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Gestational diabetes complicates about 3%-5% of all pregnancies-affecting approximately 200,000 women each year in the US. It is caused by hormonal changes during pregnancy that make the body more insulin intolerable. If left untreated, gestational diabetes can cause serious complications for both mother and child. It typically develops around 24 weeks and goes away after giving birth, though women with gestational diabetes are at a higher risk for developing type 2 diabetes. In most cases, symptoms of gestational diabetes disappear immediately after pregnancy – only 5-10% of women with gestational diabetes remain diabetic (typically type 2 diabetics). However, gestational diabetes does raise the risk of developing diabetes in later years. Women who have had gestational diabetes have a 35% to 60% chance of developing diabetes in the next 10–20 years. Recently implemented diagnostic criteria for gestational diabetes will increase the proportion of women diagnosed with gestational diabetes. Using these new diagnostic criteria, an international, multicenter study of gestational diabetes found that gestational diabetes actually affects 18% of pregnancies.
Lowered insulin levels are the underlying cause of all diabetes. Insulin is produced by the islet cells of the pancreas, which then circulate it to your body via the blood stream. In the presence of insulin, glucose (sugar) is able to transfer from the blood stream into the body cells, lowering the blood glucose level and providing the body’s cells with fuel for energy. In diabetic patients, there are several factors that can interfere with this process.
In gestational diabetes, the normal pregnancy hormones produced by the placenta to prevent low blood sugar (i.e. cortisol and estrogen) lower the body’s insulin levels to a potentially dangerous diabetic level. Like the other types of diabetes, the exact cause of gestational diabetes is unknown, however researchers have found that obese women and those with a family history of diabetes are at a higher risk.
The exact cause of gestational diabetes is unknown. But these factors may contribute to the condition:
It is possible to develop gestational diabetes with or without the risk factors listed below. However, the more risk factors you have, the greater your likelihood of developing gestational diabetes. If you have a number of risk factors, ask your doctor what you can do to reduce your risk.
Risk factors for gestational diabetes include:
Your doctor should assess your risk for gestational diabetes at your first prenatal visit. If you have a fasting blood sugar greater than 126 milligrams per deciliter (mg/dL) [7.0 mmol/L], or a random blood sugar greater than 200 mg/dL (11.1 mmol/L), that is confirmed on another day, you meet the criteria for the diagnosis of Type 2 Diabetes and you do not need to be screened.
If you are at high risk of developing gestational diabetes-very overweight, prior history of gestational diabetes, glucose in your urine, or a strong family history of diabetes-your doctor may recommend that you undergo glucose testing as soon as possible. If your initial test is not positive you should be retested between 24 and 28 weeks of gestation.
Women who are of average risk should be given the 50-gram screening test between 24-28 weeks of gestation.
Newer guidelines do not require glucose testing for low-risk women, but to be low risk you must meet all of the following criteria: less than 25 years of age, normal weight before and during pregnancy, not a member of an ethnic group with a high risk of diabetes (Asian American, African American, Hispanic American, native American, or Pacific Islander), no known diabetes in any siblings or parents, no history of abnormal glucose tolerance, no glucose in urine, and no history of poor obstetric outcomes.
The 50-gram test is used to screen for gestational diabetes, while the 3-hour glucose tolerance test is used to diagnose gestational diabetes.
The test is usually done in the morning in your doctor’s office. First, a blood sample is drawn to measure your fasting blood glucose level. Next, you will drink a glucose drink that contains 100 grams of glucose. The drink is very sweet; some people even feel a bit nauseated after drinking it. Blood samples are drawn every hour for three hours after you finish the drink.
The diagnostic values used by the American Diabetes Association are as follows:
If two or more of your blood sugar levels are higher than the diagnostic blood glucose values, you have gestational diabetes. Once you have been diagnosed with gestational diabetes, your doctor will work with you to develop an appropriate treatment plan.
In addition to the above screening tests, additional tests may include:
Gestational Diabetes usually does not cause symptoms distinguishable from those that commonly occur in pregnancy. If symptoms do occur, they may be similar to those in nongestational diabetes. These may include:
Gestational diabetes typically goes away after giving birth, though mothers who have had gestational diabetes are at a higher risk of developing type 2 diabetes.
If you are diagnosed with gestational diabetes, there are a number of things that you can do to help.
Eat a healthy diet. Try spreading out your daily food intake into smaller meals and snacks, which will help you manage your blood sugar levels and provide the best nutrition for you and your growing baby.
Gain a healthy amount of weight for your pregnancy—take care not to gain too much. The amount of weight you gain will be in part based on your weight prior to pregnancy. Talk to your midwife or doctor about what a healthy amount of weight gain would be for you.
