Gestational Diabetes

 

WHAT IS GESTATIONAL DIABETES?

Gestational diabetes is diabetes that is found for the first time during a woman’s pregnancy. Diabetes means that your blood sugar is too high, and when you are pregnant, too much sugar is not healthy for your baby. If you have been diagnosed with diabetes prior to pregnancy speak to your physician, as this information is not accurate for your condition. You may need a different plan of treatment.

 

WHAT CAUSES GESTATIONAL DIABETES?

Changing hormones and weight gain are part of a healthy pregnancy, but both changes make it hard for your body to keep up with its need for a hormone called insulin. When your body does not meet the demand for insulin, blood sugar levels remain high, and your body does not get the energy it needs from the food you eat.

 

WHAT IS MY RISK OF GESATIONAL DIABETES?

To learn your risk for gestational diabetes, write down each item that applies to you; then talk with your doctor about your risks at your first prenatal visit.

  • I have a parent, brother, or sister with diabetes.
  • I am African American, American Indian, Asian American, Hispanic/Latino, or Pacific Islander.
  • I am 25 years old or older.
  • I am overweight.
  • I have had gestational diabetes before, or I have given birth to at least one baby weighing more than 9 pounds.
  • I have been told that I have pre-diabetes, a condition in which blood glucose levels are higher than normal but not yet high enough for a diagnosis of diabetes.

If you have any of these risk factors, you may have to test for gestational diabetes early in the pregnancy.

 

WHEN WILL I BE CHECKED FOR GESTATIONAL DIABETES?

Your doctor will decide when you need to be checked for diabetes depending upon your risk factors.

  • If you are at high risk, your blood glucose level may be checked at your first or second prenatal visit. If your test results are normal, you will be checked again sometime between weeks 24 and 28 of pregnancy.
  • If you have an average risk or low risk for gestational diabetes, you will be tested sometime between weeks 24 and 28 of pregnancy.

 

HOW IS GESTATIONAL DIABETES DIAGNOSED?

The diabetes test is done by having you drink a sugary beverage containing 50gm of sugar, and your blood glucose level is checked an hour later. This test can be perfomed any time of the day, even if you have eaten. If the results are above normal, you may need further testing.

 

WHAT IF I DO NOT PASS THE ONE HOUR TEST?

You will be notified by the office to come in for a 3 hour test. For at least 3 days before the test, you should eat normally; it is very important that you do not limit or restrict your sugar or carbohydrates intake. Then you will fast for at least 12 hours before the test.

Your blood glucose will be checked before the test. Then you will drink a sugary beverage containing 100gm of sugar. The lab person will check your blood glucose levels 1 hour, 2 hours, and 3 hours later. If your levels are above normal at least twice during the test, you have gestational diabetes. Your doctor will discuss with you what is above normal.

 

HOW WILL DIABETES AFFECT MY BABY?

Untreated or uncontrolled gestational diabetes can mean problems for your baby. Such as:

  • Stillbirth
  • Large babies with extra fat- this can make delivery difficult and more dangerous for your baby.
  • Low blood glucose right after birth
  • Breathing problems
  • Increased risk of your baby developing diabetes as an adult
  • Baby will have an increased risk of being overweight or obese as an adult

 

HOW WILL GESTATIONAL DIABETES AFFECT ME?

Often, women with gestational diabetes have no symptoms. However, gestational diabetes may

  • Increase your risk of high blood pressure during pregnancy
  • Increase your risk of a large baby and the need for cesarean section at delivery

The good news is gestational diabetes will probably resolve after your baby is born. However, you will be more likely to have diabetes later in life. You may also have gestational diabetes again in subsequent pregnancies.
Some women wonder whether breastfeeding is safe after they have had gestational diabetes. Breastfeeding is highly recommended for babies, including those whose mothers had gestational diabetes.

 

HOW IS GESTATIONAL DIABETES TREATED?

Treating gestational diabetes means taking steps to keep your blood glucose levels in a target range. You will learn how to control your blood glucose using

  • A meal plan
  • Physical activity
  • Medication (if needed)

 

MEAL PLAN

You will talk with a dietitian or a diabetes educator who will design a meal plan to assist you in choosing foods that are healthy for you and your baby. Using a meal plan will help keep your blood glucose in the target range. The plan will provide guidelines as to which foods to eat, how much to eat, and when to eat. Choices, amounts, and timing are all important in keeping your blood glucose levels in the target range. You may be advised to

  • Limit sweets
  • Eat 3 small meals and 1-3 snacks every day
  • Be careful when and how much carbohydrate-rich food you eat; your meal plan will tell you when to eat carbohydrates and how many to eat at each meal and snack.
  • Include fiber in your meals in the form of fruits, vegetables, and whole-grains

 

PHYSICAL ACTIVITY

Physical activity, such as walking and swimming, can help you reach your blood glucose targets. Talk with a physician before starting an exercise regimen, and if you are already active, tell your health care team your usual exercise routine.

 

MEDICATION

Some women with gestational diabetes need oral medication or insulin, in addition to a meal plan and physical activity, to reach their blood glucose targets. If necessary, your physician will show you how to give yourself insulin. Insulin is not harmful to your baby. It cannot move from your bloodstream to the baby’s.

 

HOW WILL I KNOW IF MY BLOOD GLUCOSE ARE IN TARGET RANGE?

Your health care team may ask you to use a small device called a blood glucose meter to check your levels on your own.
You will learn

  • How to use the meter
  • How to prick your finger to obtain a drop of blood
  • Your target range
  • When to check your blood glucose

You may be asked to check your blood glucose

  • When you wake up
  • 2 hours after breakfast
  • 2 hours after lunch
  • 2 hours after dinner

The following shows blood glucose targets for most women with gestational diabetes. Talk with your physician about whether these targets are right for you.

On awakening- not above 95
2 hours after a meals-  not above 120

Each time you check your blood glucose, write down the results in a record book. Take the book with you to every visit. If your results are often out of range, your physician will suggest ways to reach your targets.

 

AFTER I DELIVER, HOW WILL I KNOW IF THE GESTATION DIABETES HAS RESLOVED?

You should have a blood glucose test 6 to 12 weeks after your baby is born to see whether you have diabetes. For most women, gestational diabetes disappears after pregnancy. You are, however, at risk of having gestational diabetes during future pregnancies or developing type 2 diabetes later in life.

Reference:
National Diabetes Information Clearinghouse: http://diabetes.niddk.nih.gov