Gestational Diabetes Gestational diabetes is a temporary condition that occurs during pregnancy.

Gestational diabetes affects two to four per cent of all pregnancies and involves an increased risk of developing diabetes for both mother and child. Gestational diabetes means diabetes mellitus (high blood sugar) first found during pregnancy. In most cases, gestational diabetes is managed by diet andexercise and goes away after the baby is born. Gestational diabetes is also called glucose intolerance of pregnancy.

Risk for Developing Gestational Diabetes Some of the most common risks for developing gestational diabetes are: A family history of diabetes in parents or brothers and sisters. Gestational diabetes in a previous pregnancy. The presence of a birth defect in a previous pregnancy. Obesity in the woman, BMI greater than 29. Older maternal age (over the age of 30). Previous stillbirth or spontaneous miscarriage. A previous delivery of a large baby (greater than 9 pounds). A history of pregnancy induced high blood pressure,urinary tract infections, hydramnios (extra amniotic fluid), etc. Women of Hispanic, First Nations, or of African-American decent. Risk for babies born to mothers with Gestational Diabetes Macrosomia (large, fat baby) Shoulder dystocia (birth trauma) Neonatal hypoglycemia (low blood sugar in the newborn) Prolonged newborn jaundice Low blood calcium Respiratory distress syndrome Develop jaundice Stillbirth Die in infancy How Is Gestational Diabetes Diagnosed? Gestational diabetes is usually diagnosed between the 24th and 28th week of pregnancy when insulin resistance usually begins. If you have had gestational diabetes before, or if your doctor is concerned about your risk of developing gestational diabetes, the test may be performed before the 13th week of pregnancy. Cure for Gestational Diabetes A cure for Diabetes has not been found yet. However, it can be controlled. Ways to control diabetes are: maintaining blood glucose levels, blood fat levels and weight. Controlling diabetes is very important and should be supervised by a medical doctor. When diabetes is controlled, it will help prevent serious complications such as: infections, kidney damage, eye damage, nerve damage to feet and heart disease. Can Gestational Diabetes be Treated? Gestational diabetes can be treated. Treatment involves taking steps to keep your blood glucose levels in a target range. Your blood glucose levels can be controlled by: Changing your meal plan Physical activity insulin (if needed)

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What is gestational diabetes?

This is a type of diabetes that some women get during pregnancy. Between 2 and 10 percent of expectant mothers develop this condition, making it one of the most common health problems of pregnancy.

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Diabetes is complicated, but in a nutshell it means you have abnormally high levels of sugar in your blood. Here's what happens: When you eat, your digestive system breaks most of your food down into a type of sugar called glucose. The glucose enters your bloodstream and then, with the help of insulin (a hormone made by your pancreas), your cells use the glucose as fuel. However, if your body doesn't produce enough insulin or your cells have a problem responding to the insulin too much glucose remains in your blood instead of moving into the cells and getting converted to energy. When you're pregnant, hormonal changes can make your cells less responsive to insulin. For most moms-to-be, this isn't a problem: When the body needs additional insulin, the pancreas dutifully secretes more of it. But if your pancreas can't keep up with the increased insulin demand during pregnancy, your blood glucose levels rise too high, resulting in gestational diabetes.

Most women with gestational diabetes don't remain diabetic after the baby is born. Once you've had gestational diabetes, though, you're at higher risk for getting it again during a future pregnancy and for developing diabetes later in life.

How will I know if I have gestational diabetes?

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Gestational diabetes usually has no symptoms. That's why almost all pregnant women have aglucose-screening test between 24 and 28 weeks. However, if you're at high risk for diabetes or are showing signs of it (such as having sugar in your urine), your caregiver will recommend this screening test at your first prenatal visit and then repeat the test again at 24 to 28 weeks if the initial result is negative. By the way, if you get a positive result on a glucose-screening test, it doesn't necessarily mean that you have gestational diabetes. It does mean that you'll need to take a longer follow-up test (aglucose tolerance test, or GTT) to find out.

How can I tell whether I'm at high risk for gestational diabetes?
According to the American Diabetes Association, you're considered at high risk for this condition (and should be screened early) if:

You're obese (your body mass index is over 30). You've had gestational diabetes in a previous pregnancy. You have sugar in your urine. You have a strong family history of diabetes. Some practitioners will also screen you early if you have other risk factors, such as: You've previously given birth to a big baby. Some use 8 pounds, 13 ounces (4,000 grams, or 4 kilos) as the cutoff; others use 9 pounds, 14 ounces (4,500 grams, or 4.5 kilos). You've had an unexplained stillbirth. You've had a baby with a birth defect. You have high blood pressure. You're over 35.

