Pregnancy Complications


Everything You Need to Know About Gestational Diabetes

Everything You Need to Know About Gestational Diabetes

Gestational diabetes is one of the conditions you may face during your pregnancy. The idea of gestational diabetes may be scary. Let's talk about what it is, and if anything can be done to manage this condition.

Key Points

  • Gestational diabetes is a condition in which blood glucose levels are not properly regulated during pregnancy.
  • Gestational diabetes can raise certain risks for your baby, so it's important that it's treated properly.
  • Gestational diabetes increases your risk of developing diabetes later in life.

What is Gestational Diabetes?

Diabetes is a condition in which the levels of blood sugar, or glucose, are not properly regulated. It is related to a hormone called insulin, which controls glucose levels.

In one type of diabetes, the body does not produce enough insulin. This is the case in juvenile-onset diabetes, or diabetes that develops before adulthood. In another form of diabetes, the insulin that is produced is not used effectively by the body. This is the case in both diabetes that develops during pregnancy and in adult-onset diabetes.

Diabetes that develops during pregnancy in a woman who did not have the condition before pregnancy is called gestational diabetes. Gestational diabetes is thought to result from metabolic changes brought about by the effects of hormones in pregnancy. About one to five percent of women whose glucose levels are tested during pregnancy are found to have gestational diabetes. Women with gestational diabetes usually do not have glucose levels that are high enough to pose risks to their own health. In most cases, gestational diabetes causes no symptoms in the mother and poses no immediate threat to her health. Even so, it is an early warning sign that she has a greater risk of developing diabetes later in her life.

Is Gestational Diabetes Dangerous?

Although gestational diabetes is usually not a threat to the mother's health, doctors test for it because it poses some real risks for the baby. If gestational diabetes goes undetected, the baby has an increased risk of stillbirth or death as a newborn. But when the problem is properly diagnosed and managed, your baby is at no greater risk than a baby whose mother does not have diabetes.

The major risk for babies of women with gestational diabetes is macrosomia, or excessive weight at birth. Most doctors define macrosomia as a birth weight of 4,500 grams (9 pounds 14 ounces) or more. A baby as large as this may have difficulty being born. Both the likelihood of cesarean birth and the risk of birth injuries are increased when the baby is macrosomic. Keeping the glucose level of a mother who has gestational diabetes within the normal range is thought to decrease this risk.

Other problems that may develop as a result of gestational diabetes include hypoglycemia, or low blood sugar, in the baby shortly after birth. This may occur because the baby has been accustomed to receiving high levels of blood sugar across the placenta, and the supply is abruptly stopped when the umbilical cord is cut at birth. Babies born to mothers with diabetes should have their glucose levels checked regularly after delivery. They frequently need early feeding or, occasionally, a glucose solution through an intravenous line to prevent low blood sugar.

If you have been diagnosed with gestational diabetes, you may be concerned about the possibility of your baby developing diabetes as an older child. Fortunately, there is no increased risk of juvenile-onset diabetes in babies born to mothers with gestational diabetes. Risk factors for diabetes in pregnancy include: being older than 30, a family history of adult-onset diabetes, previously having a large baby, a previous stillborn baby, and obesity. But, nearly half of women with gestational diabetes have no risk factors. Because heredity plays a major role in the development of gestational diabetes, there may be nothing a pregnant woman can do to avoid or cause it.

How is Gestational Diabetes Diagnosed?

Generally, gestational diabetes does not cause any symptoms. Subtle signs, such as fatigue or excessive thirst and urination, may sometimes occur, but many women without gestational diabetes also experience these changes late in pregnancy. Because the condition cannot be diagnosed on the basis of the mother's symptoms, glucose testing must be done to detect it.

Gestational diabetes is detected through glucose tolerance testing. This test is generally performed at 26 to 28 weeks of pregnancy, but it may be performed earlier if your doctor feels you are at high risk for developing this condition. Because about half of women who develop diabetes during pregnancy have no risk factors for the condition, many doctors, though not all, choose to check all women for gestational diabetes, regardless of their age or risk factors.

