According to the American Diabetes Association 9.2% of pregnant women develop gestational diabetes, and after my endocrinologist visit today, I am one of them. Luckily for me, my doctor doesn't seem too worried and thinks I have a mild case which can be treated with meal planning and will go away after I deliver. But with this revelation and the need to double and triple check my portions (although I didn't think my portions were out of whack) and the need for daily glucose testing, I decided to write a post giving all of you some more information about gestational diabetes.
What is gestational diabetes?
According to the American Diabetes Association: Pregnant women who have never had diabetes before but who have high () levels during pregnancy are said to have gestational diabetes. We don't know what causes gestational diabetes, but we have some clues. The placenta supports the baby as it grows. Hormones from the placenta help the baby develop. But these hormones also block the action of the mother's insulin in her body. This problem is called insulin resistance. makes it hard for the mother's body to use insulin. She may need up to three times as much .
Gestational diabetes starts when your body is not able to make and use all the insulin it needs for pregnancy. Without enough insulin, glucose cannot leave the blood and be changed to energy. builds up in the blood to high levels. This is called . If gestational diabetes is not effectively treated and managed, it can have negative effects on the mother and her child, so it is important to consistently consult with your doctor and follow the regiment that is prescribed to you.
How you baby can be affected:
Gestational diabetes affects the mother in late pregnancy, after the baby's body has been formed, but while the baby is busy growing. Because of this, gestational diabetes does not cause the kinds of birth defects sometimes seen in babies whose mothers had diabetes before pregnancy.
However, untreated or poorly controlled gestational diabetes can hurt your baby. When you have gestational diabetes, your pancreas works overtime to produce insulin, but the insulin does not lower your blood glucose levels. Although insulin does not cross the placenta, glucose and other nutrients do. So extra blood glucose goes through the placenta, giving the baby high blood glucose levels. This causes the baby's to make extra insulin to get rid of the blood glucose. Since the baby is getting more energy than it needs to grow and develop, the extra energy is stored as .
This can lead to macrosomia, or a "fat" baby, these are the 15+ pound babies we sometimes hear about. Babies with face health problems of their own, including damage to their shoulders during birth, because their size makes it difficult, if not impossible to pass through the birth canal. This results in a large number of gestational diabetes babies being delivered via Cesarean section. Because of the extra insulin made by the baby's pancreas, newborns may have very low blood glucose levels at birth and are also at higher risk for breathing problems. Babies with excess insulin become children who are at risk for and adults who are at risk for .
Around week 28 of your pregnancy you will have to schedule a glucose tolerance test at your doctor's office. At this test the nurse will give you a glucose drink (pretty much pure sugar) for you to drink thirty minutes before your appointment. After the thirty minutes is finished the nurse will draw your blood and that is it. You will have to wait about a week depending on your doctor for results. If the glucose levels are normal then you don't need to continue with any other tests. If your glucose levels are high, then you will need to schedule a three hour glucose test.
With the three hour test you will need to fast. So from midnight the night before all the way to your test you cannot eat or drink. When you get to the office the nurse will draw your blood again, this is the baseline to see what your glucose level is before you eat. You then have five minutes to drink the glucose drink again. Once you fish the drink, you will be sent to the waiting room to wait. The nurse will then draw your blood every hour, on the hour for the next three hours. During this time you CAN NOT eat or drink anything! Once the test is over you can eat, and you will have to wait a week or so for your results. If your test come back normal then you don't have to do anything else and you do not have gestational diabetes, if the glucose levels are high, then you will need to follow up with a specialist.
Depending on the severity of the glucose levels the specialist will either put you on an insulin regiment, or will inform you that you need to to change your eating habits. Either way, you will have to take your blood glucose levels several times a day. If your levels are not that high, and you are successful with your meal plans your doctor MAY choose to cut back on the glucose testing.
How to treat gestational diabetes:
Because gestational diabetes can hurt you and your baby, you need to start treatment quickly.
Treatment for gestational diabetes aims to keep blood levels equal to those of pregnant women who don't have gestational diabetes. Treatment for gestational diabetes always includes special meal plans and scheduled physical activity. It may also include daily testing and injections.
If you're testing your blood glucose, the American Diabetes Association suggests the following targets for women who develop gestational diabetes during pregnancy. More or less stringent glycemic goals may be appropriate for each individual.
- Before a meal (preprandial): 95 or less
- 1-hour after a meal (postprandial): 140 mg/dl or less
- 2-hours after a meal (postprandial): 120 mg/dl or less
You will need help from your doctor, nurse educator, and other members of your health care team so that your treatment for gestational diabetes can be changed as needed. Sticking with your treatment for gestational diabetes will give you a healthy pregnancy and birth, and may help your baby avoid future poor health.
Source: American Diabetes Association