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Diabetes in Pregnancy
Gestational diabetes refers to diabetes that is diagnosed during pregnancy. Gestational diabetes occurs in about 7 percent of all pregnancies. Gestational diabetes usually occurs in the second half of pregnancy and goes away as soon as your baby is born. However, if gestational diabetes is not treated during your pregnancy, you may experience some complications.
Causes
Pregnancy hormones cause the body to be resistant to the action of insulin, a hormone made by your pancreas that helps your body use the fuels supplied by food. The carbohydrates you eat provide your body with a fuel called glucose -- the sugar in the blood that nourishes your brain, heart, tissues and muscles. Glucose also is an important fuel for your developing baby. When gestational diabetes occurs, insulin fails to effectively move glucose into the cells that need it. As a result, glucose accumulates in the blood causing blood sugar levels rise.
Diagnosis
A blood test is used to diagnose gestational diabetes. Your blood glucose level is measured after you drink a sweet beverage. If your blood sugar is too high, you have gestational diabetes. Sometimes one test is all that is needed to make a definitive diagnosis. More often, an initial screening test is given and, if needed, a longer evaluation is performed.
Gestational diabetes usually does not occur until later in pregnancy when the placenta is producing more of the hormones that interfere with the mother's insulin. Screening for gestational diabetes usually takes place between weeks 24 to 28. However, women at high risk are usually screened during the first trimester.
Risk Factors
There are a number of risk factors associated with gestational diabetes, including:
- Being overweight
- Giving birth to a baby that weighed more than 9 pounds
- Having a parent or sibling with diabetes
- Previously having gestational diabetes
- Having glucose in your urine
In addition, gestational diabetes occurs more
often in African Americans, Native Americans, Latinos, Asian
Americans, Pacific Islanders and women with a family history
of diabetes
Gestational Diabetes and Your Baby
Gestational diabetes can impact your developing baby in a couple of ways:
High Birth Weight -- When the growing fetus is exposed to higher sugar levels from the maternal bloodstream, it can result in a larger baby and a high birth weight . The baby's pancreas produces extra insulin in response to the higher glucose, which results in the baby storing extra fat and growing larger. A larger baby can make delivery more complicated for both mother and baby.
Low Blood Sugar -- If your blood sugar has been elevated during the pregnancy, your baby may have low blood sugar, called hypoglycemia, shortly after birth. The extra insulin that your baby produces when your blood sugar is high continues to bring your baby's blood sugar down for a short time after birth. Without the continued supply of sugar from maternal blood, your baby's blood sugar level may fall too low. However, this is temporary and the nurses and doctors caring for your newborn will monitor your baby carefully and treat any episodes of low blood sugar that may occur.
Avoiding Complications
Remember that the complications of gestational diabetes can be prevented by keeping your blood sugar under control during your pregnancy. The goal of treatment is to keep your blood sugar in the normal range. Most women with well-controlled blood sugar deliver healthy babies without any complications.
Treatment
Diet
The first step in treating gestational diabetes is to modify your diet to help keep your blood sugar level in the normal range. You should meet with a registered dietitian to develop a customized eating plan to help you mange your blood sugar. The main principles of such as diet include:
Avoid foods high in sugar. For the remainder of your pregnancy you should avoid desserts, sweets, candy, cookies, soft drinks and fruit juice. You should eat fruit, but since fruit is high in natural sugar, limit fruit to one small serving at a time. Eat reasonable portions of high-carbohydrate foods. Carbohydrates are found in breads, cereals, rice, pasta, potatoes, beans, fruits, milk, yogurt and some vegetables. Carbohydrate foods are important to eat because they contain nutrients that are necessary for both you and your developing baby. Carbohydrate foods break down into glucose during digestion. Therefore, it is important to eat carbohydrate foods at each meal, but don't over-eat. Eat smaller more frequent meals. Space out the carbohydrate foods you consume throughout the day. Cutting down the portion of carbohydrate foods eaten at one sitting means that you need to eat more often to meet your pregnancy nutrient needs. Eating three smaller meals and adding three or four snacks between meals can help you meet your pregnancy diet goals without elevating your blood sugar.
Blood Sugar Monitoring
The only way to know that your gestational diabetes is being properly controlled is to check your blood sugar frequently. You will be instructed on the use of a home blood sugar monitor. You should check your blood sugar at least four times daily, or as directed by your doctor. Check your fasting blood sugar first thing in the morning, before you have had anything to eat or drink. Also check your blood sugar one hour after starting to eat your three main meals: breakfast, lunch and dinner. Check with your doctor for target blood sugar levels.
Other Treatments
The majority of women with gestational diabetes will be able to control their blood sugar simply by modifying their diet. You need to follow the diet guidelines until your baby is born. After delivery, most women are able to resume their normal eating habits and gestational diabetes does not interfere with your ability to breastfeed your baby.
For about 30 percent of the women who develop gestational diabetes, following a diet is not enough to control their blood sugar. For these women, insulin therapy is usually initiated. Using insulin is safe during pregnancy. Women who take insulin still need to continue with the prescribed diet and monitor their blood sugar levels.
After Delivery
After your baby is born, your blood sugar will be checked to make sure it is normal. Fortunately, gestational diabetes almost always goes away after your baby is born. If your blood sugar does not return to normal, it may mean that you had diabetes before you became pregnant.
The most important thing to remember is to check your blood sugar before you become pregnant again. Women who had gestational diabetes have an increased risk of developing type 2 diabetes. Women with diabetes before they become pregnancy have an increased risk of pregnancy complications. Elevated maternal blood sugar during the first 12 weeks of pregnancy, when the major organ systems are developing, increases risks to the fetus. Women with diabetes can help improve their chances of having a healthy baby by normalizing their blood sugar before becoming pregnant.
For more information or to request an appointment with a registered dietitian, please contact the UCSF Nutrition Counseling Center at (415) 353-1461.
More Information:
This information is for educational purposes only and is not intended to replace the advice of your doctor or health care provider. We encourage you to discuss with your doctor any questions or concerns you may have.
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