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Diabetes Forecast

The Healthy Living Magazine

What to Expect With Gestational Diabetes

Blood glucose control is key to having a healthy baby

By Erika Gebel, PhD , ,

A diagnosis of gestational diabetes can cast a shadow over the joys of pregnancy. While the vast majority of these cases end with a healthy baby and mom, gestational diabetes (high blood glucose during pregnancy in a woman who has never had type 1 or type 2 diabetes) does increase risks to the health of both baby and mother. Keeping blood glucose under control is crucial for women with gestational diabetes to help safeguard their babies and themselves.

Diagnosis

Gestational diabetes is caused by issues that arise as part of a normal pregnancy: hormonal changes and weight gain. Women whose bodies can't compensate for these changes by producing enough of the hormone insulin, which ushers glucose from the blood into cells to produce energy, develop high blood glucose and gestational diabetes. Overweight mothers are at a greater risk for the condition.

In the United States, gestational diabetes is reported in somewhere between 2 and 10 percent of pregnancies, but it is now believed that the condition affects 18 percent of women in pregnancy. The larger number is the result of new criteria for diagnosis, not just skyrocketing rates. The American Diabetes Association began recommending this year that gestational diabetes be diagnosed with only one abnormal test result rather than two, the previous method, and this is causing more cases to be detected.

Gestational diabetes usually appears roughly halfway through pregnancy, as the placenta puts out large amounts of "anti-insulin" hormones. Women without known diabetes should be screened for gestational diabetes 24 to 28 weeks into their pregnancies. (If high blood glucose levels are detected earlier in pregnancy, the mother-to-be may actually have type 2 diabetes, rather than gestational.) Before the gestational diabetes test, pregnant women should fast overnight for at least eight hours. The next morning, doctors will check fasting blood glucose, then give an oral glucose tolerance test (OGTT). This involves drinking a glucose solution and testing blood glucose one and two hours later. Gestational diabetes is diagnosed if any of these three criteria are met:

Gestational diabetes usually appears roughly halfway through pregnancy, as the placenta puts out large amounts of "anti-insulin" hormones. Women without known diabetes should be screened for gestational diabetes 24 to 28 weeks into their pregnancies. (If high blood glucose levels are detected earlier in pregnancy, the mother-to-be may actually have type 2 diabetes, rather than gestational.) Before the gestational diabetes test, pregnant women should fast overnight for at least eight hours. The next morning, doctors will check fasting blood glucose, then give an oral glucose tolerance test (OGTT). This involves drinking a glucose solution and testing blood glucose one and two hours later. Gestational diabetes is diagnosed if any of these three criteria are met:

  • Fasting glucose is 92 mg/dl or higher.
  • One-hour OGTT is 180 mg/dl or higher.
  • Two-hour OGTT is 153 mg/dl or higher.

These "cut points" were selected to optimize a developing baby's safety, based on results from the landmark Hyperglycemia and Adverse Pregnancy Outcome (HAPO) study. This study tracked over 23,000 pregnant women, correlating their blood glucose levels with the health of their newborns. HAPO established that higher than normal blood glucose levels in a pregnant woman could lead her developing baby to become overly large. Big babies are at risk for trauma during birth and may need to be delivered through cesarean section, a surgical procedure. The study also found that elevated blood glucose was associated with preeclampsia, premature delivery, and birth injury.

Family Care

Besides all the normal pregnancy upkeep, women with gestational diabetes must monitor their blood glucose. Typically, the goal is to keep blood glucose at or below 95 mg/dl before meals, 140 mg/dl an hour after a meal, or 120 mg/dl two hours after a meal.

Many women with gestational diabetes are able to achieve blood glucose targets through diet and exercise. A registered dietitian can come up with a personalized meal plan that helps control blood glucose while still including enough calories and nutrients for a developing baby. Obese women with gestational diabetes may actually be advised to restrict calories during pregnancy. Limiting carbohydrate consumption may also be recommended.

Moderate-intensity exercise is encouraged for women with gestational diabetes during pregnancy, unless a medical condition makes physical activity dangerous. Studies have shown that exercise can help women with gestational diabetes control blood glucose. If you have gestational diabetes, you'll want to talk with a doctor about whether exercise is appropriate and, if so, ask for a recommended workout routine.

If changes in diet and exercise aren't enough to keep blood glucose at safe levels, medication may be required. The gold standard is human insulin; long-acting insulin analogs and oral medications aren't typically prescribed to pregnant women for safety reasons. Women taking insulin will need to monitor their blood glucose levels more often to determine appropriate doses and timing relative to meals.

To reduce the risks of delivery complications, doctors may induce labor in women with gestational diabetes or deliver the baby through a cesarean section. Immediately after birth, the newborn can develop low blood glucose (hypoglycemia) because of excess circulating insulin and will need to be closely monitored.

Once the baby is born, it's recommended that mothers breast-feed for the first year, if possible. A recent study showed that breast-feeding for at least six months lowers the risk that the baby will become a heavy child. Furthermore, it can help a mother lose that baby weight and reduce her risk of developing type 2 diabetes later on.

Gestational diabetes should clear up soon after giving birth. If high blood glucose levels linger—screening should take place six to 12 weeks after the baby is born—the diagnosis is type 2 diabetes. This occurs in about 5 to 10 percent of gestational diabetes cases. Though it's rare, some women who've had gestational diabetes go on to develop type 1 diabetes.

Even if blood glucose levels do return to normal, women who've had gestational diabetes have a 35 to 60 percent chance of developing type 2 diabetes in the next 10 to 20 years, according to the Centers for Disease Control and Prevention. So it's a good idea to be screened for diabetes at least every three years and to take steps, such as avoiding overweight, eating nutritious meals, and exercising 30 minutes a day, to stay healthy—while watching your child grow up.

 
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