is Gestational Diabetes?
Pregnant women who have high blood sugar (glucose) levels
during pregnancy , but did not have diabetes before pregnancy are said to have
gestational diabetes (GDM). The
abnormally high blood sugar appears to be caused by hormones produced by the
placenta that block the action of the mother's own insulin.
Because insulin is
required for sugar to enter cells, the sugar rises in her blood. Gestational
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 conceived.
baby's size increases
its risk for birth injuries with a vaginal delivery increases. These injuries
may include a fractured collar bone, a fractured arm ,or paralysis of the upper arm. Fortunately,
these conditions are usually temporary.
Very rarely, an
infant may be so large it fails to deliver in a timely manner and suffers brain damage from
prolonged lack of oxygen.
If your doctor believes your baby is too large for you to safely attempt a
vaginal delivery, he or she may recommend a cesarean delivery.
Your doctor may test you if he or she thinks you are at risk for developing GDM. From 3% to 12% of all pregnancies
are diagnosed with diabetes.
Women who are
diabetic even when they are not pregnant are called pregestational diabetics.
In pregestational diabetics fasting blood sugars persistently greater than
120 mg/dl in early pregnancy can cause miscarriage and birth defects.
Mothers who are
diabetic only when they are pregnant (GDM) do not have higher rates
of birth defects, but may have a higher chance for a stillbirth if their sugars
are not controlled well.
Later in pregnancy
the excessive sugar in either type of diabetic crosses the placenta to
the baby. The consequences
are the baby grows, and grows, and grows.
Babies born to mothers with poorly controlled diabetes are also at higher risk
for low blood sugar , jaundice, polycythemia ( high numbers of red blood
cells) , low calcium levels, and an increased risk for fetal death during the
last months of pregnancy.
Lastly uncontrolled diabetes places
the mother at risk for developing polyhydramnios (excessive amniotic fluid)
and pre-eclampsia (high blood pressure with protein in the urine).
The first step
in treatment is usually a change in diet. If you are diagnosed with GDM you may
initially be instructed 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.
In addition a minimum
of three episodes of exercise per week is also recommended. The sugar lowering
effect of exercise may not be seen for 2 to 4 weeks.
If diet and
exercise don't keep blood sugar controlled, then your doctor will likely
prescribe insulin. If your blood sugar is only mildly elevated you may be
offered an oral medication called glyburide.
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
Risk of Developing Diabetes Later in Life
Most women diagnosed with gestational diabetes
may expect their blood sugars to return to normal after they have delivered. Whether a
woman develops diabetes later in life seems to be predicted to some degree by
her fasting blood sugar levels. If her fasting
glucose levels during pregnancy are 105 to 130 mg/dl, 50% of mothers may be
expected to become diabetic after pregnancy.
86 % of women with fasting blood sugars
greater than 130 mg/dL may be expected to become diabetic. 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.