GESTATIONAL DIABETES

Pregnant women who have never had diabetes before but who have high blood glucose (sugar) levels during pregnancy are said to have gestational diabetes. According to a 2014 analysis by the Centers for Disease Control and Prevention, the prevalence of gestational diabetes is as high as 9.2%.

We don’t know what causes gestational diabetes, but we have some clues. The placenta supports the baby as it grows. Hormones from the placenta help the baby develop. But these hormones also block the action of the mother’s insulin in her body. This problem is called insulin resistance. Insulin resistance makes it hard for the mother’s body to use insulin. She may need up to three times as much insulin.

Gestational diabetes starts when your body is not able to make and use all the insulin it needs for pregnancy. Without enough insulin, glucose cannot leave the blood and be changed to energy. Glucose builds up in the blood to high levels. This is called hyperglycemia.

Gestational diabetes typically does not cause any noticeable signs or symptoms. This is why screening tests are so important. Rarely, increased thirst or increased urinary frequency may be noticed.

DIAGNOSIS

Gestational diabetes is diagnosed with blood tests. Most pregnant women are tested between the 24th and 28th weeks of pregnancy, but if you have risk factors, your doctor may decide to test earlier in the pregnancy.

Blood testing confirms the diagnosis. A screening glucose tolerance test involves drinking a sugary beverage and having your blood drawn an hour later to test the glucose levels an hour later. If the screening test is not normal, you may need additional testing will generally be necessary. Another type of test is an oral glucose challenge test (OGTT). For this test your baseline blood glucose level is checked and then measured at 1, 2, and sometimes 3 hours after consuming a sugary drink. A blood glucose level of 140mg/dL or higher on this test will identify 80% of women with gestational diabetes. When that cutoff is lowered to 130mg/dL, the identification rate increases to 90%. Women who had a level of blood glucose greater than 130 mg/dL are typically recommended to take another diabetes screening test that requires fasting (not eating anything) before the test.

Glycosylated hemoglobin, or hemoglobin A1c, is another test that may be performed. This test is used to monitor long-term blood glucose levels in people with diabetes. The hemoglobin A1c level offers a measure of the average blood glucose level over the past few months.

 

TREATMENT

It’s essential to monitor and control your blood sugar to keep your baby healthy and avoid complications during pregnancy and delivery. You’ll also want to keep a close eye on your future blood sugar levels. Your treatment strategies may include:

Monitoring your blood sugar. While you’re pregnant, your health care team may ask you to check your blood sugar four to five times a day — first thing in the morning and after meals — to make sure your level stays within a healthy range. This may sound inconvenient and difficult, but it’ll get easier with practice.

To test your blood sugar, you draw a drop of blood from your finger using a small needle (lancet), then place the blood on a test strip inserted into a blood glucose meter — a device that measures and displays your blood sugar level.

Your health care team will monitor and manage your blood sugar during labor and delivery. If your blood sugar rises, your baby’s pancreas may release high levels of insulin — which can cause low blood sugar in your baby right after birth.

Follow-up blood sugar checks are also important. Having gestational diabetes increases your risk of developing type 2 diabetes later in life. Work with your health care team to keep an eye on your levels. Maintaining health-promoting lifestyle habits, such as a healthy diet and regular exercise, can help reduce your risk.

Healthy diet. Eating the right kinds of food in healthy portions is one of the best ways to control your blood sugar and prevent too much weight gain, which can put you at higher risk of complications. Doctors don’t advise losing weight during pregnancy — your body is working hard to support your growing baby. But your doctor can help you set weight gain goals based on your weight before pregnancy.

A healthy diet focuses on fruits, vegetables and whole grains — foods that are high in nutrition and fiber and low in fat and calories — and limits highly refined carbohydrates, including sweets. No single diet is right for every woman. You may want to consult a registered dietitian or a diabetes educator to create a meal plan based on your current weight, pregnancy weight gain goals, blood sugar level, exercise habits, food preferences and budget.

Exercise. Regular physical activity plays a key role in every woman’s wellness plan before, during and after pregnancy. Exercise lowers your blood sugar by stimulating your body to move glucose into your cells, where it’s used for energy. Exercise also increases your cells’ sensitivity to insulin, which means your body will need to produce less insulin to transport sugar.

As an added bonus, regular exercise can help relieve some common discomforts of pregnancy, including back pain, muscle cramps, swelling, constipation and trouble sleeping. Exercise can also help get you in shape for the hard work of labor and delivery.

With your doctor’s OK, aim for moderately vigorous exercise on most days of the week. If you haven’t been active for a while, start slowly and build up gradually. Walking, cycling and swimming are good choices during pregnancy. Everyday activities such as housework and gardening also count.

Medication. If diet and exercise aren’t enough, you may need insulin injections to lower your blood sugar. Between 10 and 20 percent of women with gestational diabetes need insulin to reach their blood sugar goals. Some doctors prescribe an oral blood sugar control medication, while others believe more research is needed to confirm that oral drugs are as safe and as effective as injectable insulin to control gestational diabetes.

Close monitoring of your baby. An important part of your treatment plan is close observation of your baby. Your doctor may monitor your baby’s growth and development with repeated ultrasounds or other tests. If you don’t go into labor by your due date — or sometimes earlier — your doctor may induce labor. Delivering after your due date may increase the risk of complications for you and your baby.

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