What Is Gestational Diabetes?
Gestational diabetes is diabetes, or glucose intolerance, that occurs during the second half of pregnancy. It occurs in approximately 3% of all pregnant women. With the birth of the baby, blood sugars usually return to normal levels.
Your body breaks down food to use as a source of energy. Insulin, a hormone produced by the pancreas, helps the sugar leave the blood and enter the body cells where it will be used as energy.
With diabetes, there is not enough insulin to help the sugar enter the cells, so it stays in the bloodstream. In pregnancy, the placenta produces hormones that change the way insulin works. These hormones have an anti-insulin effect around the placenta. Your pancreas compensates by producing more insulin. When not enough extra insulin can be produced to cover the increased blood sugar level, you become diabetic.
A woman with diabetes only during pregnancy is called a gestational diabetic. She has no trouble producing the required amount of insulin when the placenta is not there to add anti-insulin hormones to the mix. Once the placenta is gone after the delivery of the baby, the problem is gone.
Who Gets Gestational Diabetes?
Gestational diabetes can occur even when there are no risk factors. This is why all pregnant women are screened for the condition. The risk of gestational diabetes increases with age and is more likely in women who are obese, have high blood pressure or have close family members with diabetes. If you were a gestational diabetic in one pregnancy, you have a greater chance of being a gestational diabetic in later pregnancies.
Testing for Gestational Diabetes
All pregnant women in our practice are tested for gestational diabetes between 24 and 28 weeks of gestation unless you have already been diagnosed with diabetes.
The first test is called a glucose challenge test and is a screening test. It pinpoints those who should go on for a further, definitive test for gestational diabetes called a glucose tolerance test.
The visit before your glucose challenge test you will be given a drink (glucola) to take home with you. The glucola, which tastes like sweet orange soda, is better cold so serve it refrigerated or over ice. It will take you 5 to 10 minutes to drink the glucola.
Your blood will be drawn one hour after you started drinking so plan your travel time accordingly. Be sure to tell the registrar what time you began drinking the glucola. You should allow time for registration at the lab or for the technician to finish with other patients who were there before you.
You may eat normally up until the time you drink the glucola, but do not put anything in your mouth after you finish it. This includes toothpaste and cigarettes. Once the technician draws your blood, you may go back to eating and drinking normally.
If your blood sugar tests high, a nurse will call to help you schedule further testing. This glucose tolerance test lasts about three and one-half hours. You may not have anything to eat or drink after midnight the night before your test, except for water.
When you arrive at the lab your blood will be drawn for a fasting blood sugar level providing your baseline blood sugar. You will then drink glucose and have your blood drawn 1, 2, and 3 hours after you began your drink. If your blood sugar is high on two of the four tests, then you will be classified as a gestational diabetic.
How Will My Baby Be Affected?
If you keep your blood sugar in the normal range, you have a good chance of delivering a healthy baby. Your baby will not be diabetic when it is born. The baby is at greater risk of having a low blood sugar than high blood sugar.
If your gestational diabetes is not effectively controlled your baby may have one of the following conditions:
- Macrosomia – A large baby is is called a macrosomic baby. If your blood sugar levels are high, the sugar will cross the placenta to the baby. The baby will work hard to make enough insulin to cover the high blood sugar. This added insulin and sugar cause your baby to gain weight (fat) and grow very big. This is called macrosomia. A large baby is difficult to deliver and the baby may have difficulty regulating its blood sugar level immediately after birth.
- Hypoglycemia (Low Blood Sugar) – After your baby is born, it will no longer have a large amount of glucose from you and may have a rapid drop in blood sugar. Your baby will be monitored for this after delivery. Maintaining normal blood sugar levels for 24 hours before delivery helps to decrease the risk of hypoglycemia.
- Jaundice -A baby born with slightly yellow skin color is termed jaundice. This common condition in newborns is caused by a buildup of a chemical called bilirubin. A small amount of buildup is normal and will usually go away by itself. Jaundice, though, can be more severe in babies of mothers with gestational diabetes. Sometimes the babies will need to receive a special light treatment to help in the breakdown of the bilirubin.
- Stillbirth – In very rare cases, a stillbirth may occur if blood sugars are not controlled. For this reason, it is important to follow the gestational diabetic diet. Your physician will monitor your baby more closely near the end of your pregnancy.
How Can I Keep My Baby Healthy?
Once you have been diagnosed with gestational diabetes, you will be referred to a registered dietician for diabetic counseling. You should begin immediately by avoiding sugary foods. The dietician will help you formulate a diet taking into consideration your weight, stage of pregnancy, and level of activity. In most cases, the diet consists of three small meals and snacks spread throughout the day.
Different kinds of foods have different effects on your blood sugar levels. Carbohydrates have the greatest effect on your blood sugar level.
Complex carbohydrates such as whole-grain breads, tortillas, brown rice, and whole-grain crackers, are absorbed slowly and do not cause a rapid change in blood sugar. They are also high in fiber.
Simple carbohydrates such as cake, pie, candy, cookies, and jams are quickly absorbed and cause a high rise in the blood sugar level. They are to be avoided.
Proteins such as meat, fish, eggs, tofu and cheese cause only a small rise in the blood sugar level and are digested slowly.
Fats such as butter, oils, mayonnaise, salad dressings, bacon, cream cheese, and nuts, contain the most calories and may add to your weight gain. Fats are hidden in many foods so you should check the labels of prepared foods.
Will I Need Medications?
Occasionally, diet alone does not control blood sugar and medication may be needed. Oral medications often can be used to effectively treat elevated glucose levels. Some cases may require insulin injections.
Can I Exercise with Gestational Diabetes?
Exercise is an important part of any healthy pregnancy. Exercise reduces stress and helps you stay fit for labor and delivery. Exercise is especially important for gestational diabetics since it also helps you maintain a normal blood sugar level. You should always clear your exercise program with your physician. Swimming and walking are good exercises for women who have not been active.
What Monitoring May Be Done During My Pregnancy?
During the final weeks of pregnancy, we will assess fetal well-being using non-stress testing and/or ultrasound evaluation.
You may be asked to monitor kick counts. The baby moves about the same amount each day. You may be asked to monitor this movement and report to the office if the baby is not moving as much as usual.
Does This Mean I Will Need A Cesarean Section?
Most women with gestational diabetes carry their baby full term. With proper dietary control, your birth should be uneventful. With gestational diabetes, though, there is the risk your baby could be too large for the opening in your pelvis. If there is a risk of a cesarean section, your doctor will discuss this with you during an appointment.
How Will This Affect My Baby After Delivery?
Your baby’s blood sugar level will be tested right after birth. Nothing will be done if the baby?s blood sugar level is normal, If your baby’s blood sugar level is low, the baby will be given sugar water to drink.
Will My Diabetes Really Go Away After Delivery?
Blood sugar levels return to normal for 92% of gestational diabetics. Six percent have mild problems with blood sugar control and 2% will remain diabetic. (Some of these women may have been diabetic before pregnancy, but never diagnosed.) You should be tested again six weeks after the delivery of your baby.
If you are overweight, you have a 60% chance of developing adult-onset diabetes later in life. If you are at the correct weight for your height, you decrease your risk significantly.
You remain at risk for developing gestational diabetes with future pregnancies.