In addition, a study published in the March 2010 issue of Obstetrics & Gynecology found an association between excessive weight gain during pregnancy particularly in the first trimester and the risk of gestational diabetes. Researchers found the risk highest in women who were overweight to begin with and in nonwhite women. Keep in mind that many women who develop gestational diabetes don't have any risk factors. That's why most practitioners will order the screening at 24 to 28 weeks for all their pregnant patients as a matter of course. That said, a small number of women might be considered at such low risk that they might not have to get tested. You're part of this group if you meet all of the following criteria:

You're younger than 25. Your weight is in a healthy range. You're not a member of any racial or ethnic group with a high prevalence of diabetes, including people of Hispanic, African, Native American, South or East Asian, Pacific Island, and indigenous Australian ancestry. None of your close relatives have diabetes. You've never had a high result on a blood sugar test. You've never had an overly large baby or any other pregnancy complication usually associated with gestational diabetes.

How does having gestational diabetes affect my pregnancy and my baby?

Most women who develop diabetes during pregnancy go on to have healthy babies. Dietary changes and exercise may be enough to keep your blood sugar levels under control, though sometimes medication is needed, too. It's important to keep your blood sugar levels in check because poorly controlled diabetes can have serious shortand long-term consequences for you and your baby. If your blood sugar levels are too high, too much glucose will end up in your baby's blood. When that happens, your baby's pancreas needs to produce more insulin to process the extra glucose. All this excess blood sugar and insulin can cause your baby to put on extra weight, particularly in the upper body. This can lead to what's called macrosomia. A macrosomic baby may be too large to enter the birth canal. Or the baby's head may enter the canal but then his shoulders may get stuck. In this situation, called shoulder dystocia, your practitioner will have to use special maneuvers to deliver your baby. Delivery can sometimes result in a fractured bone or nerve damage, both of which heal without permanent problems in nearly 99 percent of babies. (In very rare cases, the baby may suffer brain damage from lack of oxygen during this process.) What's more, the maneuvers needed to deliver a broad-shouldered baby can lead to injuries to the vaginal area or require a large episiotomy for you. Because of these risks, if your practitioner suspects that your baby may be overly large, she may recommend that you give birth by cesarean section. Fortunately, only a minority of women with well-controlled gestational diabetes end up with overly large babies. In addition, babies who have excessive fat stores as a result of high maternal sugar levels during pregnancy often continue to be overweight in childhood and adulthood.

Shortly after birth, your baby may have low blood sugar (hypoglycemia) because his body will still be producing extra insulin in response to your excess glucose. This is much more likely if your blood sugar levels were high during pregnancy and especially during labor. Your delivery team will test your baby's blood sugar at birth and continue to check it as needed by taking a drop of blood from his heel. Feeding your baby as soon as possible after birth, preferably by breastfeeding, can help prevent or correct hypoglycemia. In severe cases of hypoglycemia, though, he'll be given an IV glucose solution. Testing your baby's blood sugar and providing an IV if necessary can prevent serious problems such as seizures, coma, and brain damage that might result if the condition were to go unnoticed. Your baby may also be at higher risk for breathing problems at birth, particularly if your blood sugar levels aren't well controlled or you deliver early (the lungs of babies whose mothers have diabetes tend to mature a bit later). The risk of newborn jaundice is increased, too. If your blood sugar control is especially poor, your baby is at risk for polycythemia (an increase in the number of red cells in the blood) and hypocalcemia (low calcium in the blood), and your baby's heart function could be affected as well. Some studies have found a link between severe gestational diabetes and an increased risk of stillbirth in the last two months of pregnancy. And, finally, women with gestational diabetes are at increased risk for developing preeclampsia, particularly those who are obese before pregnancy or whose blood sugar levels are not well controlled.

What will I need to do if I have gestational diabetes?

