What is gestational diabetes and how is it treated?

Gestational diabetes is a condition in which a pregnant woman who has never had diabetes before has high blood sugar (glucose) levels during pregnancy.  Roughly 4% of pregnant women in the U.S. are affected by Gestational diabetes.

Studies have not conclusively shown the actual causes of Gestational diabetes.  We do know that it occurs when your body is not able to make and use all of the insulin it requires during pregnancy.  Hormones from the placenta that help the baby in development may block the action of the mother’s insulin in her body.  This is termed “insulin resistance” and it makes it harder for the mother’s body to use insulin.  Without enough insulin, glucose cannot leave the blood and be changed to energy. Glucose builds up in the blood to high levels. This is called hyperglycemia.

Babies of mothers who have diabetes prior to becoming pregnant may have a higher risk of birth defects than those who have gestational diabetes.  This is because gestational diabetes typically affects the mother in late pregnancy after the baby’s body has been formed and while the baby is busy growing.  Untreated or uncontrolled gestational diabetes can, however, present a risk to your baby.  While insulin does not cross the placenta, extra blood glucose will, causing the baby’s pancreas to make extra insulin to get rid of it.  Since the baby is getting all of this extra energy that it doesn’t need, it is stored as fat.  This can lead to macrosomia, or a "fat" baby. Babies with macrosomia face health problems of their own, including damage to their shoulders during birth. Because of the extra insulin made by the baby’s pancreas, newborns may have very low blood glucose levels at birth and are also at higher risk for breathing problems. Babies with excess insulin become children who are at risk for obesity and adults who are at risk for type 2 diabetes.

Treatment for gestational diabetes attempts to put blood glucose levels on par with those of pregnant women who don’t have gestational diabetes.  At a minimum, a good treatment plan will include physical activity and specific meal plans.  It may also include daily blood glucose testing and insulin injections. Your physician can put you on track with the specifics of dietary and exercise needs for your particular case.  Treatment for gestational diabetes helps lower the risk of a cesarean section birth that a baby with macromasia may require. Sticking with your treatment for gestational diabetes will give you a healthy pregnancy and birth, and may help your baby avoid future poor health.

Typically, gestational diabetes goes away after pregnancy.  However, once you’ve had gestational diabetes, your chances are 2 in 3 that it will return in future pregnancies.  In some women pregnancy uncovers type 1 or type 2 diabetes. It can be difficult to determine whether these women have gestational diabetes or have just started showing their diabetes during pregnancy.  Also, there seems to be a link between gestational diabetes and the tendency to develop type 2 diabetes in the years to come.

Your physician should monitor your glucose levels after your gestational pregnancy.  In addition, you can lessen toe risk factors of developing type 2 diabetes later by keeping within 20% of your ideal body weight, making healthy food choices and exercising regularly.

While gestational diabetes is a cause for concern, the prognosis for a woman with gestational diabetes is excellent.  With dietary, insulin and exercise changes, your physician should be able to help you maintain levels of insulin that are healthy for you and healthy for your baby.



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