|What Is Gestational Diabetes?
It is a temporary form of diabetes that can occur in pregnant women, usually in the second trimester (between weeks 24-28). It means that the woman's blood sugar level has risen which in turn increases her risk of pregnancy problems. Sometimes called type 3 diabetes it usually (but not always) disappears after delivery. Some scientists believe that pregnancy 'unmasks' an already existing disease but others regard it as a separate form of diabetes. While symptoms may disappear after childbirth, the afflicted woman has a 50 percent increased risk of developing type 2 diabetes within 5 to 10 years. Gestational diabetes affects between 4 and 8 percent of all pregnancies, or about 135,000 American women a year. These figures are rising, probably because more women are obese and obesity in women is a major risk factor. As diabetes poses considerable problems in pregnancy, any woman with a diabetes diagnosis is considered a HIGH-RISK PREGNANCY. This includes women who already had the disease before becoming pregnant (type 1 and type 2 diabetics). Being high-risk means that you will be monitored more closely by your healthcare team, and it will limit your birthing options - for example, you are unlikely to be able to deliver in a birthing center or to have the option of a homebirth.
What Are The Signs?
In most instances there are no symptoms, or the symptoms are so mild that they do not endanger the woman or her growing baby. Typical diabetes symptoms which might occur include:
• Increased thirst
• Blurred vision
• Yeast infection or vaginitis infection
• Increased need to urinate
• Nausea and vomiting
• Weight loss despite increased appetite
However, as most of these are also typical symptoms of pregnancy, the signs may be missed. This is why most pregnant women are routinely screened for blood sugar levels.
Who Is At Risk?
Some experts think not all pregnant women need to be screened for diabetes - in particular those who are thin, don't have a family history of the disease and take regular exercise. However the medical consensus is to screen all pregnant women because it is feared some women with the disease will otherwise be missed. However, you are unlikely to develop the disease if you:
1. Are under 25
2. Had a healthy pre-pregnancy weight.
3. Have no family history of the disease.
4. Tested normal to a glucose tolerance test.
5. Have not previously given birth to a baby that weighs more than 9 pounds or with a birth defect.
6. Haven't had unexplained miscarriages or stillbirths.
7. Your blood pressure readings are at within a healthy range.
Women at increased risk:
African Americans, Hispanic Americans and Native Americans. For some interesting statistics on the subject, see diabetes facts.
How Is It Diagnosed?
All pregnant women will be offered a screening test between weeks 24 and 28. This test is called a glucose tolerance test. If you experienced gestational diabetes in a previous pregnancy, this test will be performed much earlier in the first trimester, around week 13. You will need to fast for 8 hours and then you will be told to drink a glucose beverage. The doctor waits an hour and then takes a sample of blood from your veins. If your glucose level is less than 140, you are considered normal. If it is above this, you will be tested again an hour later and then again in another hour (3 times in total) before a diabetes diagnosis is given.
Once you have been diagnosed with gestational diabetes you will be given a glucose monitor (images) to test your levels at home every day. Read about blood glucose monitoring and our guide to buying glucose monitors.
How Is It Treated?
The aim of diabetes treatment is to keep the mother's blood glucose levels as normal as possible and to make sure that the baby is developing safely. In most cases, following a specific diet plan and taking regular exercise is all that is required on the mother's part. If however this fails to control her levels, diabetes drugs or insulin shots will be necessary. Fortunately most women who develop gestational diabetes do not required medicines or insulin.
Diet And Exercise Therapy
Pregnant women with diabetes should:
1. Maintain a daily calorie control based on their ideal body weight. The American Diabetes Association recommends contacting a dietitian for nutritional counseling. They will help you develop specific meal plans based on your height, weight and activity level.
2. Eat 3 meals a day plus a bedtime snack.
3. Have a glucose level less than 120 mg/DL one hour after meals.
4. Take a prenatal vitamin. You may also have to take extra calcium and iron.
5. Take moderate amounts of exercise, something like walking or swimming. Be sure to inform yourself about your condition, knowledge is power! Check out our diabetes resources for some excellent websites.
Monitoring Your Baby
Your pregnancy healthcare team will carefully monitor your baby's progress in the womb. This will involve ultrasound scans and nonstress tests. Both tests are completely painless so there is nothing to worry about.
Pregnancy ultrasounds will primarily be used to check for signs of macrosomia (abnormally large growth in the baby). If this is detected, doctors may discuss labor induction to prevent injury to your body during childbirth. See picture, why babies can grow larger than normal.
A fetal nonstress test (image) is very simple to perform. A special belt, which has the ability to measure the heart rate of the fetus, is strapped around the mother's tummy. When the baby moves, its heart rate normally increases 15 to 20 beats above its normal rate. There are set clinical rates which the healthcare provider will compare your baby's results with. If the baby does not move, it does not necessarily indicate a problem. Your little bundle of joy may just be sleeping! The nurse might use a small buzzer to wake it up.
What Complications Can It Cause?
Early Pregnancy Problems
If diabetes occurs early in pregnancy the major concern is miscarriage and birth defects. However this is more of a concern for women with type 1 diabetes (or type 2), because most cases of gestational diabetes do not occur until week 24 onwards. See, what are the signs of a miscarriage?
Late Pregnancy Complications
Most problems occur, if they are going to, around the time of delivery and childbirth. Women with gestational diabetes tend to have larger babies which increases the risk of:
1. Trauma/injury to the mother during delivery.
2. Cesarean section delivery being necessary or labor induction.
Formerly many doctors insisted on all diabetic patients be delivered by C-section by week 38. Today opinions are a little more conservative and most women with gestational diabetes will be offered a normal vaginal delivery, unless the baby is particularly large.
3. One other concern is that gestational diabetes increases the risk for high blood pressure during pregnancy - this can be dangerous if it leads to preeclampsia.
4. Some studies report a link between severe gestational diabetes and an increased risk of intrauterine fetal death in the last 8 weeks of pregnancy.
5. Increased risk of excess amniotic fluid, a condition called polyhydramnios.
As gestational diabetes increases a woman's risk of developing type 2 diabetes within 10 years, she should be checked every year going forward for signs of the disease.
Shortly after birth your baby will be checked for signs of low blood sugar (hypoglycemia) because its body will still be producing extra insulin in response to the excess glucose in your blood. This is only likely to occur if you didn't manage to balance your blood sugar levels during pregnancy or labor. The baby's blood sugar will be tested by taking a drop of blood from its heel immediately after birth. If there is a problem, the baby should be immediately fed, preferably breast fed, to correct the situation. In severe cases the baby will be put on an IV glucose drip to prevent any serious damage like coma and brain damage. Longer term the risk of childhood and adult obesity is higher in babies exposed to diabetes than those who are not. This is because they tend to store excessive fat as a result of the mother's high blood sugar levels during gestation.
How Can I Reduce My Risks Of Developing It?
Diabetes prevention: The best way to ensure a healthy pregnancy is to start your prenatal care as early as possible, take a read of our prenatal care guide. Know the risks for gestational diabetes and reduce your risk factors where possible:
a. If you are overweight, try to lose weight before becoming pregnant.
b. If you smoke, quit.
Monitor your weight gain: How much weight should I gain during pregnancy?
What If The Father Is Diabetic But Not The Mother?
If the father of the baby has diabetes, but the mother has not - this poses no risk to the child. It is the environment of the womb, where the baby grows, that has an effect on its development. Specifically, in the case of a diabetic mother, her blood sugar levels are higher than normal which creates a more challenging environment.
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