Diabetes mellitus is a disease in which levels of glucose (sugar) in the bloodstream are higher than normal. Glucose is produced in the body from the foods you eat. The pancreas, an organ located
just behind the stomach, produces insulin. Insulin is a hormone that takes the glucose from the bloodstream and carries it inside your body’s cells where it is used for energy. Diabetes occurs when sugar builds up in the blood.
What is gestational diabetes?
Gestational diabetes mellitus (GDM) is a form of diabetes that can develop during pregnancy,
usually in the second trimester. During pregnancy the placenta produces hormones that help the baby develop. These hormones also block the effects of insulin in the woman’s body, increasing her blood sugar levels.
Who is at risk?
Any pregnant woman can develop the condition, but some women are at greater risk than others. Known risk factors for GDM include:
- Age (older than 25 years; the risk is even greater after age 35)
- Race (occurs more often in African Americans, Hispanics, American Indians, and Asian Americans)
- Being overweight/obese
- Personal medical history of gestational diabetes, prediabetes, or previously delivering a baby weighing more than nine pounds or polycystic disease of the ovaries
- Family history of type 2 diabetes (in parents or siblings)
How do you know if you have gestational diabetes?
The majority of women with GDM have no warning signs or symptoms. Because of the lack of symptoms and the increase rate of diabetes, all women should be tested for diabetes before
pregnancy and to be tested again (if it was normal before) for GDM between the 24th and 28th weeks of pregnancy.
For the of minority women who are obese and who have had a previous history of GDM or a family history of diabetes, testing at the first prenatal visit is recommended. The test is called oral glucose tolerance test (OGTT) and involves measuring blood glucose levels both before and after drinking a sugary liquid.
..................Column Break..................Possible symptoms of gestational diabetes Increased thirst and urination, fatigue (feeling tired all the time), blurred vision, infections of the bladder, vagina or skin.
Can gestational diabetes be dangerous?
High blood sugar in women with GDM can affect them and their baby. For the mother, it increases the risk of premature delivery and preeclampsia, or pregnancy-induced high blood pressure.
High blood sugar in the mother can cause the baby to grow too large. Very large babies may get wedged in the birth canal and have birth injuries. Large size also increases the chances of needing a cesarean delivery. High blood sugars in the mother may be a cause of stillbirth.
Uncontrolled GDM also increases the risk of jaundice and breathing problems in the newborn. After birth, the baby may develop low blood sugar (hypoglycemia), a potentially dangerous condition. While in the womb, the baby’s pancreas produces large amounts of insulin in response to the mother’s high blood sugar, and it continues to
do so after delivery. Without the sugar supplied by the mother, the excess insulin can cause the baby’s own glucose level to drop too low.
How is gestational diabetes treated?
Eating a healthy, well-balanced diet and getting regular exercise are important in preventing and treating GDM. Your health care provider will
carefully monitor your blood sugar and may also refer you to an expert, such as an endocrinologist or diabetes educator, to help you keep your blood sugar under control. If diet and exercise are not enough, you may need treatment with insulin as oral antidiabetic medications are not recommended.
Glucose testing and goals during pregnancy Test blood glucose at home and keep a written record to assist the health care team. Before breakfast levels should be less than 90 mg/dl and
two hours after meals (before snacks) levels should be less than 120 mg/dl.
Dietary recommendations:
- Avoid cookies, cakes, pies, fruit juices and soft drinks, chocolate, all kinds of cereals, fruit drinks, Kool-Aid, jellies, or canned fruit packed in syrup
- Limit convenience foods that are high in carbohydrates and salt: Instant noodles, canned soups, instant potatoes, or packaged stuffing
- Eat small frequent meals, about three meals and three snacks every day with less carbohydrate first thing in the day
- Include a good source of protein at every meal and snack, such as low fat meat, chicken, fish, low fat cheese, nuts, peanut butter, cottage cheese, eggs, and turkey
- Choose high-fibre foods, whole grain breads and cereals, vegetables, beans, legumes, fresh fruits, and nuts
- Drink plenty of water, Eight cups of water a day is recommended
- Eat extra low or no calorie foods if you are hungry: raw veggies, extra lettuce in salads, cabbage, cucumbers, carrots, green onions, mushrooms, zucchini, spinach, asparagus, broccoli, cauliflower, celery, green beans, radishes, green pepper, caffeine-free tea, caffeine-free coffee with sweet n low, sugar-free gelatin, diet soda (once daily)
What should you do with this information?
If you are pregnant or thinking about getting pregnant, ask your doctor what you can do to
..................Column Break..................prevent GDM. If you have GDM, you should check your blood sugar level regularly to make sure it
is under control. GDM usually goes away after pregnancy, but more than half of women who have had GDM develop type 2 diabetes within five years of delivery or later in life.
Women with a history of GDM are also more likely to have a heart attack or stroke. If you have ever had GDM, you and your doctor should discuss lifestyle changes to help you prevent type 2 diabetes and other health problems.
Important tips after delivery
- Continue healthy eating and exercise after birth
- Continue monitoring blood sugar after delivery for one week. You should contact your doctor if you find that two hours after a meal your blood sugar is above 160mg/dl
- Glucose tolerance test two months after delivery to ensure no diabetes
- Yearly and before any plan for future pregnancy, do fasting blood sugar in the lab and A1C test
- It is also recommended to use an effective means of contraception and to ensure the absence of diabetes before removing it