You'll need to keep diligent track of your glucose levels, using a home glucose meter or strips. To keep those levels where they should be, you'll want to:

Eat a well-planned diet. The American Diabetes Association recommends getting nutritional counseling from a registered dietitian who'll help you develop specific meal and snack plans based on your height, weight, and activity level. Your diet must have the correct balance of protein, fats, and carbohydrates, while providing the proper vitamins, minerals, and calories. To keep your glucose levels stable, it's particularly important that you don't skip meals, especially breakfast, and that you avoid sugary items like candy, cookies, cakes, and soda. This may sound daunting, but it's not so hard once you get the hang of it. And don't think of yourself as being on a special or restrictive diet. The principles of the diabetic diet are good ones for everyone to follow. Think of this as an opportunity to create healthier eating habits for yourself and your whole family. If everyone in the house is eating the same foods, you won't feel as deprived. Exercise. Studies show that moderate exercise also helps improve your body's ability to process glucose, keeping blood sugar levels in check. Many women with gestational diabetes benefit from 30 minutes of aerobic activity, such as walking or swimming, each day. Ask your practitioner what level of physical activity would be beneficial for you. Take insulin if necessary. If you're not able to control your blood sugar well enough with diet and exercise alone, your provider will prescribe insulin shots for you to give yourself as well. About 15 percent of women with

gestational diabetes need insulin. Recently, some practitioners have been prescribing oral medications instead of injections for some cases of gestational diabetes.

Will I need additional testing while I'm pregnant?

Your practitioner may want to monitor your baby more intensively during your last two to three months of pregnancy, depending on the severity of your diabetes and whether you have any other medical or obstetrical problems. This will likely mean that you'll have more frequent prenatal visits than you normally would. She'll explain how you should start counting your baby's movements at 28 weeks so you can alert her immediately if you sense that your baby is less active. If you're unable to keep your blood sugar under control or it's high enough that you need medication, or if you have any other risk factors, you'll probably start to have tests to check on your baby's well-being, beginning at about 32 weeks (and possibly as early as 28 weeks, depending on your individual situation). This testing may include fetal heart monitoring (nonstress tests) and periodic ultrasound tests called biophysical profiles. If you have mild gestational diabetes kept well under control without medication and you have no other problems, you probably won't begin these tests until about 36 weeks or possibly later. You may also have one or more ultrasounds during the third trimester to monitor your baby's growth. Your practitioner may order one in the early part of the third trimester to help assess your need for medication. You'll likely have an ultrasound close to your due date, too. If your baby seems to be getting very big, you might be induced before your due date, or your practitioner may recommend delivering by c-section. Note: If your diabetes was diagnosed in the first half of your pregnancy, it's more likely that you had unrecognized diabetes before you conceived. In this case, your provider may order a fetal echocardiogram (an ultrasound that focuses on your baby's heart) because the risk of birth defects, especially heart defects, is higher if your blood sugar was high during the first 8 weeks of pregnancy, when your baby's body was being formed.

Will I continue to have diabetes after my baby is born?

Probably not. Most women with gestational diabetes do not remain diabetic after giving birth. But some do. As many as a third of women who had gestational diabetes will continue to have diabetes or what's known as impaired glucose tolerance. That means their glucose levels are higher than normal, but not as high as they would be with diabetes. For this reason, you'll need to have a glucose test about six to 12 weeks after delivery. This test requires an overnight fast and can be done at your six-week postpartum visit. In addition, for women who had gestational diabetes and a normal postpartum screening, the American Diabetes Association recommends repeat testing at least every three years.

Does having gestational diabetes put me at higher risk for diabetes in the future?
Yes. About one-third to one-half of women who have gestational diabetes will have it again in a later pregnancy. And up to 50 percent of women with gestational diabetes will develop diabetes at some point in the future. Your risk is highest if any of the following apply to you:

You're obese. (Your risk is 50 to 75 percent if you're obese and less than 25 percent if you are of normal weight.) You had very high blood sugar levels during pregnancy (especially if you needed medication). Your diabetes was diagnosed early in your pregnancy. The results of your postpartum glucose test were borderline (relatively high, but not high enough to classify you as a diabetic)

What can I do to minimize my risk of developing diabetes in the future?

Keeping your weight down, making healthy food choices, and exercising regularly can help you ward off the disease. In addition, breastfeeding your baby may provide you with some protection. There's research suggesting an association between breastfeeding and increased postpartum weight loss, as well as a decreased risk of developing type 2 diabetes and cardiovascular disease.

What can I do to minimize related risks for my child through infancy and beyond?
As mentioned earlier, do your best to keep your blood sugar levels in check during pregnancy. After birth, nurse your baby. There's evidence that breastfeeding has a positive effect on glucose metabolism and may help prevent childhood obesity and decrease your child's risk of diabetes, among other things. And because your child is at higher risk for childhood and adult obesity as well as an increased risk of cardiovascular disease and diabetes it's particularly important that you help him eat a healthy diet, maintain a normal weight, and stay physically active. Finally, be sure your child's healthcare practitioner knows that you had diabetes during pregnancy. For more information on diabetes, contact the American Diabetes Association.

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