Definition

During pregnancy, a woman's body alters the way it handles glucose. Glucose is a sugar that supplies energy and is the primary source of nutrition for the baby. Insulin, from the pancreas, regulates the glucose in your blood. During pregnancy, the placenta produces a hormone called Human Placental Lactogen. Human Placental Lactogen along with other factors unique to pregnancy, make it more difficult for insulin to keep blood sugars within normal limits. In some women, the condition of pregnancy exceeds the patient's ability to make enough insulin to maintain normal blood sugar levels. When this occurs, the mother is said to have gestational diabetes. Most women will have no symptoms and therefore will have trouble believing that they have gestational diabetes.

Glucose is the primary energy source and growth factor for fetuses. When your blood sugar is higher than normal, the chance of having a baby who is large is increased. A larger baby can contribute to a longer labor and/or more difficult deliveries for both mother and baby.

In addition, some babies experience hypoglycemia after birth. Hypoglycemia is a condition of low blood sugar. This can occur because the baby has become accustomed to producing larger amounts of insulin to handle the larger amounts of glucose received from the mother. When the supply of glucose from the mother is stopped suddenly at birth, the infants can then demonstrate hypoglycemia.

Hypoglycemia in the newborn can be a serious condition if it is unexpected and unrecognized. The closer the mother's blood sugar levels are to normal limits, the less potential for hypoglycemia and excessively large infants. Usually blood sugars can be controlled through diet; however, occasionally insulin is needed to control blood sugars for gestational diabetic patients.

Occasionally, as mentioned above, insulin is required to maintain normal blood sugar control. Insulin is safe to give during pregnancy. It does not cross the placenta.

Diagnosis

The standard of care in this country is for every patient to receive a one-hour glucola test at 28 weeks gestation. This test involves drinking a liquid with glucose one hour before having blood drawn.

If the blood glucose level is elevated as a result of the one-hour glucola test, the patient is then scheduled for a three-hour glucose tolerance test. After an overnight fast, the patient's blood is drawn for a fasting blood sugar level. The patient is then given another glucola solution to drink and the blood sugar is then drawn at three hourly intervals. This is the definitive test for screening for gestational diabetes.

Controlling Blood Sugar

The goal of treatment is to bring glucose levels within normal range. This can be achieved through diet, appropriate food choices, exercise, and occasionally through insulin. You must avoid peaks and valleys in sugar levels by eating small frequent meals, all including carbohydrates, protein and fats. Most of your calories should come from carbohydrates (starchy foods such as rice, breads, grains, dried beans, and vegetables). Fiber slows sugar absorption so fresh fruits are better than juices. Eliminate refined sugars (cakes, candy) and hidden sugars (honey, corn syrup, maple syrup).

Coping with Gestational Diabetes

It is okay to feel mad, sad, frustrated, exasperated, and resentful, or anything else for that matter. Find a way to cope with your emotions. Go for a walk, talk with a relative or friend or even have a good cry, but don't get pulled down by negative emotions. Consider this an opportunity to alter lifestyle habits for the better and to develop good eating and exercise habits for now and in the future. Your (and your baby's) health depends on it!

Fetal Surveillance

Close observation of fetal size and well being is important. Fetal movement counts (FMC's) are the easiest, most non-invasive method to monitor fetal well being. All expectant mothers begin FMC's around 32 weeks gestation. It becomes especially important for mothers with gestational diabetes to monitor fetal well being after 36 weeks gestation.

In the third trimester, formal testing with weekly or twice weekly NST's (non-stress tests) is initiated for women requiring insulin to control their blood sugars.

After the Birth

Samples of your baby's blood will be monitored after birth. It is important to nurse early and frequently to bring and keep the infant's blood sugar within normal limits. Glucose supplements may be necessary through either an oral feeding of glucose water or an IV depending on the infant's ability to nurse well and monitored glucose levels.

Gestational diabetes will usually disappear after the birth; however, it is likely to reappear with future pregnancies. It also can indicate a future risk of a woman developing diabetes when not pregnant. You will have a follow-up 2-hour Glucose Tolerance test if you required insulin during your pregnancy around 6-8 weeks postpartum. You should also ask your primary medical physician for future testing of blood sugars even if other pregnancies are not planned. It would be wise to continue your newly adapted diabetic diet to decrease your chances of adult onset diabetes later in life.