Gestational Diabetes is Not a Failure

Let’s talk for a minute about gestational diabetes. (And by “talk,” I mean “I write, you read.”)

Gestational diabetes is high blood sugar (also called hyperglycemia) during pregnancy, and it occurs in up to 10% of pregnancies in the United States. It can cause the developing baby to grow larger than they otherwise would. It can also can impair functioning of the placenta, which is the organ that supplies the growing baby with nutrition and oxygen. These possibilities can pose risks to pregnant parents and babies, so it’s good to identify those with gestational diabetes in order to monitor and manage their blood sugar. Fortunately, testing for the condition is inexpensive and easy. We know exactly how to manage high blood sugar, and we have many options to reduce or eliminate the risks it poses during pregnancy and birth. There is absolutely no reason why being diagnosed with gestational diabetes should be devastating to expecting parents.

But for many, it’s exactly that. Gestational diabetes, like other forms of diabetes, is stigmatized and associated with “irresponsible behaviors” that the patient “should be able to control.” The language around gestational diabetes is discriminatory, from the moment a diagnosis is made. This usually happens over the phone, when your provider or a staff member tells you that “You failed your glucose tolerance test.” Failed. (Side note to providers and their staff: PLEASE STOP SAYING THAT!)

Why they gotta say it like that?

This is absurd. If you have high blood pressure, no one says you “failed your blood pressure measurement.” If you have protein in your urine, no one says you “failed your urinalyses.” But for gestational diabetes, we make an exception and blame the patient. It’s an ugly, hateful, harmful thing to do, and it’s worth asking ourselves “Why do we do that?”

To be frank, we do that because we live in a society that is fat-phobic and diabetes-ignorant. It’s a common perception that diabetes is a “fat people disease.” We get the message that being at a healthy weight, eating well, and exercising can completely eliminate the risk of developing diabetes. That’s not true for diabetes outside of pregnancy, and it’s not true for gestational diabetes either. The truth is that genetics play a role, lifestyle plays a role, and the specific placenta (and resulting hormones) grown in any particular pregnancy plays a role too.

I present to you: The Gestational Diabetes Triangle. See how you can only control one corner?

The thing about genetics, though, and placentas too, is that we can’t control them. We get what we get. Lifestyle, on the other hand, is something we CAN influence, and so lifestyle tends to get all the blame when we talk about gestational diabetes. It’s true that changes to diet and exercise can make a significant impact on blood sugar, don’t get me wrong! But it’s also true that those changes can only do so much, and if the other factors are stacked against you, no amount of “good behavior” will totally eliminate your hyperglycemia. Is it worth doing everything you reasonably can to improve? Of course! But is it rational to expect perfection? NO. To those of you who have been diagnosed with gestational diabetes and feel like failures, like you did this to yourself and your baby, like if you had just been “better,” this never would have happened: You did not do this. This is not your fault. You did not do this. This is not your fault.

I’m tempted to stop there, but I can’t resist just a little more academic info. If you’ve breathed your sigh of relief and are ready to move on with your day, by all means exit here.

Otherwise, allow me to take a brief foray into how the human body changes carbohydrates into energy: When we eat carbs, they get broken down into glucose, aka sugar, in our bloodstream. Our bodies are then triggered to produce a hormone called insulin, which allows that sugar to enter our cells and be used for energy. In any pregnancy, our bodies develop a resistance to insulin which causes a rise in the level of sugar in our blood. I’ll say it again, this happens in any pregnancy, not just those with gestational diabetes. This is nature’s way of making sure our developing babies get the energy THEY need to grow big and healthy. Insulin resistance is a characteristic of a healthy pregnancy.

Now, when insulin resistance goes too far, we get hyperglycemia and that’s too much of a good thing. As we discussed (remember, us talking = I write and you read), gestational diabetes does need to be monitored and managed. But don’t think of your hyperglycemia as being a failure, think of it as your body over-achieving at trying to grow a big baby. Talk with your doctor. Let them know that you’re not a failure, you’re a good parent. Be an active participant in your treatment plan, and lean on your doula for support. Pregnancy with gestational diabetes is still beautiful, miraculous, and pure. You did not do this. This is not your fault. It’s just a part of your journey.

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