Gestational Diabetes
Gestational Diabetes
Gestational Diabetes(pronounced jess-TAY-shun-ul die-uh-BEET-eez)
Gestational diabetes is a carbohydrate intolerance of variable severity that starts or is first recognized during pregnancy. Gestational diabetes is usually diagnosed during the 24th to 28th weeks of pregnancy. In many cases, the blood glucose level returns to normal after delivery.
It is recommended that all pregnant women be screened for gestational diabetes during the 24th and 28th weeks of their pregnancy. The symptoms are usually mild and not life-threatening to the pregnant woman
However, the increased maternal glucose (blood sugar) levels are associated with an increased rate of complications in the baby, including large size at birth, birth trauma, hypoglycemia (low blood sugar), and jaundice. Rarely, the fetus dies in the womb late in the pregnancy.
Maintaining control of blood sugar levels significantly reduces the risk to the baby. The risk factors for gestational diabetes are
- being older when pregnant
- African or Hispanic ancestry, obesity, gestational diabetes in a previous pregnancy,
- having a previous baby weighing over 9 pounds
- an unexplained death in a previous fetus or newborn,
- a congenital malformation (birth defect) in a previous child,
- and recurrent infections
Symptoms
- Increased thirst
- Increased urination
- Weight loss in spite of increased appetite
- Fatigue
- Nausea and vomiting
- Frequent infections including those of the bladder, vagina, and skin
- Blurred vision
Note: Usually there are no symptoms.
Why didn't I have diabetes before?
Remember that only pregnant women get gestational diabetes. When you're pregnant, your body goes through a lot of changes. In this case, being pregnant changed your metabolism. Now that you're pregnant, the insulin in your body can't do its job. Your body can't get the sugar out of your blood and into your cells to use for energy.
Why isn't the insulin doing its job
The placenta, a system of vessels that passes nutrients, blood, and water from mother to fetus, makes certain hormones that prevent insulin from working the way it is supposed to. This situation is called insulin resistance. To keep your metabolism normal, your body has to make three times its normal amount of insulin or more to overcome the hormones made by the placenta.
For most women, the body's extra insulin is enough to keep their blood sugar levels in the healthy range. But, for about 5 percent of pregnant women, even the extra insulin isn't enough to keep their blood sugar level normal. At about the 20th to the 24th week of pregnancy, they end up with high blood sugar or gestational diabetes.
It takes time for insulin resistance to affect your body in a way that health care providers can measure, which is why tests for gestational diabetes are usually done between the 24th and 28th week of pregnancy
How can I prevent or delay getting type 2 diabetes later in life
You can do a lot to prevent or delay type 2 diabetes.
- Reach and maintain a reasonable weight. Even if you stay above your ideal weight, losing 5 to 7 percent of your body weight is enough to make a big difference. For example, if you weigh 200 pounds, losing 10 to 14 pounds can greatly reduce your chance of getting diabetes.
- Be physically active for 30 minutes most days. Walk, swim, exercise, or go dancing.
- Follow a healthy eating plan. Eat more grains, fruits, and vegetables. Cut down on fat and calories. A dietitian can help you design a meal plan.
Remind your health care team to check your blood glucose levels regularly. Women who have had gestational diabetes should continue to be tested for diabetes or pre-diabetes every 1 to 2 years. Diagnosing diabetes or pre-diabetes early can help prevent complications such as heart disease later.
Your child’s risk for type 2 diabetes may be lower if you breastfeed your baby and if your child maintains a healthy weight
How is gestational diabetes treated
Treating gestational diabetes means taking steps to keep your blood glucose levels in a target range. You will learn how to control your blood glucose using
- a meal plan
- physical activity
- insulin (if needed)
Meal Plan
You will talk with a dietitian or a diabetes educator who will design a meal plan to help you choose foods that are healthy for you and your baby. Using a meal plan will help keep your blood glucose in your target range. The plan will provide guidelines on which foods to eat, how much to eat, and when to eat. Choices, amounts, and timing are all important in keeping your blood glucose levels in your target range.
