Gestational diabetes refers to the unusually high blood glucose levels in a non-diabetic woman who is carrying a baby. This occurs in women who produce the right amount of insulin but the effect of this hormone is blocked by a variety of other hormones like progesterone, cortisol, prolactin, and estrogen, to name a few. This condition called insulin resistance begins during 20 to 28 weeks into pregnancy and increases as the placenta grows. The pancreas is often able to produce enough insulin to overcome insulin resistance, but once it runs out of the ability to keep up with the resistance, this results in a condition known as gestational diabetes.
The condition presents very few symptoms. The woman may experience rapid and excessive weight gain, frequent hunger, thirst, and urination, or recurrent vaginal infections.
Who gets gestational diabetes?
Women who are at risk for gestational diabetes are those with close relatives who have diabetes. Typically, African-American, Asian-American, and American-Indian women are more prone to this condition compared to women of other races. Other risk factors include being 25 years old or older, being overweight, and women who have been diagnosed with pre-diabetes. Women who had previous pregnancies, which resulted in the birth of a baby that weighs more than the normal range, a stillborn, or one with a birth defect, are also at risk for gestational diabetes. Women who are hypertensive are also at a greater risk.
Diagnosing gestational diabetes
The condition is diagnosed through a glucose tolerance test, which is done from 24 to 28 weeks into the pregnancy. For women who are at risk, the doctor may schedule a screening test as early as 13 weeks into the pregnancy.
In this test, the woman is made to drink a glucose solution and a blood sample is taken from her after one hour. The woman is safe from the condition if the readings are 140 mg/dL and below. If the value is higher, the woman is made to undergo a three-hour glucose tolerance test. The results of the test are compared to the normal levels. If two or more levels are higher than the normal, a diagnosis of gestational diabetes can be made.
Other types of tests done for determining the presence of the condition include the glucose challenge test and fasting and random blood sugar tests. Early diagnosis is important, especially in preventing serious complications later on.
Gestational diabetes and your baby
Babies born to mothers with gestational diabetes are often born overweight, more than 9 pounds and 14 ounces. Because of the baby’s large size, delivery can be difficult. The baby may suffer from low blood sugar levels and may also suffer from breathing problems.
The baby may also need monitoring during the pregnancy stage. The doctor can order a non-stress test on the baby, where the baby‘s heart rate and movements are measured. If the baby’s heart rate does not go up for the duration of the test when it is externally stimulated, the doctor will then order a stress test.
Treatment and management of gestational diabetes
There are three areas that need to be covered in the management of gestational diabetes. These include diet, exercise, and diabetes medications. The woman should follow a nutritional plan that helps keep the blood sugar level within the normal range, from 60 to 120 mg/dL. The plan should include complex carbs such as pasta, potatoes, peas, and dried beans, as well as foods high in fiber such as grain cereals, fruits, vegetables, and breads. Diabetics should also avoid foods that are high in sugar and those with saturated fats such as fatty meats, foods loaded with butter, bacon, and ice cream, to name a few. However, snacks are important. They should eat a snack before bedtime, preferably one that is protein- or carbohydrate-based.
Women with gestational diabetes are encouraged to exercise four times a week for 15 to 30 minutes each time. The activity should not be too strenuous because they should avoid overexertion. Walking, swimming, dancing, and other milder forms of exercise are recommended for pregnant women.
Maintaining a healthy pregnancy weight is also important. A weight gain of 25 to 35 pounds for a pregnant woman is healthy. The total amount of proper weight gain also depends on how underweight the woman is prior to the pregnancy. Following an exercise program is very important. They can work with their fitness trainers who can tailor an exercise program that will suit their current physical condition.
Depending on the severity of the condition, the doctor may recommend a daily or weekly blood sugar monitoring. There are blood glucose monitoring kits that can be purchased for home use.
Insulin therapy
Insulin injections may be needed if dietary changes and changes in physical activity do not bring the blood sugar level to the normal range. When there are two abnormal values that occur within the week, the woman is given insulin. A typical regimen is composed of intermediate-acting insulin and/or regular insulin, which is adjusted gradually as insulin resistance increases. The patient is advised on how to take the insulin, when to take it, and in what amount or dosage to ensure effective results.