Gestational Diabetes

Gestational Diabetes

Pregnancy related diabetes or gestational diabetes can occur in pregnant women. Gestational diabetes is often associated with high glucose blood levels or hyperglycemia. Gestational diabetes affects about four percent of all pregnant women. The disease usually goes away after delivery, but women who suffer from gestational diabetes are at a higher risk for developing diabetes later in life.

How is it diagnosed?
Your blood sugar will be evaluated during glucose screening and tolerance tests.

This is a type of diabetes that some women develop during pregnancy. Between 2 and 7 percent of expectant mothers develop this condition, making it one of the most common health problems of pregnancy.

When you eat, your digestive system breaks most of your food down into a type of sugar called glucose. The glucose enters your bloodstream and then — with the help of insulin, a hormone made by your pancreas — provides fuel for the cells of your body. Like the type 1 and type 2 diabetes you can get when you're not pregnant, gestational diabetes causes the glucose to stay in your blood instead of moving into your cells and getting converted to energy. Why does this sometimes happen when you're pregnant?

During pregnancy, your hormones make it tougher for your body to use insulin, so your pancreas needs to produce more of it. For most moms-to be, this isn't a problem: As your need for insulin increases, your pancreas dutifully secretes more of it. But when a woman's pancreas can't keep up with the insulin demand and her blood glucose levels get too high, the result is gestational diabetes.

Most women with gestational diabetes don't remain diabetic once the baby is born. Once you've had it, though, you're at higher risk for getting it again during a future pregnancy and for becoming diabetic later in life.

How does having gestational diabetes affect my pregnancy?
These days, most women who develop diabetes during pregnancy go on to have healthy babies. Your doctor should monitor you closely and you'll most likely be able to keep your blood sugar levels under control with diet and exercise, and by getting insulin shots if you need them. But poorly controlled diabetes can have serious consequences for you and your baby.

For most women with gestational diabetes, the main worry is that too much glucose will end up in the baby's blood. When that happens, your baby's pancreas needs to produce more insulin to process the extra glucose. All this excess blood sugar and insulin can cause your baby to make more fat and put on extra weight, particularly in the upper body.

This can lead to what's called macrosomia. A macrosomic baby may be too large to enter the birth canal. Or the baby's head may enter the canal but then his shoulders get stuck. In this situation, called shoulder dystocia, your practitioner and her assistants will have to use special maneuvers to deliver your baby. Delivery can sometimes result in a fractured bone or nerve damage, both of which heal without permanent problems in nearly 99 percent of babies. (In very rare cases, the baby may suffer brain damage from lack of oxygen during this process.) What's more, the maneuvers needed to deliver a broad-shouldered baby can lead to injuries to the vaginal area or require a large episiotomy for you.

Because of these risks, if your practitioner suspects that your baby may be overly large, she may recommend delivering by cesarean section. Fortunately, only a minority of women with well-controlled gestational diabetes end up with overly large babies.

Shortly after delivery, your baby may also have low blood sugar (hypoglycemia) because his body will still be producing extra insulin in response to receiving extra glucose from you. Your delivery team will test his blood sugar at birth by taking a drop of blood from his heel. If it's low, you'll want to feed him as soon as possible, either by breastfeeding or giving him some formula or sugar water. (In severe cases of hypoglycemia, he might be given an IV glucose solution.)

He may also be at somewhat higher risk for jaundice, polycythemia (an increase in the number of red cells in the blood), and hypocalcemia (low calcium in the blood). If your blood sugar control is especially poor, your baby's heart function could be affected. Some studies have found a link between severe gestational diabetes and an increased risk for stillbirth in the last two months of pregnancy. And finally, having gestational diabetes makes you about twice as likely to develop preeclampsia as other pregnant women.

Gestational diabetes risk of having it again in the future
About two-thirds of women who have the condition will go on to have it in future pregnancies. And a few studies have found that about 50 percent of women who get gestational diabetes will develop type 2 diabetes within the first five years after delivery. Your risk is highest if any of the following apply to you:

• You're obese.

• You had very high blood sugar levels during pregnancy (especially if you needed insulin).

• Your diabetes was diagnosed early in your pregnancy.

• The results of your postpartum glucose test were borderline (that is, they were relatively high, but not high enough to classify you as a diabetic).