Type I, Type II, adult onset … diabetes terminology can be confusing. When a woman with no prior diabetes develops high glucose (sugar) levels in her blood during pregnancy, that condition is referred to as “gestational diabetes.”
By Andrea Renskoff
Gestational diabetes affects about 4 percent of all pregnant women in the United States, according to the American Diabetes Association. Race and family history can present a higher risk. But the number of cases is on the rise because the likelihood of developing it is much greater in women who are of older maternal age or who are overweight.
Hormones from the placenta help the baby develop. However, those same hormones can interfere with a woman’s ability to produce and use insulin. Glucose builds up in her blood when there isn’t enough insulin to convert it into energy. In most cases, a woman’s glucose levels will return to normal after delivery.
Screening – Although increased thirst and frequent urination can be warning signs of diabetes, those are commonplace during pregnancy. Gestational diabetes rarely presents any symptoms. The glucose screening given between the 24th and 28th week of pregnancy will most often be the first indication of the condition. A woman will drink a solution that tastes like a very sweet soda and an hour later, blood will be drawn. If the glucose level is suspiciously high, she’ll be scheduled for a longer test in which blood is taken over the course of several hours.
Treatment – If gestational diabetes is diagnosed, it can usually be controlled with a food plan. A woman’s obstetrician may refer her to a certified diabetes educator (CDE). Roz Morgan, R.N., a CDE at the Cedars-Sinai Diabetes in Pregnancy Program in Los Angeles, notes that “many women eat helter skelter.” But a sensible meal plan with portion sizes, carbohydrate counting and planned snacks is essential to diabetes management.
If a woman is able to, exercise can improve glucose metabolism. Walking, prenatal yoga, swimming and water aerobics are all effective. “Nothing exhausting, no huffing or puffing,” Morgan warns. “You do not want to initiate contractions.”
The woman will also be given a home monitoring kit to check her own blood sugar. She’ll prick the tip of her finger to extract a drop of blood onto a test strip. The strip is then placed in a meter that will display a glucose level. She’ll need to record and report these levels to her CDE or doctor, who may continue to make adjustments to her food plan depending on those numbers.
In rare cases, diet is unable to lower the glucose levels on a regular basis and a patient may need to use insulin injections. There is no risk of harm to the baby.
Fetal Care – The extra blood sugar in the mother may go through the placenta, essentially overfeeding the fetus. This could lead to macrosomia, a large baby. To keep a close watch, an obstetrician may refer a patient to a specialist to oversee the treatment, or will schedule her for more frequent prenatal visits and testing. This typically involves additional ultrasound monitoring of fetal growth and non-stress tests to measure fetal heart rate and uterine contraction.
Delivery – Early delivery is rarely called for. “If the mother has proper monitoring throughout the pregnancy and has achieved optimal glucose management, she should be able to deliver at term,” says obstetrician and maternal fetal medicine specialist Daryoush Jadali, M.D. And as long as the fetus has not become so large as to risk shoulder damage during vaginal delivery, there is no need for Cesarean birth.
dana">“The baby has blood glucose testing immediately upon delivery,” Dr. Jadali explains. In extremely rare cases, the baby’s glucose level will be low. In that instance, a glucose supplement is fed to the baby, who is observed in a special care unit. Most of the time, however, mother and baby’s glucose levels are normal after delivery. The mom’s glucose is tested again at her postpartum checkup.
Follow-Up – Because both the mother and baby affected by gestational diabetes are at higher risk to develop diabetes later in life, the lifestyle changes made during pregnancy should continue after delivery.
dana">“We can delay the appearance of diabetes with a planned form of exercise, an eating plan of balanced foods, and by maintaining a normal weight for the whole family,” Morgan explains.
dana">“Do not bring any food into the home that you should not eat daily. This is a lifelong process. If you want a Krispy Kreme doughnut, go get one, but don’t bring a box of them into your home.”
Gestational Diabetes: What to Expect, 4th ed., from the American Diabetes Association, 2001. Includes information on treatment, nutritional recommendations, exercise, monitoring and testing.
Managing Your Gestational Diabetes: A Guide for You and Your Baby’s Good Health, by Lois Jovanovic-Peterson, M.D., John Wiley and Sons, 1998. Help advice from a diabetic physician and mother.
On the Web
American Diabetes Association – 800-DIABETES(342-2383) – Provides overview and related links.
Web MD – Search on “gestational diabetes” for links to in-depth articles about diagnosis and treatment.
Related Reading: Coping with the Challenges of a High-Risk Pregnancy
Andrea Renskoff is a freelance writer and frequent contributor to United Parenting Publications.