Approximately 22 million adults in the United States have a diagnosis of diabetes mellitus, a disease that affects the way that the body processes glucose, which is generally obtained from the diet.
Glucose is the main source of energy for cells within the body. The pancreas makes the hormone insulin, which helps glucose enter the cells so it can be used efficiently. In gestational diabetes, there is either a problem with the body’s production of insulin or the cells’ acceptance of the hormone, which leads to an increase in the amount of glucose in the bloodstream. If the disease is not recognized and treated, it can affect almost every organ system.
During pregnancy, the placenta releases hormones that may make it harder for some women’s bodies to use insulin. This increase in insulin resistance is what causes gestational diabetes, or diabetes of pregnancy.
Even if you have never had a problem with diabetes prior to getting pregnant, it is possible that you could be affected with gestational diabetes. The following risk factors would make this diagnosis more likely.
• A strong family history of diabetes.
• A history of diabetes in previous pregnancies or having had a baby weighing more than nine pounds.
• Multiple gestation (twins, triplets, etc).
• Hispanic American, African American, Native American, South or East Asian or Pacific Islander ethnicity.
• Increasing maternal age.
Depending on your risk factors, your healthcare provider may recommend screening for diabetes early in pregnancy. If you have a positive screening test in the first or early second trimester, the diagnosis of pre-existing diabetes (before pregnancy) is more likely, as the placenta does not tend to affect insulin resistance significantly until after 20 weeks.
Because many studies have shown that gestational diabetes can develop in women should be screened between 24 and 28 weeks’ gestation. Typically, this screening test involves drinking a beverage with a consistent glucose content and then measuring the blood sugar at a prescribed time afterwards. If the results of this test are abnormal, some women will go on to have another diagnostic test, while others will be given the diagnosis of diabetes based only on this result.
If you are diagnosed with gestational diabetes, your first step is usually meeting with your healthcare provider to discuss the potential impact of diabetes on your pregnancy.
Unfortunately, having gestational diabetes can increase the risks of other complications during pregnancy. These problems include:
• The development of high blood pressure or pre-eclampsia.
• Your baby gaining more weight than is healthy, which can lead to complications at delivery and even an increased risk for childhood obesity and diabetes.
• Other adverse outcomes for your baby, including stillbirth.
Fortunately, most of these risks appear to be related to control of blood sugar. Hence, good control can mean that women with diabetes can still have healthy pregnancies. At the time of diagnosis, all women should receive nutrition counseling and instruction on how to have a diabetic diet, which is basically a healthy balanced diet consisting of less fat and simple sugars and more fruits, vegetables and whole grains.
Women with gestational diabetes will be taught how to use a blood sugar monitor called a glucometer, and will check their blood glucose levels using a small drop of blood from pricking a finger at least four times a day. Many pregnant women are able to control their diabetes with diet alone, but if changes in diet are not sufficient to meet the glucose goals, sometimes oral medications or subcutaneous injections of insulin may be necessary.
Depending on how the diabetes is controlled, your provider will make recommendations about special testing to monitor your baby’s well-being and the timing of delivery. The benefits of delivery before the due date or spontaneous labor may outweigh the risks for gestational diabetes.
If you are diagnosed with diabetes during pregnancy, you should undergo testing within a few months of delivery to ensure that you no longer have any problems with insulin resistance. While most women do not require ongoing treatment after delivery, the risk of developing diabetes later in life is almost double for gestational diabetics. It is important that your provider is aware of this complication and performs regular screening for diabetes in the future.
Lynsey Caldwell Owen, MD, FACOG, is an obstetrician/gynecologist at Arlington Women’s Center and Virginia Hospital Center in Arlington, VA.