Gestational Diabetes

by Lindsey Foley

I work in an OB/GYN office and every pregnant woman gets screened for gestational diabetes at the end of her 2nd trimester. I didn’t know much about it so I though I’d do a little research and let everyone know what I found out:
Overview: Gestational diabetes is a condition that about 7% of women develop during their pregnancy, usually during the second or third trimester. In gestational diabetes, the woman’s body doesn’t respond properly to insulin, causing her blood glucose levels to remain elevated. Diabetes is more likely to develop during pregnancy because pregnancy (or other) hormones get in the way of our body’s ability to properly react to insulin. In most cases, once a woman delivers, her gestational diabetes goes away. That being said, there is a chance that her diabetes will not subside and therefore, every woman who develops gestational diabetes must be tested for diabetes after she delivers.
Risk Factors: Women who are at an increased risk for developing gestational diabetes:
· Developed gestational diabetes in a previous pregnancy
· Are over the age of 30
· Delivered a large baby in a previous pregnancy
· Are overweight · Have excessive weight gain during pregnancy
· Have family history of diabetes
· Are of an ethnicity with increased risk for diabetes, such as Native American, African American or Hispanic
Though these are known risk factors, many women who develop gestational diabetes do not have fit into any of these categories.
Testing: Pregnant women are tested between 24 and 28 weeks of their pregnancy. They consume a drink containing 50 grams of sugar then have their blood drawn one hour later to check their blood glucose level. If she fails this test, she must take a 3 hour glucose tolerance test in which she is fasting, consumes 100 grams of sugar then has her blood drawn 1, 2 and 3 hours later. These blood glucose levels are analyzed to determine if she has developed gestational diabetes.
Possible complications: If women with gestational diabetes properly control their blood glucose level, they may have no added complications. If their diet is not properly controlled, women who develop gestational diabetes are at an increased risk for macrosomia (high birth weight), preeclampsia (increased blood pressure with swelling and rapid weight gain), polyhydramnios (increased amniotic fluid), stillbirth and newborn complications. Also, research has shown that the child born to a mother with gestational diabetes is at an increased risk for childhood obesity and for developing type 2 diabetes.
Keeping gestational diabetes under control: Women who develop gestational diabetes are often referred to a dietician who can develop a proper diet for her. The diet may vary based on her maternal weight, stage in pregnancy and the baby’s weight. Women with gestational diabetes need to avoid sweets and may have a recommended diet that is about 20% of calories from protein, 30% to 40% from fats (mostly unsaturated) and 40% to 50% from complex carbohydrates. In addition to a strict diet, regular exercise can help keep gestational diabetes under control. In some cases, when proper diet and exercise aren’t enough to keep the mother’s blood glucose levels down, insulin shots or another medication may be needed. As long as gestational diabetes is kept under control, it poses no added risk to the fetus.
Sources:
Manore, Melinda, Janice Thompson and Linda Vaughn. The Science of Nutrition. Pearson, Benjamin Cummings. 2008.
March of Dimes; http://www.marchofdimes.com/

Submitted by Lindsey Foley

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