How is Gestational Diabetes Managed During Pregnancy?

The key to managing gestational diabetes is controlling your blood sugar level. In most cases, this can be done through a carefully planned diet, plenty of exercise, and regular testing of the blood glucose level. Once gestational diabetes is diagnosed, many doctors will obtain a set of glucose test results each week until you deliver. The set consists of testing your glucose levels in the morning before you have eaten breakfast and again two hours after you have eaten breakfast. Some doctors also include a mid-afternoon blood sugar level in the set.

To keep track of how well you are controlling your diabetes, your doctor may recommend that you use a home testing kit to check your blood glucose more often than once a week. Test strips for testing sugar in the urine are not useful for monitoring glucose levels in pregnancy because there is little correlation between the sugar levels in the blood and in the urine.

In almost all women with gestational diabetes, the condition can be controlled through diet and careful monitoring of their glucose level. If, despite diet and exercise, a woman's blood glucose level remains too high, daily insulin injections may be required to lower it to a safe level. Insulin does not cross the placenta to reach the baby. Medication taken by mouth to lower the blood glucose level is not given during pregnancy.

In addition to helping you maintain a normal blood glucose level, your doctor may also advise weekly monitoring of the baby during the last weeks of pregnancy. This may be done by non-stress testing, contraction stress testing, or biophysical profiles. An ultrasound exam may also be done to measure the size and weight of the baby in the last weeks before your due date. This test can help your doctor decide whether a cesarean birth will be needed. She or he may also ask you to keep a “kick count,” a record of how often you feel your baby moving.

Because of the higher likelihood of large babies in mothers who have gestational diabetes, cesarean birth is more common. The need for a cesarean birth is difficult to predict before labor, however, unless the baby is very large or the mother's pelvis is very small. Most often, a cesarean procedure becomes necessary because of “failure to progress” in labor. This happens when the cervix stops dilating or the baby does not descend into the birth canal.

In most women with gestational diabetes, the baby usually does not have to be delivered before term. If labor has not begun on its own by 40 to 41 weeks, it may be induced with oxytocin. Amniocentesis might be performed beforehand to determine whether the baby's lungs are mature enough for delivery.

Will Gestational Diabetes Go Away?

Gestational diabetes almost always disappears shortly after delivery. To make sure that your glucose level has returned to normal, your doctor may check it once or twice on the day after delivery. The glucose test may be repeated six weeks after delivery.

If you have had gestational diabetes in one pregnancy, your risk of it developing again in another pregnancy is increased. You are also more likely to develop diabetes as you get older. About half of women with gestational diabetes eventually develop adult-onset diabetes. For this reason, it is important to follow your doctor's advice concerning diet and exercise after delivery, and to have your glucose level checked at least yearly. Women who develop diabetes in pregnancy can breast feed their babies and are encouraged to do so.

How Can I Lower My Risk of Developing Diabetes?

If your risk of developing adulthood diabetes is higher because of gestational diabetes, you may be wondering what you can do to lower your odds of developing it. There are a few steps you can take to lower your risk of developing diabetes later in life.

Managing your diet is important. Avoid consuming excessive amounts of sugar. This can be done by restricting your intake of foods and drinks that are high in sugar, such as soda, candy, and some desserts. Avoiding excessive weight gain is also important; maintain a balanced diet that isn't too high in saturated fats.

Exercising regularly can help you maintain a healthy weight. This may be difficult when you have a newborn, but as your child ages you'll be able to start exercising again. At the very least, try to walk for 20 to 30 minutes every day. Don't overdo it; listen to your body, and work with your doctor and a fitness coach as needed.

Keep up with all of your physicals. If you had gestational diabetes, your doctor may check your glucose levels at all of your future physicals. While it might be tempting to postpone or cancel your annual physical in lieu of doing something else, it's important you go. If you do develop diabetes, catching it sooner rather than later will help prevent it from becoming more severe.

Do not take the content of this article as professional medical adviceIt's important to exercise due diligence when obtaining relevant information in matters pertaining to your health. Always consult with your healthcare provider before making any medical decisions.

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