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Gestational Diabetes

During pregnancy, the placenta supplies a growing fetus with nutrients and water, as well as produces a variety of hormones to maintain the pregnancy. In early pregnancy, hormones can cause increased insulin secretion and decreased glucose produced by the liver, which can lead to hypoglycemia (low blood glucose levels). In later pregnancy, some of these hormones (estrogen, cortisol, and human placental lactogen) can have a blocking effect on insulin, a condition called insulin resistance.

As the placenta grows, more of these hormones are produced, and insulin resistance becomes greater. Normally, the pancreas is able to make additional insulin to overcome insulin resistance, but when the production of insulin is not enough to overcome the effect of the placental hormones, gestational diabetes results or there may be worsening of pre-existing diabetes.

What Causes Diabetes During Pregnancy?

Glucose, a sugar that results from the digestion of food, is the body's main nourishment. During pregnancy, your body also supplies your baby with glucose, which is delivered through the placenta and is your baby's only source of nourishment.

The placenta also makes certain hormones to help the baby develop. But these hormones make it harder for your body to use insulin. About halfway through pregnancy, the placenta increases its production of these anti-insulin hormones.

If your body makes too many anti-insulin hormones, they can block the movement of glucose from your bloodstream into your cells. This is called insulin resistance. At the same time, your pancreas may not be able to produce enough insulin. When too much glucose builds up in your bloodstream, diabetes can result.

Who Is At Risk?

Several factors increase your chances of developing diabetes during pregnancy. These include:

  • A family history of diabetes

  • Previously giving birth to a stillborn baby or to a baby weighing more than nine pounds

  • Obesity

  • Being over age 25

  • Being African-American, Native-American or Hispanic

How Does Diabetes Affect Pregnancy?

In women with gestational diabetes and type 2 diabetes, the sugar (glucose) in your blood directly affects the size of your baby. If your blood sugar level is high, the baby gets too much nourishment and overgrows. This can lead to a condition called macrosomia or "fat" baby. Macrosomia causes problems for both you and your baby.

What Are The Risks To The Baby?

Babies who get too much sugar (glucose) from their mother's blood accumulate fat around the shoulders and trunk. That can make them too difficult to delivery vaginally. Your doctor may recommend delivering the baby early.

Other risks associated with gestational diabetes and type 2 diabetes include:

  • Damage to the baby's shoulders during delivery

  • Low blood sugar in the baby at birth

  • Higher risk for obesity and type 2 diabetes later in life for the baby

  •  Jaundice (a yellowish discoloration of the skin) two to three days after birth

Risks associated with type 1 diabetes include:

  • Low blood sugar at birth

  • Breathing problems at birth

  • Jaundice two to three days after birth

  • Increased chance of major birth defects

What Are The Risks To The Mother?

Risks associated with gestational and type 2 diabetes include:

  • Possible need for cesarean delivery

  • Pregnancy-related high blood pressure and swelling of the hands and feet

  • Urinary tract infections

  • An increased chance of developing diabetes later in life or in a subsequent pregnancy

Risks associated with type 1 diabetes include:

  • Premature labor and delivery

  • Possible need for cesarean delivery

  • Pregnancy-related high blood pressure and swelling of the hands and feet

  • Urinary tract infections

  • Buildup of ketones (harmful acids) in the blood

  • Possible worsening of eye disease

  • Possible (reversible) progression of kidney disease

How Can I Avoid Complications?

Problems associated with diabetes in pregnancy are manageable and preventable. The key to prevention is careful control of your blood sugar as soon as gestational diabetes is diagnosed.

  • Women with pre-existing diabetes should get their blood sugar under control three to six months before conception, to lessen the risk of birth defects.

  • Gestational diabetes, which starts later in pregnancy, does not cause birth defects.

Will My Baby Be Healthy?

During pregnancy, several tests will be done to make sure your baby is developing properly and to help predict the time of delivery.

  • Ultrasound - This test involves passing a special wand over the skin of the abdomen. Sound waves are transmitted into the body and bounce back, creating an image that shows the growth and development of the baby.

  • Alpha-fetoprotein test - This is a blood test that detects a particular protein produced by the baby's liver. Abnormal levels of alpha-fetoprotein (AFP) indicate a high risk for certain types of birth defects.

  • Amniocentesis - In this test, a long thin needle is inserted into the abdomen and a sample of amniotic fluid (the fluid that surrounds the baby within the uterus) is taken. Cells in the fluid help doctors determine if the baby's lungs are mature enough to withstand early delivery.

  • Non-stress test - A fetal monitor, strapped to the mother's abdomen, records the baby's heart rate for a short period of time. This reading helps doctors assess the health of the baby in the last weeks of pregnancy.

  • Fetal monitoring - During labor and delivery, a fetal monitor keeps constant track of the baby's heart rate in order to detect the first indications of distress.

Screening and Diagnosis

Screening for gestational diabetes is a routine part of prenatal care. Most health care providers recommend a blood test known as a glucose challenge test between 24 and 28 weeks of pregnancy or earlier if you're at particularly high risk of gestational diabetes.

You'll begin the glucose challenge test by drinking a syrupy glucose solution. One hour later, you'll have a blood test to measure your blood sugar level. A blood sugar level below 130 to 140 milligrams per deciliter (mg/dL) is usually considered normal on a glucose challenge test, although this may vary at specific clinics or labs. If your blood

Sugar level is higher than your clinic's threshold; you'll likely need a second test to confirm the diagnosis.

For the follow-up test, you'll be asked to fast overnight. Then you'll drink another sweet solution this one containing a higher concentration of glucose and your blood sugar level will be checked every hour for a period of three hours. If at least two of the blood sugar readings are higher than normal, you'll be diagnosed with gestational diabetes.

If you're age 25 or younger and have no risk factors for gestational diabetes, there's some debate about whether gestational diabetes screening is needed. Some health care providers argue that younger women don't need the test. Others say that screening all pregnant women no matter their age is the best way to catch all cases of gestational diabetes.

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