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Pregnancy & Diabetes
Coping with Gestational Diabetes

If you are like most women, you will coast through pregnancy with no serious complications. Even if you're feeling great during this time, it is important to see your health-care provider on a regular basis. Complications can arise at any time but, the good news is that most problems, if detected early, can be treated effectively so that neither your health nor your baby's is harmed. One of the most common complications women encounter in pregnancy is gestational diabetes. Because most women with gestational diabetes have no obvious symptoms, your obstetrician will screen you for it around your sixth or seventh month, or between 24 to 28 weeks of gestation.

What is gestational diabetes?

Diabetes occurs when your body either makes inadequate amounts of insulin and/or is unable to respond to insulin's message. When there isn't enough insulin, or there is no response to insulin's message, then glucose cannot enter your cells and builds up in your blood. When diabetes occurs during the pregnancy, it is called gestational diabetes.

How does gestational diabetes occur?

The answer is not clear. As your baby grows it will take glucose from your body to help it grow. The placenta will make hormones to make your sugar higher so that you will have enough sugar for yourself. These hormones interfere with the body's ability to use its insulin, raising your blood-sugar levels. Gestational diabetes probably occurs because some women have an inherited predisposition to diabetes. They may not be able to make enough insulin to counteract the effects of the placental hormones.

Gestational diabetes affects approximately three million women. You may be at increased risk if you are over age 30, have had gestational diabetes in the past, have a family history of diabetes or gestational diabetes, or have previously given birth to a large baby (over 9 1/2 pounds). However, there are other women without these risk factors who get gestational diabetes and that is why your obstetrician must screen every pregnancy.

How is gestational diabetes diagnosed?

Your doctor will ask you to fast and then draw a glucose level one hour after drinking a glucose solution. If the blood sugar is less than 140 mg (milligram) / dl (deciliter), then it is unlikely that you have gestational diabetes. If the level is over 140 mg/dl, then you will need to take a similar but longer test to confirm the diagnosis.

Why is gestational diabetes important?

If your sugar level is not well controlled, complications may occur for both you and your baby. You may develop recurrent urinary tract infections. You may also be at a higher risk for pre-eclampsia, a serious disorder of high blood pressure due to pregnancy often requiring hospitalization.

In receiving a higher sugar load, your baby may grow to a large size. In this situation, there is an increased risk for delivery by c-section for failure to progress or an increased risk of injuring the baby's shoulder(s) or other birth trauma with a vaginal delivery.

How is gestational diabetes treated?

Luckily, gestational diabetes is very easily treated and you will probably be able to control your blood-sugar levels with diet and exercise. Often just modifying your diet, watching the amount and type of foods that you eat, and changing the timing of your meals will be enough to keep the blood glucose level in the normal range. You may be taught how to check your own blood sugars so that your doctor will know how you are doing throughout your pregnancy. You may also be referred to a dietician.

If these measures aren't enough to bring your glucose level down, insulin therapy will be required for the remainder of your pregnancy (self-administered twice-daily insulin injections). Insulin has been used for many years in pregnant patients and it is safe if properly monitored.

Usually patients find that insulin therapy is a lot easier than they thought it would be. The insulin syringe has a very small needle and many patients insist it is less painful than getting blood drawn.

Gestational diabetes affects 2-3% of pregnant women. Some women never have it again, some will have it with a second pregnancy, and some may eventually develop diabetes. The good news is that it is easily treated.

Kai H. Yang, MD is associated with Metabolism Associates, P.C. in New Haven. She and her partners, Jean G. Henry, MD & Barr Forman, MD often see patients with gestational diabetes in their practice. Note: This information should not be used as a substitute for the medical care and advice of your personal health care provider.

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