Acupuncture and Gestational Diabetes

Gestational diabetes

Diabetes Overview

Diabetes rates in the United States are increasing, with 29.1 million people diagnosed in the U.S., 28 percent of Americans with undiagnosed Type 2 diabetes, and as many as 86 million with prediabetes per the CDC.  Currently, approximately 2-5% of pregnant women develop gestational diabetes, and this number may increase to 7-9% of mothers who are more likely to have risk factors.  With the increasing rate of diabetes in the US, the percentage of mothers more likely to have risk factors will continue to grow exponentially.  Risk factors include women aged 25 or older, a family or personal history of diabetes, a body max index (BMI) of 30 or higher, and/or women of African American, Hispanic, or Asian/Pacific Islander origin.  In addition, women with gestational diabetes are at greater risk for developing Type 2 diabetes post-partum, perpetuating the increasing rate of diabetes world-wide.

Gestational Diabetes

Gestational diabetes is diagnosed when a pregnant woman has high blood glucose levels. The exact cause of gestational diabetes is unknown, but it is believed to be caused by a disconnection between the insulin and hormones produced by the placenta. The digestive system breaks down most food into a type of sugar called glucose. The glucose enters the bloodstream and then, with the help of insulin (a hormone made by the pancreas), provides energy for the cells of the body. During pregnancy, however, placental hormones block the mother’s production of insulin, the hormone that regulates blood glucose levels. This requires the mother’s body to produce more insulin.  When the pancreas can’t keep up with the insulin demand and the glucose stays in the blood, the result is gestational diabetes. 

Testing for Gestational Diabetes

The glucose screening for gestational diabetes usually takes place in the second trimester, usually between the 24th and 28th week of pregnancy.  During the appointment, the mother will drink a sugary drink and then a blood test will be drawn an hour later. If there are elevated levels of sugar in the blood, a glucose tolerance test will be administered.  The glucose tolerance test combines fasting overnight and drinking a higher concentration of a sugar drink.  Blood will then be drawn on the hour for 3 hours. If there is still elevated sugar level in the blood, then gestational diabetes will be diagnosed by the OB.

Risks and Treatment Options

Uncontrolled, gestational diabetes can lead to a number of risks for both the mother and the baby. For the mother, one study showed that gestational diabetes is associated with post-partum depression, stating that women with gestational diabetes were almost four times more likely to develop post-partum depression than women without gestational diabetes[1].  Other pregnancy complications include macrosomia- a newborn larger than usual, increasing the chances of caesarean section or difficult labor. Women with gestational diabetes have a higher risk of developing type two diabetes post-partum, and each additional pregnancy adds to that risk threefold. Evidence also suggests that the vasculature of women with a prior case of gestational diabetes is permanently altered, predisposing them to cardiovascular disease[2].  Gestational diabetes also puts the child at risk both short and long term. The child could develop jaundice, breathing difficulties, and low blood sugar levels at birth, and may be at an increased risk of obesity and developing diabetes later in life. In addition, females whose mothers had gestational diabetes are more likely to experience it with their own pregnancies later in life, perpetuating the cycle of gestational diabetes.

The top 2 contributors to diabetes are little to no physical activity and obesity, therefore the OB will suggest diet and lifestyle changes as well as constant monitoring of blood sugar. If blood sugar levels still remain high, medications such as metformin might be prescribed to lower blood sugar. While studies have shown that metformin is considered safe to take during pregnancy[3], there are concerns that there could be unwarranted effects as it can cross the placenta and circulate in the developing fetus[4].  Until more studies are done, other interventions in addition to diet and exercise such as acupuncture and a Chinese medicine way of thinking can help keep blood sugar low and to having to take western medications.

Acupuncture

Acupuncture has been used for thousands of years for a variety of conditions, including symptoms experienced during pregnancy. Studies have shown that acupuncture treatments during pregnancy are safe[5], not only for gestational diabetes, but also for other pregnancy ailments such as neck and back pain[6].  Although there are some acupuncture points that are considered ‘forbidden points’ during pregnancy, those points are widely known to acupuncturists and are generally not used to for regulating gestational diabetes.  

