What you should know about Gestational diabetes
Are you at risk of developing this condition during pregnancy?
Most of us are aware of diabetes and the impact it can have on the health and overall quality of life for children and adults. But pregnant women should also know about gestational diabetes, their potential risk for developing this condition during pregnancy, and what it can mean for them and their baby.
First, what is diabetes? According to Joanna Paolilli, MD, FACOG, from OB/GYN Associates of Southern NH, diabetes is a disorder that disrupts the way your body uses sugar. The body needs insulin to help sugar get into cells where it is used for energy, and if there isn’t enough insulin, or if the body stops responding to insulin, sugar will build up in the blood.
During pregnancy, Paolilli said, obstetricians screen patients for gestational diabetes — a term used to describe carbohydrate intolerance with onset or first recognition of carbohydrate intolerance during pregnancy.
“Gestational diabetes can be further categorized as diet-controlled or insulin requiring,” Paolilli said. “The risk for gestational diabetes is increased in pregnant women over age 25, obese women, women with a strong family history of type 2 diabetes, women who have excessive weight gain in pregnancy, and certain ethnicities such as Hispanic, African, Native American, Asian and Pacific Island ancestry. It is diagnosed in about five percent of pregnancies.”
Denise Poulin, MD, FACOG, also from OB/GYN Associates of Southern NH, adds that “pregnancy can cause healthy women to develop diabetes due to hormonal and physical changes,” and explains that, because there are no reliable symptoms that allow diabetes during pregnancy to be easily detected and diagnosed, all women are screened for gestational diabetes at 26 to 28 weeks by blood testing after a sugar challenge.
This typically consists of consuming a concentrated sugar drink and having your sugar levels checked at specified times after you have finished the drink. Earlier screening at 16 weeks is also available for high-risk women, those who have had diabetes previously, or those who have another medical condition that predisposes them to diabetes.
Once a diagnosis of gestational diabetes has been made, Paolilli said, surveillance of blood sugars with daily self-monitoring is needed throughout the pregnancy.
So you’ve been diagnosed with gestational diabetes — now what?
Heather Feltmate, MD, Dartmouth-Hitchcock Nashua Department of Obstetrics and Gynecology, said a woman with gestational diabetes is more likely to have a very large baby, also known as fetal macrosomia. This can cause difficulty with delivery, including maternal or fetal trauma, or a higher likelihood of cesarean delivery being necessary.
A woman with gestational diabetes mellitus, or GDM, is also more likely to have high blood pressure, potentially complicating their pregnancy, and babies of GDM mothers are more likely to have higher rates of jaundice, low blood sugar, as well as difficulties with breathing.
“The diagnosis and treatment of gestational diabetes is important because babies born to these women are at an increased risk of being large (over 10 pounds),” adds Paolilli. “Babies born to gestational diabetics have a greater risk of the shoulders getting stuck in a traditional delivery, known as shoulder dystocia. A shoulder dystocia could lead to a shoulder bone fracture or arm paralysis, either temporarily or permanent. There is an increased risk of cesarean delivery and increased risk of fetal death if blood sugars are not controlled during pregnancy. After delivery, the baby could have respiratory distress because of lung immaturity, or need treatment for low blood sugar levels. The best way to avoid these complications is strict control of blood sugars during pregnancy.”
According to Poulin, at OB/GYN Associates of Southern NH women who are identified as having diabetes are evaluated by a specialized diabetes education team consisting of a nurse educator and a dietician. These women are put on a specific diet and taught to check their blood sugar levels to assess how well their diabetes is controlled, and are reevaluated weekly. Some women cannot achieve good blood sugar control on a special diet alone, Poulin said, and need to begin insulin treatment, which is taught by the nurse educator, and the results are reported to both the educator and the obstetrical providers for adjustment of treatment.
By controlling blood sugars, she said, a woman avoids directly increasing her baby's sugar levels. When a developing baby has high blood sugar, the baby makes extra insulin to handle the sugar, which is a problem because insulin is a growth hormone that can cause a baby to grow larger than average.
“By recognizing and treating diabetes, we can prevent babies from growing too large, and in so doing, reduce the need for cesarean section,” Poulin said. “There are other health risks to babies from diabetes, which can be prevented by treatment.”
Although gestational diabetes can’t necessarily be prevented, the risk of developing it can be lessened by exercising and eating healthy during pregnancy and not exceeding your recommended pregnancy weight gain as advised by your doctor, as well as practicing overall good prenatal care and management.
Julia K. Agresto works full-time as a writer at Rivier University in Nashua, as well as freelancing as a writer for various publications and volunteering as a public relations coordinator for a charity group in Connecticut. She lives in Nashua.