You may be advised to
- limit sweets
- eat three small meals and one to three snacks every day
- be careful about when and how much carbohydrate-rich food you eat; your meal plan will tell you when to eat carbohydrates and how much to eat at each meal and snack
- include fiber in your meals in the form of fruits, vegetables, and whole-grain crackers, cereals, and bread
Physical Activity
Physical activity, such as walking and swimming, can help you reach your blood glucose targets. Talk with your health care team about the type of activity that is best for you. If you are already active, tell your health care team what you do.
Insulin
Some women with gestational diabetes need insulin, in addition to a meal plan and physical activity, to reach their blood glucose targets. If necessary, your health care team will show you how to give yourself insulin. Insulin is not harmful for your baby. It cannot move from your bloodstream to the baby's.
How will I know whether my blood glucose levels are on target
Your health care team may ask you to use a small device called a blood glucose meter to check your levels on your own. You will learn
- how to use the meter
- how to prick your finger to obtain a drop of blood
- what your target range is
- when to check your blood glucose
You may be asked to check your blood glucose
- when you wake up
- just before meals
- 1 or 2 hours after breakfast
- 1 or 2 hours after lunch
- 1 or 2 hours after dinner
The following chart shows blood glucose targets for most women with gestational diabetes. Talk with your health care team about whether these targets are right for you.
| Blood glucose targets for most women with gestational diabetes |
|
On awakening
|
not above 95
|
|
1 hour after a meal
|
not above 140
|
|
2 hours after a meal
|
not above 120
|
Each time you check your blood glucose, write down the results in a record book. Take the book with you when you visit your health care team. If your results are often out of range, your health care team will suggest ways you can reach your targets.
Will I need to do other tests on my own
Your health care team may teach you how to test for ketones (KEE-tones) in your morning urine or in your blood. High levels of ketones are a sign that your body is using your body fat for energy instead of the food you eat. Using fat for energy is not recommended during pregnancy. Ketones may be harmful for your baby.
If your ketone levels are high, your health care providers may suggest that you change the type or amount of food you eat. Or you may need to change your meal times or snack times.
How will gestational diabetes affect my baby
Untreated or uncontrolled gestational diabetes can mean problems for your baby, such as
- being born very large and with extra fat; this can make delivery difficult and more dangerous for your baby
- low blood glucose right after birth
- breathing problems
If you have gestational diabetes, your health care team may recommend some extra tests to check on your baby, such as
- an ultrasound exam, to see how your baby is growing
- "kick counts" to check your baby's activity (the time between the baby's movements) or special "stress" tests
Working closely with your health care team will help you give birth to a healthy baby
After I have my baby, how can I find out whether my diabetes is gone
You will probably have a blood glucose test 6 to 12 weeks after your baby is born to see whether you still have diabetes. For most women, gestational diabetes goes away after pregnancy. You are, however, at risk of having gestational diabetes during future pregnancies or getting type 2 diabetes later.
How is gestational diabetes diagnosed?
Your health care team will check your blood glucose level. Depending on your risk and your test results, you may have one or more of the following tests.
Fasting blood glucose or random blood glucose test
Your doctor may check your blood glucose level using a test called a fasting blood glucose test. Before this test, your doctor will ask you to fast, which means having nothing to eat or drink except water for at least 8 hours. Or your doctor may check your blood glucose at any time during the day. This is called a random blood glucose test.
These tests can find gestational diabetes in some women, but other tests are needed to be sure diabetes is not missed.
Screening glucose challenge test
For this test, you will drink a sugary beverage and have your blood glucose level checked an hour later. This test can be done at any time of the day. If the results are above normal, you may need further tests.
Oral glucose tolerance test
If you have this test, your health care provider will give you special instructions to follow. For at least 3 days before the test, you should eat normally. Then you will fast for at least 8 hours before the test.
The health care team will check your blood glucose level before the test. Then you will drink a sugary beverage. The staff will check your blood glucose levels 1 hour, 2 hours, and 3 hours later. If your levels are above normal at least twice during the test, you have gestational diabetes
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