Women, Medicaid & Gestational Diabetes
Jan 01, 2020
For many women, pregnancy is an emotional and transformative experience. The body - and even the brain - of a pregnant woman undergoes physical changes, preparing her for childbirth and motherhood. It is during such a vulnerable time in a woman’s life that her health should be of the utmost priority. But for some, especially those who have low incomes or are on Medicaid, health care isn’t a necessity that’s easily obtained. This is unfortunately the case for women who experience pregnancy complications, such as gestational diabetes mellitus (GDM). Due to lack of prenatal care, many women suffer symptoms of GDM without receiving diagnosis or treatment, leading to health consequences that extend past the time of delivery.
GDM is a form of diabetes mellitus that comes about during pregnancy. There are different variations of diabetes: type 1, type 2, and gestational, with type 2 being the most common. Unlike type 1 diabetes, which is an autoimmune disorder that a person is born with, type 2 diabetes develops over time and is influenced by lifestyle habits such as diet and exercise. GDM is a form of type 2 diabetes, which occurs when an individual’s blood sugar, also known as glucose, is too high. Insulin is the hormone that the body uses to regulate glucose levels; however, a person with diabetes either doesn’t produce enough of the hormone or is unable to use it properly, also known as insulin resistance. Through lack of insulin or the body’s inability to process it, too much glucose stays in the blood and not enough reaches the cells for the body to remain energized and functional.
GDM happens when the body can’t make enough insulin to sustain pregnancy, which leads to insulin resistance. According to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), GDM usually has very mild to no symptoms. Symptoms that do appear are usually excessive thirst and urination. Treatment for GDM includes a healthy nutritional regimen, exercise, and sometimes insulin injections. Managing GDM also requires frequent monitoring of glucose levels by use of a meter which analyzes a single drop of blood, usually from the prick of a finger. However, diabetes equipment such as meters, test strips, and insulin - as well as maintaining a healthy diet - costs a considerable amount of money for those with low-income budgets or who are food insecure.
A 2014 report from the journal Preventing Chronic Disease suggests that GDM affects between 4 and 9 percent of American pregnant women. From 2008 to 2014, the number of pregnant women with GDM jumped from 8 percent to 24 percent. Reviews in Obstetrics and Gynecology found that GDM occurs at lower rates in white women than women of other racial backgrounds. Additionally, women of lower socioeconomic status are more likely to suffer complications related to GDM. Diabetes during pregnancy is concerning because it may affect the health of fetus as well as the mother. Infants born to mothers with GDM are more likely to be premature, grow abnormally large, or have breathing problems, jaundice, or low calcium or glucose levels.
Diabetes is a manageable condition, but without proper food and health care its complications are debilitating at best and deadly at worst. Those living with diabetes know that maintaining balanced glucose levels is imperative to their well-being. Even with increased access to health care, such as Medicaid (which funds 45 percent of the United States’ births, according to the Kaiser Family Foundation), food insecurity and difficulty paying for housing, utilities, transportation, and medication persists among those on a low-income budget. When a person with diabetes is forced to eat cheap, processed foods and struggle to pay for their insulin, they know that their life is on the line. However, those who rely on Medicaid must often choose between the immediate issue of keeping the lights on and their family fed or the long-term consequence of compromised health, due to choosing bills over medication.
GDM is usually a predictor for type 2 diabetes, hypertension, or cardiovascular disease down the line, especially if the mother doesn’t receive proper postpartum care. According to the Centers for Disease Control and Prevention (CDC), women with GDM are seven times more likely to develop type 2 diabetes after pregnancy than women without it. Additionally, GDM in women is linked to the onset of diabetes in their offspring, according to the Canadian Medical Association Journal (CMAJ). Dr. Kaberi Dasgupta, of the Centre for Outcomes Research and Evaluation (CORE), states that children whose mothers carried them with GDM are likely to develop diabetes before the age of 22.
The American Diabetes Association (ADA) states that addressing the diabetes epidemic in the U.S. includes addressing poverty. Due to this country’s wage gap, women are paid less than men, thereby more likely to face poverty. The United States Census Bureau reports that women earned around $10,000 less than men by the end of 2018. Many women may also suffer significant pay loss or lose their jobs altogether if they take time off work for prenatal appointments. Even with Medicaid, out-of-pocket costs for medical bills can be financially devastating. When expectant mothers put off their prenatal care due to costs, conditions such as GDM are able to go by undetected until the illness reaches an advanced stage. Another reason some women don’t receive prompt prenatal care is that they were previously uninsured and applied for Medicaid after becoming pregnant. Many cannot be seen by a practitioner while waiting for Medicaid approval.
Besides prenatal care, postpartum appointments make a world of difference to the health of the mother with GDM and her child. While some mothers return to normal glucose levels after delivery, others must continue with diabetes treatment. Proper nutrition and exercise, long after delivery, are determining factors concerning mother and child’s health. Adequate lifestyle changes may not only delay or prevent the onset of type 2 diabetes in the future, they could also prevent the woman from experiencing GDM again in future pregnancies. Postpartum care for mothers with GDM includes at-home visits with a doula or nurse practitioner, training for proper nutrition, and planned physical exercise. Postpartum care also addresses depression, breastfeeding (beneficial to the mother’s health as well as the baby’s), and continued assessment of the mother’s overall physical health, including glucose levels and cardiovascular health. While most women are only covered by Medicaid for 60 days after delivery, some experts suggest that this coverage be expanded to 12 months.
Gestational diabetes cannot always be prevented. Access to health care, social support services, as well as information, greatly improves mother and baby’s outcomes. All parents and their children, regardless of income, deserve a head start at healthy living. Between the nine months of gestation and the first year of the child’s life, the care a mother receives is the difference between quality of life or potentially a lifetime of complications for both the woman and her child.