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Gestational
Diabetes: Diagnosed in women during late stages of pregnancy
Some women develop
gestational diabetes during the late stages of pregnancy. Although this form of
diabetes usually goes away after the baby is born, a woman who has had it is
more likely to develop type 2 diabetes later in life, while the baby is more
likely to develop obesity and impaired glucose tolerance and/or diabetes later
in life. Unlike type 1 diabetes, gestational diabetes was not caused by a lack
of insulin, but by blocking effects of other hormones on the insulin that are
produced, a condition referred to as insulin resistance.
The hormones of
pregnancy or carbohydrate intolerance cause gestational diabetes; it is diagnose
during pregnancy through an oral glucose tolerance test. Between 6 and 9 percent of
pregnant women, develop gestational diabetes. The placenta supplies a growing
fetus with nutrients and water, as well as produces a variety of hormones to
maintain the pregnancy. Some of these hormones (estrogen, cortisol, and human
placental lactogen) can have a blocking effect on insulin. This is call
contra-insulin effect, which usually begins about 20 to 24 weeks into the
pregnancy. Self-care and dietary changes are essential in treatment.
Risk Factors
Any woman can develop gestational diabetes during pregnancy, some
of the factors that may increase the risk include the following:
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Obesity.
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Family history of diabetes.
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Having give birth previously to a very large infant, a still
birth, or a child with a birth defect.
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Having too much amniotic fluid (polyhydramnios).
-
Age Factor - women who are older than 35 are at a greater
risk for developing gestational diabetes than younger women.
However, increased glucose in the
urine is often included in the list of risk factors; it is not to believe to be
a reliable indicator for gestational diabetes.
Complication
Unlike type 1 diabetes, gestational diabetes generally does not cause birth
defects. Birth defects usually originate sometime during the first trimester
(before the 13th week) of pregnancy. But, the insulin resistance from the
contra-insulin hormones produced by the placenta does not usually occur until
approximately the 24th week. Women with gestational diabetes generally have
normal blood sugar levels during the critical first trimester.
The complications of gestational diabetes are usually manageable and
preventable. The key to prevention is careful control of blood sugar levels
just as soon as the diagnosis of gestational diabetes is made.
Infants of mothers with gestational diabetes are vulnerable to several
chemical imbalances, such as low serum calcium and low serum magnesium levels,
but, in general, there are two major problems of gestational diabetes:
macrosomia and hypoglycemia.
-
Macrosomia
Macrosomia refers to a baby that is considerably larger than normal. All of
the nutrients the fetus receives come directly from the mother's blood. If
the maternal blood has too much glucose, the pancreas of the fetus senses
the high glucose levels and produces more insulin in an attempt to use this
glucose. The fetus converts the extra glucose to fat. Even when the mother
has gestational diabetes, the fetus is able to produce all the insulin it
needs. The combination of high blood glucose levels from the mother and high
insulin levels in the fetus results in large deposits of fat which causes
the fetus to grow excessively large.
-
Hypoglycemia
Hypoglycemia refers to low blood sugar in the baby immediately after
delivery. This problem occurs if the mother's blood sugar levels have been
consistently high, causing the fetus to have a high level of insulin in its
circulation. After delivery, the baby continues to have a high insulin
level, but it no longer has the high level of sugar from its mother,
resulting in the newborn's blood sugar level becoming very low. The baby's
blood sugar level is checked after birth, and if the level is too low, it
may be necessary to give the baby glucose intravenously.
Treatment
Specific treatment for gestational diabetes will be determined by your
physician based on:
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your age, overall health, and medical history
-
extent of the disease
-
your tolerance for specific medications, procedures, or therapies
-
expectations for the course of the
disease
-
your opinion or preference
Treatment for gestational diabetes focuses on keeping blood glucose levels
in the normal range. Treatment may include:
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