your health status. The Obstetric Panel by Access Medical Laboratories can provide indications of any disturbances associated with red and white blood cells. 

Diabetes Screening

If you have a personal or family history of gestational diabetes, getting screening testing done early on can help detect trends toward GD. Markers, like glucose, insulin, and hemoglobin A1c (HbA1c) are valuable for diagnosing and monitoring gestational diabetes.

Micronutrient Panel

Studies have found an association between micronutrient alterations and gestational diabetes. Findings amongst women with gestational diabetes included high folate with low vitamin B12 or, vice versa, high B12 with low folate status. There have also been amino acid changes detected, particularly betaine and choline, which play a role in methylation, placental function, neurodevelopment, and epigenetics. A micronutrient test that also includes amino acids is a great option for investigating imbalances and providing individualized solutions.

Integrative Medicine Techniques for Gestational Diabetes Management

Taking an integrative medicine approach in addressing gestational diabetes can be an excellent way to support mother and fetal development. Making changes in the area of nutrition, exercise, and mental-emotional support can truly help you successfully overcome this temporary situation with no long-term effects. 

Nutrition for Gestational Diabetes Management

Dietary modifications are the primary intervention when it comes to managing gestational diabetes. Reducing simple carbohydrates, which tend to have a higher glycemic index, thus spiking your blood sugar, is a focal point. Recent evidence suggests that a Mediterranean-style nutrition plan can provide optimal nutrition and guidance for decreasing blood sugar and insulin resistance. This should include lean protein, with an emphasis on seafood, fresh and antioxidant-rich fruit, and vegetables, healthy fats from olive oil, nuts and seeds, and minimally-processed whole grains. A Mediterranean diet falls into alignment as a low-glycemic way of eating, which is ideal for gestational diabetes.

Exercise for Gestational Diabetes Management

Physical activity and safe exercise during pregnancy are encouraged to help support a healthy pregnancy. The American Diabetes Association recommends engaging in 30 minutes of exercise per day for those with gestational diabetes. This can help regulate glycemic control and promote insulin sensitivity. If you were someone who regularly exercised prior to pregnancy, you should maintain your exercise at a moderate intensity. If you have lived a more sedentary lifestyle, are overweight, or are newly diagnosed with GD, it's recommended to start with low-intensity aerobic exercises. This can include around 15 minutes of walking, biking, or circuit training. As you become more comfortable, increase your functional movement to 30 minutes per day, at a minimum of five days a week. This may sound daunting if you are new to implementing an exercise routine, so start slow, set realistic goals, and work with a professional if necessary. 

Mindfulness And Stress Reduction for Gestational Diabetes Management

During pregnancy, your body goes through drastic changes while growing a baby. While exciting, this poses both physical and mental-emotional stress. A systemic review dived into the literature on mental health in correlation to gestational diabetes. Results of a meta-analysis of 18 studies revealed that women with GD are at an increased risk of developing both anxiety and depression. Likewise, there is a positive correlation between women who suffer from anxiety prior to pregnancy and the development of gestational diabetes. With this in mind, it’s crucial to incorporate techniques for managing stress and promoting emotional well-being if you are diagnosed with this condition. Leaning on a good support system such as friends, family members, or your community to help you can help ease your mind and assist with physical stress. Resting when you can, practicing deep breathing, and allowing yourself to process emotions through crying or laughing can be therapeutic. While meditation is not specific to gestational diabetes, it can greatly benefit women while they are pregnant by inducing relaxation, increasing mental clarity, reducing negative feelings, decreasing anxiety, and being a great stress coping mechanism. 

Complementary Therapies for Gestational Diabetes Management

Integrative medicine and complementary care options can be an asset to your health. In addition to conventional medicine care, consider traditional Chinese medicine (TCM) modalities and evidence-based natural blood sugar support supplements. 

Acupressure

The use of acupuncture and acupressure has not been widely investigated in women with gestational diabetes. There is one study that found promising results during the 12-week trial. The end result concluded that gestational diabetes can improve glycemic control and insulin sensitivity. Working with a TCM practitioner that also does acupuncture would be a really great avenue for this holistic approach. 

Traditional Chinese Medicine and Herbs

Utilizing Chinese medicine and traditional herbal medicine can be greatly beneficial for pregnancy and gestational diabetes. Being cautious about the safety of plant-based medicine is essential, as many are not safe for pregnancy. There are three evidence-based remedies that have promising results in the reduction of blood glucose and insulin function- Zuo Gui Wan, Rubus Ideaus (red raspberry leaf), and Astragalus. Working with a trained TCM practitioner or herbalist is the best way to treat this condition individualistically with herbal medicine.

Myoinositol Supplementation for Gestational Diabetes

Inositol, which is a sugar produced from glucose in the body, can be taken exogenously in the form of myoinositol to support pregnant women with gestational diabetes. A study of 69 women with GD found that the study group who took both folic acid and myoinositol had significantly lower glucose and insulin results compared to the control group who took only folic acid. This study also revealed that the combo folic acid and myoinositol increased adiponectin which is a marker of cellular response to insulin.  

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Summary

Gestational diabetes can occur in both women with a predisposition and completely healthy pregnant women. The causation is due to hormonal dysfunction from the placenta, which prevents insulin from properly doing its job, resulting in elevated blood sugar. Thankfully there are dietary and exercise practices you can put into place which will greatly help in managing this condition and allow you to have a healthy pregnancy. As complementary and integrative medicine continues to gain traction, these modalities of care are being sought out to support women through conditions such as gestational diabetes. Seeking out a holistic practitioner as part of your multidisciplinary team can assist you in your pregnancy journey and help you overcome the obstacles of this condition.