Get physical. One of the best things you can do is move around. Regular physical activity can help keep blood sugar levels under control, and also has the added benefits of:
The purpose of screening is early diagnosis and treatment. Screening tests are usually administered to people without current symptoms, but who may be at high risk for certain diseases or conditions.
Your doctor should assess your risk for gestational diabetes at your first prenatal visit. You meet the criteria for the diagnosis of Type 2 Diabetes and you do not need to be screened if you have:
If you are at high risk of developing gestational diabetes, your doctor may recommend that you undergo glucose tolerance testing as soon as possible. If your initial test is not positive, you should be retested between 24 and 28 weeks of gestation.
If you are at average risk, then you should be given the 50-gram screening test between 24-28 weeks of gestation.
Newer guidelines do not require glucose testing for low-risk women. But, to be low risk you must meet all of the following criteria:
For the 50-gram glucose screening test, you do not need to fast. You are given a drink that contains 50 grams of glucose. One hour later, your blood sugar level is tested.
Here are some ways to reduce your risk of gestational diabetes:
The National Academy of Science’s Institute of Medicine makes the following recommendations regarding weight gain during pregnancy:
*These values are based on body mass index (BMI)-the ratio of your weight in kilograms to your height in meters squared. Recognize that these values are for Caucasians, which may not apply to Asians who have smaller body frames and different percentage of body fat.
Besides increasing your risk for gestational diabetes, excessive weight gain during pregnancy is also a risk factor for overweight post-pregnancy. It should be noted that the subject of recommended pregnancy weight gain remains somewhat controversial and that some feel that the above guidelines are too high. Talk with your doctor about what range of weight gain is right for you.
Even before pregnancy begins, nutrition is a primary factor in the health of the mother and the baby. Besides lowering your risk of Gestational Diabetes, eating a healthy diet lowers your and your baby’s risk of serious complications during and after pregnancy. A healthy diet is one that is low in saturated fat and rich in fruits, vegetables, and whole grains.
The US Department of Agriculture’s MyPyramid website has dietary guidelines for pregnant and nursing women. The interactive site allows you to create a personalized food plan.
Participating in a regular exercise program can lower your risk of developing gestational diabetes by helping you maintain a healthy weight. But, it is very important that you discuss exercise with your doctor before you begin.
Choose exercises that do not require your body to bear any extra weight. Good examples are:
When you exercising, be sure to stay hydrated. Drink plenty of fluids, even if you are not thirsty. If your body temperature goes up too high, it can be dangerous for your baby.
Avoid contact sports or vigorous sports. Also, avoid any exercises that increase your risk of falls or injury.
The treatment and management of gestational diabetes involves lifestyle modifications (such as eating a healthful diet and beginning an exercise program), frequent daily blood sugar testing, and possibly insulin.
Gestational diabetes treatment aims to control your blood sugar level, thereby reducing possible complications to you and your baby. According to the Mayo Clinic, between 10 and 20 percent of women with gestational diabetes need insulin. In addition, some physicians prescribe an oral blood sugar control medication (see the list above). However, other doctors feel that not enough research has been done to confirm that oral drugs are as safe and as effective as injectable insulin for pregnant women with gestational diabetes. If your doctor prescribes an oral medication, you may want to consider getting a second opinion. Many people with diabetes use combinations of medications and insulin to better control and manage their condition. Your physician and the other members of your care team will help determine what is best for you. n.
Aside from lifestyle modifications, which can be very positively impacting, there is no evidence that herbal supplements can help to control gestational diabetes or its complications. As well, one needs to be very careful with any type of herb or medication when pregnant. Please talk to your health care provider before taking any type of supplement, herb, or medicine.
If you suspect that you have diabetes or you find that you are experiencing one or more of the symptoms of diabetes, you should talk to your doctor. He or she will be able to run the proper diagnostic tests and determine whether or not diabetes is causing your symptoms.
If you have already been diagnosed with diabetes, call your doctor immediately if:
Call 911 emergency services right away if you have symptoms of diabetic ketoacidosis (DKA) a life-threatening condition that develops when the body is not getting enough insulin. These include:
If you suspect you have gestational diabetes, speak to your midwife or OB/Gyn immediately.
You have a unique medical history. Therefore, it is essential to talk with your doctor about your personal risk factors and/or experience with gestational diabetes. By talking openly and regularly with your doctor, you can take an active role in your care.
Here are some tips that will make it easier for you to talk to your doctor:
Specific questions to ask your midwife or doctor about gestational diabetes
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