Gestational Diabetes
Introduction
Gestational diabetes is a type of diabetes that occurs only during pregnancy. Like other forms of diabetes, gestational diabetes affects the way your body uses blood sugar (glucose) — your body's main source of fuel. As a result, your blood sugar level is too high.
If untreated or uncontrolled, gestational diabetes can result in a variety of health problems for you and your baby.
If you have gestational diabetes, you and your doctor will devise a plan to keep your blood sugar levels within a normal range. The good news is that controlling your blood sugar can help ensure a healthy pregnancy for you and a healthy start for your baby.
Signs and symptoms
Most women don't experience any signs or symptoms of gestational diabetes. When they do occur, signs and symptoms may include:
- Excessive thirst
- Increased urination
During digestion, your body breaks carbohydrates into simple sugar molecules that it can eventually use for energy. One of these sugar molecules is glucose, the main energy source for your body. Glucose is absorbed directly into your bloodstream after you eat, but it can't enter your cells without the help of insulin.
Your pancreas — a gland located just behind your stomach — produces insulin continuously. The insulin "escorts" sugar into your cells, providing your body with energy while maintaining a normal level of sugar in your blood.
Your liver also plays a key role in maintaining a normal blood sugar level. If you have more glucose than your cells need for energy, your body can remove that excess from your bloodstream and store it in your liver as glycogen. Then, when you run low on glucose — for example, if you haven't eaten for a while — your body can tap into that stored glucose and release it into your bloodstream.
The amount of glucose in your blood fluctuates in response to a number of factors, including the food you eat, exercise, stress and infections. Yet the complex relationship among insulin, glucose and your liver ensures that your blood sugar stays within set limits.
During pregnancy, your placenta — the organ that supplies your baby with nutrients through the umbilical cord — produces hormones that prevent insulin from doing its job. These hormones, which include estrogen, cortisol and human placental lactogen, are vital to preserving your pregnancy. Yet they also make your cells more resistant to insulin.
As your placenta grows larger in the second and third trimesters, it secretes even more of these hormones, further increasing insulin resistance. Normally, your pancreas responds by producing enough extra insulin to overcome this resistance. But you may need up to three times as much insulin as normal, and sometimes your pancreas simply can't keep up. When this happens, too little glucose gets into your cells and too much stays in your blood. This is gestational diabetes. It usually occurs about the 20th to 24th week of pregnancy and can be measured by the 24th to 28th week of pregnancy. After your baby is born and placental hormones disappear from your bloodstream, your blood sugar levels should quickly return to normal.
Treatment
Controlling your blood sugar is essential to keeping your baby healthy and avoiding complications during delivery. Most women with gestational diabetes are able to control their blood sugar with diet and exercise, but some may need medication in addition to lifestyle changes. In either case, monitoring your blood sugar is a key part of your treatment program because it tells you whether your blood sugar is staying within a normal range.
The most recent data support aggressively treating all pregnant women with gestational diabetes. Evidence favoring aggressive treatment comes from the same 2005 study that proved the benefit of screening all pregnant women for gestational diabetes. Researchers compared pregnancy outcomes in two groups of women with gestational diabetes. One group received aggressive treatment — dietary advice, frequent blood glucose monitoring and insulin injections for elevated blood glucose levels. Another goal of aggressive treatment was to maintain tight control of blood glucose. The blood glucose goals for this group were 63 to 99 milligrams of glucose per deciliter (mg/dL) for fasting blood sugar and 126 mg/dL or lower two hours after meals. The other group received routine care, which may or may not have included insulin.
The women who received aggressive treatment and maintained tighter glucose control developed significantly fewer childbirth problems than did the women who had routine care. Aggressive treatment was particularly effective in reducing the types of problems caused by having unusually large babies, as women with high blood glucose during pregnancy often do.
In addition, the group that received aggressive treatment reported lower rates of depression and scored higher on health-related quality of life three months after giving birth than did the group receiving routine care. It isn't clear, however, why these particular benefits occurred.
Monitoring your blood sugar
If you've just learned that you have diabetes, monitoring your blood sugar may sound inconvenient and difficult. But once you learn how it's done, you'll likely grow more comfortable with the procedure.
