Gestational Diabetes
By Sarah Henry
A few lucky women get through pregnancy without ever noticing any changes in the way their bodies process food. But some women who never had diabetes before becoming pregnant develop a condition called gestational diabetes. When you have this condition, high amounts of sugar circulate in your blood. You may feel unusually tired and thirsty, or notice a frequent need to urinate. If your blood sugar level gets very high, your vision may become blurry. However, some women have no symptoms at all.
Left untreated, high sugar levels can pose health problems for you and your developing baby. Fortunately, it's a condition that can be treated easily with diet and exercise, or medication, and it usually goes away after the baby is born.
What's my risk for gestational diabetes?
Only three to eight out of every 100 pregnant women get gestational diabetes, but your risk increases with age. The condition is more common among women who become pregnant after age 25. It's also more likely to affect women who are obese or overweight, have high blood pressure, or a family history of diabetes. Women who had gestational diabetes with a previous pregnancy, who gave birth to a very large baby (heavier than 9 pounds), or who had a stillborn baby are also at higher risk.
In addition, women of Hispanic, African American,Native American,South or East Asian,Pacific Islander, or Indigenous Australian descent are more likely to have the condition.
How do I know if I have the disease?
You can have gestational diabetes even if you have no symptoms and aren't at risk for getting the condition. But you may notice some symptoms before then, including unusual thirst, the need to urinate frequently, fatigue, nausea, blurred vision, and frequent bladder, vagina, or skin infections.
Many health-care practitioners recommend that women get their blood screened for high levels of glucose, usually around the 24th week of pregnancy. Called a Screening Glucose Challenge Test, the test involves drinking a sugary solution, then having blood drawn and tested for the levels of sugar that remain in the blood.
A normal reading should be less than 140 milligrams per deciliter and means you probably don't have gestational diabetes. If it's over 200 mg/dl, you probably do have gestational diabetes, and your doctor will work closely with you on your diet and exercise and possibly prescribe insulin if needed to control your glucose. If your glucose level is more than140 mg/dl, but less than 200mg/dl, the diagnosis is a little less clear. In that case, your doctor will usually ask you to take another test called a glucose tolerance test (GTT).
How can gestational diabetes affect a pregnancy?
Chronically high blood sugar levels can increase your chance of having a baby that's too large for a vaginal delivery, meaning that you could have a difficult delivery or require a cesarean section.
Uncontrolled gestational diabetes also puts you at greater risk for a disorder called preeclampsia, or high blood pressure during pregnancy. This can cause problems for both you and your baby. Your baby may need to be delivered early, or you may be confined to bed rest, either at home or in a hospital, for the last few weeks or months of pregnancy. In severe cases, preeclampisa can lead to seizures.
Gestational diabetes also puts you at higher risk for a condition called polyhydramnios, in which there is too much amniotic fluid around the fetus. Polyhydramnios can cause the amniotic sac to break or lead to preterm labor.
If you have gestational diabetes, you're also more likely to get urinary tract infections. You may not have any symptoms of a UTI, and an untreated infection can spread from your bladder to your kidneys and harm both you and your growing child.
What can I do to manage gestational diabetes?
A healthy diet and regular exercise can go a long way to managing your blood sugar levels. Your doctor may recommend a visit to a registered dietitian or diabetes educator to talk about a planning a diet that controls blood sugar and meets the needs of a growing baby. For most women, this means planning small meals and snacks that incorporate whole grains, vegetables, fruits, and protein.
If you don't exercise already, talk with your health-care provider about how much and what types of activities are right for you.
Your doctor or diabetes educator may suggest you check your blood sugar levels at home with a glucose monitor before eating and two hours afterward. A normal plasma blood sugar level in the morning before eating for a pregnant woman is typically no higher than 105 mg/dl; 155 mg/dl or less one hour after a meal, and 130 mg/dl or lower two hours after eating.
If dietary changes and exercise aren't enough to keep your glucose levels in check, then you may need insulin. Your doctor will discuss this option with you, if necessary. It’s considered safe to take insulin during pregnancy as long as you carefully monitor your glucose levels for harmful highs and lows.
Although you'll probably need to pay close attention to your health, there's no cause for alarm. In most cases, women with gestational diabetes deliver healthy babies and go into labor on their own at the right time. However, if you haven't gone into labor at 40 weeks, many doctors will recommend inducing labor.
Can the disorder harm my newborn?
If you have gestational diabetes it doesn't mean your child will have diabetes. But your baby may need special attention after birth to make sure he doesn't have breathing difficulties, jaundice, low blood sugar levels, a calcium and magnesium deficiency, or too many red blood cells. In most cases, these problems are minor and can be treated.
What happens after I give birth?
Blood sugar levels usually return to normal following the birth of your baby. Your doctor will order another round of blood tests to check your sugar levels after the birth and one or two months later to make sure the condition has disappeared completely.
Even if you get a clean bill of health after delivery, you may get gestational diabetes again in a subsequent pregnancy and are more likely to develop type 2 diabetes when you're older. Most clinicians recommend getting a fasting blood sugar test about six to 12 weeks after your baby is born to make sure that your blood sugar is still normal, and periodically thereafter.
Fortunately, there are things you can do to ward off diabetes, during pregnancy and after. By eating a nutritious diet and exercising regularly, you'll be doing yourself a favor that will benefit your baby as well.
-- Sarah Henry is a freelance writer whose health and parenting stories have appeared in The Washington Post, the Los Angeles Times Magazine, Health, Hippocrates, and Parenting. She has also written for WebMD, BabyCenter and ParentCenter.
