gestational diabetes

I chose this topic today because a woman I care a great deal about has recently learned that she has gestational diabetes.

So what is that and what does it mean?
Diabetes is defined as having a blood sugar level over 130 if fasting and 180 if after a meal. When blood sugar levels run high after one becomes pregnant but not before, then it is gestational diabetes. (there are some instances of gestational diabetes however, that fall into the category of previous diabetes that was undiagnosed). There are not always symptoms, but increased thirst, light headedness and frequent urination are a few. A blood glucose test is usually performed during pregnancy.
Gestational diabetes can cause problems and it is important to get blood sugar levels under control and to treat the condition with the utmost respect. Gestational Diabetes affects about 4% of pregnant women. It usually occurs and is diagnosed between the second and third trimester. Though only around 30% of women with gestational diabetes develop diabetes beyond pregnancy, there is a 60% chance that this will occur for each woman who has gestational diabetes. There is also increased risk of the infant becoming obese and also developing type 2 diabetes. What this really tells us is that the recommendations to maintain a healthy weight, to eat frequent, consistent, small meals and to exercise are universal and paramount.

Women who are diagnosed with this condition, often because of screening during their sixth month, must control their blood sugars. When diagnosed, the mother should receive a referral to a certified diabetes educator who will assist in meal planning. How one eats can do a lot to prevent blood sugar spikes and thus less need for insulin to be secreted. Exercise can also reduce blood sugar, however, there may be a need for exogenous insulin and if so, special education on how to use the medicine is needed as well. No other diabetes medication is considered safe during pregnancy.

Insulin and exercise are both known to lower blood sugar levels. Pregnant women should not start new vigorous exercise, but are usually able to continue with the same physical activity level they had before they become pregnant, unless of course they were sedentary. Walking is usually considered a safe activity. All women who are pregnant and especially those with these risks, should maintain regular prenatal care and get direction from their provider on what exercise is best and how often it should be done.

With regard to controlling blood sugar through nutrition; frequent, small meals are suggested. Complex carbohydrates, whole grains, fruits and vegetables as well as lean proteins are recommended. It is also noted that saturated fat, fried and greasy foods should be avoided. Pregnant women are also encouraged to consume 20+ grams of fiber each day, and to drink plenty of water.

As you can see, these suggestions are pretty much the same as those for the general population. These guidelines can reduce weight gain and prevent chronic disease. Women with gestational diabetes are also encouraged to monitor their weights. I cannot emphasize enough that this is not a disease to tackle on your own. The baby and the mother are at risk for problems - birth problems, growth problems and still birth. The risk is greatest if the diabetes is not controlled. This is different than being diagnosed with DM2 and twenty years later having a heart attack from it - the adverse outcome can happen within months if the condition is not taken seriously.

Risk factors and etiology:
There are some risk factors, but please note, many cases of gestational diabetes are in women who did not have the named risk factors. If you are curious, they include - being overweight prior to pregnancy, being over age 25, having had gestational diabetes during a previous pregnancy, having a family history of diabetes, and being a person of color.
The disease develops (etiology) during the course of a normal pregnancy phenomena. When pregnant, the placenta itself makes hormones. The hormones have many effects but one is to reduce the impact of the mothers insulin on her blood sugar level. The idea is to increase nutrient flow from the mom to the baby and in so doing the mom might be at risk for low blood sugar, so the body is trying to prevent that outcome by interfering with natural insulin response. However, sometimes that back fires and the mothers blood sugar is too high. Usually the mother will begin to produce extra insulin (from the pancreas) to account for this change, but in gestational diabetes this extra insulin does not move the blood sugar out of the blood stream. The infant's pancreas is also working so that when the infant has too much blood glucose, it will release insulin. The glucose passes through to the baby but the mom's insulin doesn't. Glucose or blood sugar that cannot be used is stored as fat. The baby is at risk for a condition in which it has too much fat (macrosomia) at birth and it will continue to be at risk for obesity and diabetes after birth.

All this being said, controlling the blood sugar of the mother, through smart eating and exercise can prevent these adverse outcomes. A woman with this condition should take advantage of any and all resources made available to them by their OBGYN. To control the blood sugar, testing is required. Certified Diabetes Educators, both nurses and dietitians can educate on how to test blood sugar and use insulin if needed. Blood testing cannot be avoided. The baby may also undergo fetal monitoring, ultrasound and other tests as the pregnancy progresses. At birth the baby will undergo some testing to make sure his or her blood sugars are normal. Again, the baby will be at risk for obesity which is a big factor in diabetes - parents should provide the child with the same healthful diet the mother was encouraged to consume. After birth, the mother will also be tested for some time to see if her blood sugar and insulin response returns to normal. It should because the placenta is no longer there to cause hormone challenges, but again about one third of women will develop diabetes, or may have had undiagnosed diabetes prior to pregnancy.

If you have this condition you should read more, as the links below were my resources. Start here: http://www.cdc.gov/ncbddd/bd/diabetespregnancyfaqs.htm#willmybaby
and here:
http://www.diabetes.org/diabetes-basics/gestational/what-is-gestational-diabetes.html
and here:
http://www.webmd.com/baby/tc/gestational-diabetes-topic-overview