Gestational Diabetes
Most women are aware that gestational diabetes is a very serious health condition that can occur during pregnancy.
All pregnant women should get their routine prenatal care to monitor their baby’s growth and development and to get screened for dangerous health problems such as gestational diabetes.
What is Gestational Diabetes? Gestational diabetes is a condition where blood sugar levels become abnormally high during pregnancy. This condition is described as inability to process sugars normally that is first diagnosed in pregnancy. Up to 10% of pregnancies are complicated by this health condition and since it is responsible for pregnancy complications and abnormal fetal growth, all pregnant women are screened for this important disorder.
Who is at Highest Risk for Gestational Diabetes?
The risk factors for gestational diabetes include:
- Ethnicity: Research has shown that there is a stronger risk for developing gestational diabetes in women who are African American, Hispanic, Native American and Asian.
- Age: Gestational diabetes occurs more frequently in older mothers.
- Obesity: Women who are overweight or obese are at increased risk for gestational diabetes.
- Family History of Diabetes: Women who have a first degree relative with diabetes are at higher risk for this condition.
- Previous History of Gestational Diabetes: In addition, women who have had gestational diabetes in previous pregnancies are also at a much higher risk for developing this condition during future pregnancies.
Why Does Gestational Diabetes Develop?
Pregnancy is a unique condition that affects numerous aspects of the body, including the hormones that regulate blood sugar. During pregnancy there are adjustments in the amounts of insulin and other hormones that are released to provide sufficient levels of glucose to the developing baby and its mother.
As the pregnancy progresses, steroid hormone levels increase creating some insulin resistance in the mother. In turn, the body releases 50% more insulin than in non-pregnant women to keep sugars controlled. Hyperglycemia, or high blood sugar, develops when the body cannot produce enough insulin during this part of the pregnancy. These high glucose levels are most abnormal during the post-prandial period, or after meals.
Gestational Diabetes Signs & Symptoms
Mothers with gestational diabetes really do not exhibit the classic symptoms of diabetes such as increased thirst and urination. Because gestational diabetes lacks specific symptoms that can suggest this problem is developing, all women must be screened for this condition during pregnancy.
The Gestational Diabetes Test
The gestational diabetes test should be performed in all pregnant women between 24-28 weeks of gestation using an oral glucose tolerance test. Women with the following risk factors will need to be screened earlier in the pregnancy:
- Morbid obesity
- History of PCOS
- Prior history of gestational diabetes
- Sugar in the urine
- Strong family history of type 2 diabetes
Typically the gestational diabetes test is carried out in a two step fashion using the glucose challenge test and the 3 hour glucose tolerance test.
- Glucose Challenge Test: In the first step, women are asked to consume a beverage containing 50 grams of sugar and blood is drawn one hour later. This test is called glucose challenge test and it can be done non-fasting. An abnormal test result is a reading between 130-140 mg/dl or higher.
- 3 Hour Glucose Tolerance Test: If the glucose challenge test is abnormal, the mother will return for a 3 hour oral glucose tolerance test (OGTT) using a drink containing 100 grams of sugar.
How is gestational diabetes diagnosed? To be diagnosed with gestational diabetes, the patient must have two or more abnormal readings on the 3 hour oral glucose tolerance test (OGTT). The normal results are listed below:
- Fasting: <95 mg/dl
- 1 Hours: 180 mg/dl
- 2 Hours: 155 mg/dl
- 3 Hours: 140 mg/dl
Gestational Diabetes Diet & Treatment
Gestational diabetes should be aggressively managed to prevent maternal and fetal complications. Mothers with this condition may experience complications such as diabetic retinopathy, kidney disease, and high blood pressure. High levels of insulin can cause complications for the developing baby that include developmental abnormalities, high birth weight, breathing problems and low blood sugar after delivery.
Gestational Diabetes Diet
For many women with gestational diabetes, dietary changes and frequent blood sugar monitoring can be used to improve glucose levels. Women are advised to avoid large meals and limit amounts of carbohydrates to half of their daily food intake. It is recommended that women follow a gestational diabetes diet that allows 3 normal meals and 3 snacks to keep sugar levels steady. A consultation with a nutritionist is often very beneficial for women with gestational diabetes diet questions.
Gestational Diabetes Medications
Sometimes medications are necessary to reduce the risk of complications from gestational diabetes. This may be either oral diabetes medications, insulin or a combination of both.
Gestational diabetes is a common health condition that can cause many problems during pregnancy. It is easily detected through routine blood testing and obstetric care. Careful regulation of the diet and medications are important to help prevent complications that are associated with hyperglycemia during pregnancy. It is essential that all women with gestational diabetes keep their routine appointments for all blood work, ultrasounds and doctors visits to keep their baby healthy!
