Diabetes Management
Gestational diabetes is considered to be any form of impaired glucose tolerance first recognized during pregnancy. This occurs in as many as 18% of all pregnancies and is more common in older mothers-to-be, smokers and obese patients.
Although risk factors aid in determining the chance of developing gestational diabetes, there are no risk factors present in about 50% of affected women. For most women, gestational diabetes does not persist after pregnancy. However, women who have had gestational diabetes have a higher chance of developing type 2 diabetes later in life than women who have not had gestational diabetes.
Symptoms
Patients usually show no symptoms of gestational diabetes, thus necessitating universal screening for the condition between the 24th and 28th weeks of pregnancy.
Diagnosis
The screening to determine the presence of gestational diabetes includes the patient drinking a sweet glucose solution, then having blood drawn to test sugar levels. If the findings are higher than normal, a follow-up test is performed after an overnight fast. A similar glucose solution is consumed in the morning and the blood is tested every hour in a three-hour period. If these measurements are found to be high at least twice in this three hour period then diabetes is present.
Gestational diabetes is essential to diagnose, as it poses significant risk to both child and mother. Most of these risks are directly related to the elevated levels of glucose in the blood, and their severity increases as the blood glucose concentration gets more extreme. The mother has a greater chance of developing high blood pressure and preeclampsia during pregnancy.
The excess sugar can cause certain growth abnormalities in the baby such as macrosomia (very large baby). These abnormalities can increase the likelihood of needing a Cesarean section. Babies born to mothers with gestational diabetes have an increased risk for chemical imbalances (i.e. low blood calcium and magnesium), an abnormally high red blood cell count and hypoglycemia at birth. Babies born to mothers with gestational diabetes also face a higher risk of obesity and type 2 diabetes as they mature.
Treatment
Treatment for gestational diabetes is primarily focused on reducing the inherent risks to both mother and child. The most common method is nutrition, exercise and glucose monitoring.
If these measures prove to be inadequate, then insulin therapy is added in conjunction with the nutrition and exercise plan. Each mother receives an individualized nutrition plan and education by our registered dietitian and frequent follow-up and nutrition exercise intervention during pregnancy. It is also recommended to follow-up after baby to provide the mother the best chance to reduce her diabetes risk. It is also important to note that breastfeeding has been linked to a reduced risk of diabetes in both mother and child.
