Gestational Diabetes

Unique only to pregnant women, gestational diabetes is a condition that causes hyperglycemia in the last half of pregnancy.

Gestational diabetes, similar to type 1 and type 2 diabetes, in that it is directly related to how the body responds to insulin released by the pancreas.

Insulin is released in response to elevated levels of glucose in the blood.

The hormones produced by the placenta, the structure that provides essential nutrients to the unborn baby, can disrupt the way insulin is used in a woman’s body.  A woman who develops gestational diabetes is not able to compensate for this disruption and develops insulin resistance.

In the last half, of pregnancy the baby is rapidly growing, and the placenta is producing high levels of hormones that impede the normal insulin action.

A woman with insulin resistance cannot produce enough insulin to reduce high levels of blood sugar and gestational diabetes develops.

Factors That Increase The Risks.

Gestational diabetes can be a random pregnancy problem, but there are certain factors that increase the risk. A pregnant woman over the 25 years old and with a body mass index over 30 is at highest risk of developing pregnancy-related diabetes.

Existing health conditions such as pre diabetes, a family history of type 2 diabetes, or a previous pregnancy where gestational diabetes developed will contribute to an increased risk.

Also, if a woman experienced a stillbirth of unexplained causes, or delivered a baby weighing over nine pounds the risk increases.

Gestational diabetes can occur in all races, but Hispanic, black, American Indian, and Asian women are diagnosed most often.

Prenatal Care 

Routine prenatal care is vital to the early diagnosis and management of gestational diabetes. A doctor will order a simple diabetes screening test in the second trimester, between 24 and 28 weeks of pregnancy.

This test is called an initial glucose challenge test, or commonly referred to as the one hour glucose test. This is an in office screening that requires drinking a thick, glucose liquid solution. After one hour, a finger-prick blood test is taken.

Glucose readings under 140 mg/dL are considered normal. If the reading is higher than 140 mg/dL, a follow-up screening is scheduled.

The follow up glucose test, also called a three hour glucose test, requires overnight fasting. Upon arrival to the appointment, a fasting blood sugar reading will be taken and then the glucose liquid will be taken.

The patient’s blood glucose will be tested once every hour for three hours. Two readings within this screening process over 140 mg/dL will point to a gestational diabetes diagnosis.

Treatment for Gestational Diabetes 

The treatment for gestational diabetes depends on the severity of the disease and the ability to control glucose levels with diet. Under the direction of a doctor and dietician, diet and moderate exercise recommendations are created.

A healthy diet will include fruits, vegetables, whole grains, and lean proteins. Carbohydrates and sweets should be limited as they have a direct effect on blood sugar levels.

Incorporating a moderate exercise regimen will reduce sugar levels. Daily glucose monitoring at home will be required. If glucose levels remain high, insulin may be required.

A woman with gestational diabetes will require additional fetal monitoring, especially during the last trimester.

The placenta will be assessed to insure the proper amount of oxygen and essential nutrients are transported to the baby. Non stress tests are performed to monitor fetal activity and heart rate.

Decreased fetal movement could indicate a lack of oxygen. A biophysical profile is a prenatal test that combines a non stress test with ultrasound imaging.

The purpose of this test is to monitor fetal movement, breathing, and check the volume of amniotic fluid. A low-fluid volume could indicate the baby is not receiving adequate nutrition from the placenta.

Complications For Mother And Child

Uncontrolled pregnancy related diabetes can lead to complications for the mother and child.

The most common complications to the baby include macrosomia, or excessive fetal growth, respiratory distress syndrome, jaundice, and hypoglycemia, or low-blood glucose, which happens soon after delivery.

Developmental delays with motor skills, attention deficit disorders and hyperactivity have been linked to children born to mothers with gestational diabetes.

Children born to mothers with gestational diabetes are at higher risk of developing adult onset type 2 diabetes and obesity.

The most reported complications for the mother are pre eclampsia, a combination of protein in the urine and remarkably high blood pressure, increase occurrence of urinary tract infections, and a greater risk of developing type 2 diabetes later.