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Gestational Diabetes

What You Need to Know as a Patient

What is Gestational Diabetes?

Diabetes mellitus is a condition in which a person has an abnormally high blood sugar (glucose). Diabetes occurs when the body does not produce insulin, the hormone in the body that lowers blood sugar, or  the cells in the body do not respond to insulin .

Gestational diabetes mellitus (GDM) is diabetes that is found for the first time when a woman is pregnant. The high blood sugar in gestational diabetes appears to be caused by hormones produced by the placenta that prevent the mother's cells from responding to her insulin. Gestational diabetes usually develops in the second trimester as the placenta is getting larger.  If your diabetes was diagnosed in the first half of your pregnancy, it's possible you had diabetes even before you became pregnant. It is estimated that gestational diabetes affects about 18% of pregnancies.

What are The Symptoms?

Usually there no symptoms with gestational diabetes, or the symptoms are mild. However,  if your blood sugars are very high you may  experience excessive thirst, excessive hunger,  weight loss, fatigue,  frequent urination, frequent infections, numbness of the hands and feet, and sometimes blurred vision.

How do I Know if I have Diabetes?

If you have risk factors for diabetes your doctor will usually test for diabetes at your first prenatal visit by measuring your fasting blood glucose or hemoglobin A1C.

Risk Factors for Gestational Diabetes

  • Non-Caucasian
  • BMI > 25 (at risk BMI may be lower in some ethnic groups)
  • History of GDM or pre-diabetes, unexplained stillbirth, malformed infant
  • Previous baby 4000 gm or more (8 lbs 13 oz)
  • 1st degree relative with diabetes mellitus
  • Glucosuria (high levels of sugar in the urine)
  • Medications that raise glucose (e.g. steroids, betamimetics, atypical antipsychotics)
  • Polycystic ovarian syndrome, cardiovascular disease, hypertension, hyperlipidemia

The American Diabetes Association recommends testing all other women who have not already been diagnosed  with diabetes at 24 to 28 weeks using the  75 gram 2 hour oral glucose tolerance test (OGTT)  or 100 gram 1 hour oral glucose tolerance test

Why is it Important to Treat Gestational Diabetes?

Untreated or poorly controlled gestational diabetes can hurt you and your baby. Uncontrolled diabetes increases your risk for developing polyhydramnios (excessive amniotic fluid),  pre-eclampsia (high blood pressure), and having cesarean section . Babies born to mothers with poorly controlled diabetes are at higher risk for stillbirth, growing very large, serious injury at birth , low blood sugar , jaundice,  and low calcium levels.


What is the Treatment For Gestational Diabetes?

Often changes in diet and exercise are enough to keep your blood sugar in the desired ranges. You may at first be asked  to:

  • Avoid sugars and sweets
  • Avoid instant foods.
  • Do not drink fruit juices
  • Eat 3 meals and snacks daily. Wait 2 to 3 hours between meals and snacks.
  • Do not eat fruit for breakfast. Eat fruit for snacks
  • Do not eat dry cereal (like cornflakes) for breakfast.
  • Eat more cooked or raw vegetables.

A minimum of three episodes of exercise per week is recommended. The sugar lowering effect of exercise may not be seen for 2 to 4 weeks.

Usually, you will also be asked to check your blood sugar levels when you wake up in the morning before you eat (fasting) and 1 hour after you begin eating breakfast, lunch, and dinner. 

Desired normal values are
 

  Fasting blood sugar      less than 90 mg/dL
 1 hour after meals  less than 130 mg/dL

You can use the form Daily Blood Glucose and Food Record to keep tract of your blood sugars and foods you have eaten. (To print set printer to landscape on page set up.)

If diet and exercise don't keep blood sugar controlled, then your doctor will likely prescribe insulin or an oral medication. Approximately 15% to 20% of women with gestational diabetes will require insulin therapy. The major side effect of these medications is possible low blood sugar (hypoglycemia).

Will I Always Have Diabetes?

Gestational diabetes is usually temporary. Most women diagnosed with gestational diabetes may expect their blood sugars to return to normal after they have delivered.

However, women with high fasting blood sugars during pregnancy are more likely to remain or become diabetic after delivery. 50% of mothers with fasting glucose levels of 105 to 130 mg/dl may be expected to become diabetic after pregnancy.  It is recommended that  women with gestational diabetes be retested for diabetes six weeks after delivery. It is important that this follow up be done, so that women with diabetes may be effectively treated to avoid the harmful effects of neglected diabetes on the mother's health and her future pregnancies.

Reviewedby Mark Curran, M.D. F.A.C.O.G

 

 

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