Gestational Diabetes

Gestational diabetes is a type of diabetes that happens during
pregnancy. Unlike type 1 diabetes, gestational diabetes is not caused by having too
little insulin. Instead a hormone made by your placenta keeps your body from using
the insulin as it should. This is called insulin resistance. Blood sugar (glucose)
then builds up in your blood instead of being absorbed by the cells in your
body.

The symptoms of gestational diabetes often go away after delivery.
But sometimes they don’t. Or you may have a greater risk of developing type 2
diabetes later.

Healthcare providers don’t know what causes gestational diabetes.
But they do know what happens.

The placenta gives your growing baby nutrients and water. The
placenta also makes several hormones to keep the pregnancy healthy. These hormones
include:

  • Estrogen
  • Progesterone
  • Cortisol
  • Human placental lactogen

These hormones can affect how your body uses insulin
(contra-insulin effect). This often begins about 20 to 24 weeks into your pregnancy
and could lead to gestational diabetes.

During pregnancy, more fat is stored in your body, you take in
more calories, and you may get less exercise. All of these things can make your
blood sugar (glucose) levels higher than normal and possibly lead to gestational
diabetes.

As the placenta grows, it makes more of the hormones. The risk for
insulin resistance becomes greater. Normally your pancreas is able to make more
insulin to overcome insulin resistance. But if it can’t make enough to overcome the
effects of the placenta’s hormones, you can develop gestational diabetes.

Any woman can develop gestational diabetes during pregnancy. But
you may be more likely to get it if you:

  • Are overweight or obese
  • Have a family history of diabetes
  • Are older than 25
  • Are African American, American Indian, Asian American,
    Hispanic or Latino, or Pacific Islander
  • Have pre-diabetes (impaired glucose tolerance)
  • Have high blood pressure

Gestational diabetes doesn’t cause any symptoms. That’s why it’s
important to get tested for it if you are at high risk.

If your blood sugar levels are very high, you may have these
symptoms:

  • You urinate more than normal
  • You are hungrier or thirstier than normal.
  • You have blurred vision
  • You have nausea and vomiting
  • You lose weight even though you are hungrier

You should be tested for gestational diabetes in your 24th to 28th
week of pregnancy.

The American Diabetes Association also advises that you be tested
for type 2 diabetes if you have risk factors for this condition. This testing should
be done at your first prenatal visit.

Screening is done by these tests:

  • One-hour glucose
    tolerance test.
    You drink a special beverage high in sugar. One hour
    later, the healthcare provider measures your blood sugar (glucose) levels. If
    your levels are higher than a certain level, this is considered an abnormal
    result.
  • Three-hour
    glucose tolerance test.
    If the 1-hour test is abnormal, you will have a
    second glucose tolerance test done to confirm the diagnosis. You will drink
    another special beverage, but with more sugar. Your healthcare provider will
    measure your blood sugar levels 1 hour, 2 hours, and 3 hours later. You have
    gestational diabetes if at least two of the glucose measurements are higher than
    normal.

If you are diagnosed with gestational diabetes, you should get
tested for diabetes 4 to 12 weeks after your baby is born. You should also get this
screening at least every 3 years for the rest of your life.

You and your healthcare provider will figure out the best
treatment for you based on:

  • How old you are
  • Your overall health and past health
  • How sick you are
  • How well you can handle specific medicines, procedures, or
    therapies
  • How long the condition is expected to last
  • Your opinion or preference

Treatment for gestational diabetes focuses on keeping your blood
sugar levels in the normal range. Treatment may include:

  • Special diet.

    You should eat 5 servings of vegetables, fruits, low-fat or nonfat dairy
    products, and lean meats. Use liquid fats for cooking instead of solid fats. You
    should eat whole grains and avoid high-calorie snacks or sweet desserts.

  • Exercise.
    You should do moderate exercise unless your healthcare provider tells you not
    to.
  • Daily blood
    glucose monitoring.
    Your goal is to keep your blood sugar levels lower
    than 130mg/dL to 140mg/dL 1 hour after eating.
  • Insulin
    injections.
    You may need these to control your blood sugar levels. Or
    you may need other medicines taken by mouth.

Gestational diabetes usually doesn’t cause birth defects. But it
can affect your baby in other ways if your blood sugar levels are not under
control.

Below are the 2 major health problems that can develop.

Macrosomia

Macrosomia means a baby who is much larger than normal. This
happens if the mother’s blood has too much blood sugar in it. The fetus’
pancreas senses this high level of blood sugar and makes more insulin. The fetus
then changes the extra blood sugar into fat. This extra fat means a larger
baby.

A larger than normal baby can be difficult to deliver. The
baby may have trauma or nerve damage, or need to be delivered by cesarean
section.

Hypoglycemia

Hypoglycemia is low blood sugar. This can happen to the baby
just after he or she is born if the mother’s blood sugar levels are too high.
The high levels in the mother cause the fetus to make more insulin. Once the
baby is born, he or she no longer has the high blood sugar levels from the
mother. This causes the baby’s blood sugar levels to fall very low.

Your blood sugar levels will be watched very closely during
labor. Your healthcare provider may give you insulin to keep your blood sugar in
a normal range. This will prevent your baby’s blood sugar from dropping greatly
after delivery.

Babies born to mothers with gestational diabetes may also have
low levels of calcium or magnesium in their blood.

These complications can be prevented. The key to prevention is
careful control of your blood sugar levels just as soon as the diagnosis of
diabetes is made.

  • Gestational diabetes is a type of diabetes that happens
    during pregnancy.
  • It may be caused by the hormones made by your placenta.
    These hormones can make insulin in your body not work as well as it should.
  • Gestational diabetes happens about halfway through pregnancy
    and doesn’t cause birth defects.
  • If your blood sugar is not under control, your baby can
    develop problems. One problem is larger growth than normal. The other problem is
    very low blood sugar just after birth.

Tips to help you get the most from a visit to your healthcare
provider:

  • Know the reason for your visit and what you want to
    happen.
  • Before your visit, write down questions you want
    answered.
  • Bring someone with you to help you ask questions and
    remember what your provider tells you.
  • At the visit, write down the name of a new diagnosis, and
    any new medicines, treatments, or tests. Also write down any new instructions
    your provider gives you.
  • Know why a new medicine or treatment is prescribed, and how
    it will help you. Also know what the side effects are.
  • Ask if your condition can be treated in other ways.
  • Know why a test or procedure is recommended and what the
    results could mean.
  • Know what to expect if you do not take the medicine or have
    the test or procedure.
  • If you have a follow-up appointment, write down the date,
    time, and purpose for that visit.
  • Know how you can contact your provider if you have
    questions.