Gestational Diabetes: How Does This Diagnosis Affect My Pregnancy?

Any pregnancy is filled with tests to continually monitor the health and well-being of both mother and child. Just one of the tests that an expecting mother can anticipate normally occurs around 24 weeks gestation; it is a fasting glucose test. A fairly simple test, the mother fasts for a pre-determined amount of time, and has blood drawn to check blood sugar levels. If this test shows any indication of a problem, a glucose tolerance test is ordered. This is a more involved test in which the mother drinks a sugary drink, and then has blood drawn at 1 hour intervals for 3 hours. The glucose tolerance test better shows how a woman's body handles high amounts of sugar ingestion; if the blood sugar levels at any given blood draw are too high, the diagnosis of gestational diabetes is made.

Let me back up- what exactly IS gestational diabetes? Babycenter's article entitled Gestational Diabetes helps to explain the condition. When food is eaten, our bodies break it down into simple sugars, the most basic being glucose. The pancreas releases a hormone called insulin which basically transports the glucose into the body's cells, where the glucose converted into energy. During gestational diabetes, the body cannot get the glucose into the cells, so levels build up in the bloodstream instead. This is the same thing that happens in Type 1 or Type 2 diabetes, but gestational diabetes refers only to diabetes that occurs or is diagnosed during pregnancy.

Diabetes during pregnancy can occur from a few different reasons. During pregnancy, the body's demand for insulin increases in order to support the growing baby, and also because of the weight gain of the mother. That increased demand, coupled with the fact that pregnancy hormones make it more difficult for the body to use insulin efficiently, put stress on the pancreas to produce higher levels of insulin to keep up with the demand. This phenomenon, known as "insulin resistance" can increase as the pregnancy continues, because as the placenta grows, it increases production of the hormones responsible for the resistance. For some reason, some women cannot keep up with the increased levels of insulin needed, and when that happens, blood sugar builds up in the bloodstream, where it is detected with bloodwork, or with a glucose monitor.

So who gets gestational diabetes? The article "Pregnancy: Gestational Diabetes," from WebMD discusses some of the risk factors involved; these include obesity prior to becoming pregnant, a prior pregnancy with gestational diabetes, being over age 25, family history of diabetes, previously giving birth to a stillborn baby or one over 9 pounds, and also having too much amniotic fluid. However, even with these risk factors, over half the diagnosed cases of gestational diabetes have none of these risk factors.

Once a diagnosis is made, what is the next step? A diagnosis of gestational diabetes can be stressful and worrying for a mother-to-be, so education is really the key here. This diagnosis requires a little more work from the mother, but she can fully expect to carry to term a healthy baby, as long as she keeps her blood sugar levels under control. Uncontrolled blood sugar levels do carry certain potential risks, among them babies being born very large, which can make birth difficult for mother and baby. Also, a higher risk of high blood pressure occurs for the mother, and there is a greater risk for hypoglycemia (low blood sugar) for the baby at birth.

After a diagnosis of gestational diabetes, the mother-to-be will meet with their doctor to discuss the management of their blood sugars- this is on an individual basis, as each case can vary greatly, and often times treatments will change throughout the course of pregnancy as hormone levels change. The most important thing to discuss is the monitoring of blood sugar levels using a glucose meter. Diet modifications will probably be discussed, including keeping careful track of the number of carbohydrates ingested, since they are composed of mostly sugars. A good exercise plan is another treatment tool, but again blood sugar monitoring is key, because too much exercise can actually lower blood sugars too much, causing hypoglycemia. A mom to be will likely have a team of health professionals helping her to keep track of her treatments and their efficacy; among them may be a diabetic specialist, dietician, and ob/gyn. As a last resort, a woman may need to go on insulin injections to treat her high blood sugar if diet and exercise are not enough; if this happens, good communication with her doctors are even more crucial to make sure the levels are accurate.

As pregnancy progresses, extra monitoring of the baby will begin for someone diagnosed with gestational diabetes. This usually includes fetal non-stress tests where the doctor will look at the movements of the baby as well as the fetal heart rate to make sure the baby is doing well. Also, ultrasounds may be ordered to check the size of the baby to make sure they are not getting too big. Both tests are painless and non-invasive, and can also be helpful in providing reassurance to the mother.

Are there any future problems associated with a gestational diabetes pregnancy? As WebMD notes in their article "Pregnancy: Gestational Diabetes," generally blood sugar levels return to normal after delivering, because the bodies hormone levels return to reduced state. It is a good idea, however to continue monitoring blood sugar levels after having gestational diabetes, especially because there is a 60% risk of developing Type 2 diabetes (also known as insulin resistance) after having gestational diabetes. Risk can be lowered by maintaining a healthy diet and exercise program, and continuing to monitor the amount of carbohydrate intake. While future pregnancies carry a 40-50% risk of another gestational diabetes diagnosis, a woman can be proactive in reducing some of these risks.

Gestational diabetes occurs in 2 to 7 percent of all pregnancies, according to Babycenter, making it one of the most common pregnancy complications. While any mention of complication can be worrisome for a mother-to-be, it is very possible to have a wonderful pregnancy with the delivery of a healthy baby as the result. It is important to have good communications with a diverse team of specialists to help the mother to monitor her blood sugar, and to adapt any treatments as needed. While it can all be overwhelming, the mother-to-be is ensuring not only a healthy start for her baby, but also continued health for herself.

Sources:

Gestational Diabetes, Babycenter

Gestational Diabetes, American Diabetes Association

Pregnancy: Gestational Diabetes, WebMD