Chinese medicine calls diabetes the “Wasting-Thirsting Disorder.” An excess of urine or cloudy urine, thirst, and/or food intake define how acupuncturists treat the disease. Factors are caused by improper diet, stress, and overexertion. Chinese medicine differentiates the condition by upper body, middle body, and lower body. If the condition focuses on more upper body, a patient will exhibit predominantly excessive drinking. In this case, acupuncture points and Chinese herbs will be used to nourish fluids and alleviate thirst. If the condition is more middle body, patients will have excessive hunger and constipation. Acupuncture and Chinese herbs will be used to promote bowel movements and inhibit food cravings, aiding in weight loss. If the condition is more in the lower body, symptoms include excessive and/or cloudy urine. In Chinese medicine theory, the kidneys manage urinary function, and acupuncture needles and Chinese medicine will focus on strengthening the kidney. Of course, patients may exhibit some or all of these symptoms, in which case acupuncturists can work on all three aspects.

Diet

Diet and exercise are also an important factor in the treatment of gestational diabetes. Losing just a small amount of weight can help maintain glucose levels drastically. Western medicine promotes cutting back on simple or refined carbohydrates such as juices and white bread and white sugar, and replacing with vegetables and proteins.  Meals should be reduced to smaller portions, eaten more frequently, and at regular times each day. Taking it a step further, Chinese medicine advises avoiding ‘cold’ foods, such as raw vegetables. Rather, cook the vegetables so that they are already warm and therefore easier for your body to digest. Many foods can be consumed that align with the Chinese medicine diagnosis. Pumpkins are overall particularly good for diabetes.  In line with the Chinese medicine diagnosis of diabetes, foods that target upper body symptoms to quench thirst and nourish fluid include crab apple, mulberry and guava, celery, bok choy, mung bean, snow peas, spinach, and tomatoes. Foods that work with the middle body to fight excessive hunger and constipation include plums and mulberry. Foods that help with the lower body to promote kidney and urination function include celery, spinach, bamboo shoots, corn silk, millet, pearl barley, snow peas, soybeans, spinach, green beans, guava, strawberries, and plums. In addition to helping diabetes in general with their cooling function, celery, corn silk, and shittake mushrooms can also help lower blood pressure.

Summary

There is no cure for diabetes and gestational diabetes. Unmanaged, women with gestational diabetes have a higher risk of complications both during pregnancy and after birth, as well as creating potential risks to the child. Diet and exercise can be used to manage blood sugar levels, and medications can be added as needed. Acupuncture and a Chinese medicine view of diet and exercise using Tai Chi can provide an additional safe avenue to managing gestational diabetes by optimizing the body’s ability to function normally and prevent the onset of Type 2 diabetes.


[1]   Bryn, M., & Penckofer, S. (2015). The relationship between gestational diabetes and antenatal depression. Journal of Obstetric, gynecologic, and neonatal nursing: JOGNN 44(2), 246-55 doi: 10.1111/1552-6909.12554

[2] Plows, J. F., Stanley, J. L., Baker, P. N., Reynolds, C. M., & Vickers, M. H. (2018). The pathophysiology of gestational diabetes mellitus. International journal of molecular sciences. 19(11), 3342 doi:10.3390/ijms19113342

[3] Given, J. E., Loane, M., Garne, E., Addor, M.C., Bakker, M., Bertaut-Nativel, B.,…Dolk, H. (2018). Metformin exposure in first trimester of pregnancy and risk for all or specific congenital anomalies: Exploratory case study. BMJ. 361(k2477) doi: 10.1136/bmj.k2477

[4] Nguyen, L., Chan, S.Y., & Teo, A.K.K. (2018). Metformin from mother to unborn child – are there unwanted effects? EBioMedicine. (35), 394-404 doi: 10.1016/j.ebiom.2018.08

[5] Moon, H.Y., Kim, M.R., Hwang, D.S., Jang, J.B., Lee, J., Shin, J.S.,…Lee. Y.J. (2019). BJOG doi: 10.1111/1471-0528.15925

[6] Steel, A., Adams, J., Sibbritt, D., Broom, A., Gallois, C., & Frawley, J. (2012). Utilisation of complementary and alternative medicine (CAM) practitioners within maternity care provision: results from a nationally representative cohort study of 1,835 pregnant women. BMC pregnancy and childbirth (12)146, doi:10.1186/1471-2393-12-146

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