To test your blood sugar, you draw a drop of blood from your finger using a small needle (lancet), then place the blood on a test strip inserted into a blood glucose meter — a small, computerized device that measures and displays your blood sugar level.
Your blood sugar fluctuates throughout the day. What and how much you eat and even the time of day also can have an effect. For that reason, your doctor may ask you to check your blood sugar four to five times a day. Your goal is to make sure you're keeping your blood sugar levels within a healthy range.
Your doctor will also monitor your blood sugar during labor. If your blood sugar levels rise, your baby's blood sugar will rise, too. This can cause your baby to have high levels of insulin, which may lead to low blood sugar right after birth.
Eating a healthy diet
A healthy diet is important for every pregnant woman, but it's even more important if you have gestational diabetes. Eating the right kind and amount of food is one of the best ways to control your blood sugar levels.
In general, you'll need more fruits, vegetables and whole grains — foods that are high in nutrition and low in fat and calories — and fewer animal products and sweets. Even so, no one diet is right for every woman. If you have gestational diabetes, work with a registered dietitian or counselor who can help you put together an individual meal plan based on your blood sugar level, height, weight, exercise habits and food preferences.
Getting regular exercise
In general, the more active you are, the lower your blood sugar. Physical activity causes sugar to be transported to your cells where it's used for energy, lowering the levels in your blood. Exercise also reduces blood sugar by increasing your sensitivity to insulin: Your body requires less insulin to transport glucose into your cells.
In addition, regular exercise can help prevent some of the discomforts of pregnancy, such as back pain, muscle cramps, swelling, constipation and difficulty sleeping. It can also help prepare you for labor and delivery. The increased muscle strength and endurance you develop reduce stress on your ligaments and joints during delivery, help you during labor, and shorten your recovery time.
Your doctor will discuss exercise as a part of the treatment for gestational diabetes. Once you understand the ground rules, take some time to think about which activities you enjoy. Walking, cycling and swimming are good ways to get a safe aerobic workout. Ordinary activities such as housework and gardening also can lower your blood sugar.
Aim for moderate aerobic exercise on most days. If you haven't been active for a while, start slowly and build up gradually. For best results, combine aerobic activity with stretching and strength-training exercises. Exercising at the same time every day, varying your fitness routine and working out with other pregnant women can help you stay motivated.
Taking medications
Sometimes diet and exercise may not be enough. In that case, you may need to take daily medication to help lower your blood sugar to safe levels.
Until recently, insulin was the only option for women with gestational diabetes because it doesn't cross the placental barrier. But the oral anti-diabetes drug, glyburide, also may be safe and effective in controlling blood sugar in gestational diabetes. Doctors in Europe use metformin to treat gestational diabetes, and this medication is being studied in the United States.
Monitoring your baby
Your obstetrician will likely recommend close monitoring of your baby's growth — usually using ultrasound. This test combines high-frequency sound waves and computer processing to generate pictures of the inside of your uterus. Although ultrasound can give a good idea of your baby's size, it tends to be less accurate as your baby gets bigger.
If you need medications to control your gestational diabetes, your obstetrician may also recommend a nonstress test (NST) or biophysical profile to make sure your baby is getting enough oxygen and nourishment, especially as you approach your due date. A nonstress test is just that — a noninvasive test that causes no stress to your baby. In fact, it shouldn't be stressful for you either. NST usually takes less than 30 minutes and requires no hospitalization. It's a simple procedure that checks how often your baby moves and how much his or her heart rate increases with movement. A biophysical profile combines an ultrasound with NST to provide more information about your baby's breathing, tone, movement and the volume of amniotic fluid in your uterus.
In most cases, your doctor will try to prevent your pregnancy from going longer than 40 weeks because being overdue may increase the risk of complications. Although most women with gestational diabetes deliver happy, healthy babies, labor with gestational diabetes isn't routine, and Caesarean delivery is necessary in some cases. However, gestational diabetes doesn't affect your ability to breast-feed or care for your new baby.
Informations obtained from National Institute of Health.