Gestational Diabetes
| Author: Judy Kohn, RN, BSN, CDE |
| Last Updated: Thursday, November 15, 2007 |
Q: "I was recently diagnosed with gestational diabetes. I am following the prescribed diet and have not seen my numbers get close to the maximum that my doctor told me was acceptable. I would like to know how serious this condition can be in the future, once I deliver my baby. I have no desire to have diabetes for the rest of my life. Would you suggest following the diet even after the baby is born, to reduce my chances? I entered the pregnancy overweight, and this has given me a huge incentive to lose the weight once the baby is born."
A: Gestational Diabetes is "temporary" diabetes that occurs in about 3 to 8 percent of pregnant women. The risk factors for gestational diabetes are being older when pregnant, being of Hispanic, African American, Native American, or Pacific Islander ancestry, being overweight, having had gestational diabetes in a previous pregnancy, having a previous baby weighing over 9 pounds, an unexplained death in a previous fetus or newborn, a congenital malformation (birth defect) in a previous child, and recurrent infections.
During pregnancy, the placenta (which is the organ that nourishes the baby) produces several hormones; these hormones are important to the baby's growth, but they also affect the action of insulin, causing insulin resistance. All pregnant women have some degree of insulin resistance, and during pregnancy, all women have to produce at least twice as much insulin to overcome this resistance. Some women aren't able to produce this extra insulin, and thus they can develop gestational diabetes.
Gestational diabetes usually occurs around the 24th week of pregnancy, when the placenta begins producing the larger quantities of hormones that cause insulin resistance. That is why all pregnant women are screened at this time.
Treatment
Gestational diabetes is treated with diet and exercise to keep the glucose within strict parameters. If diet and exercise cannot accomplish these goals, some women are treated temporarily with insulin, until the baby is delivered. Needless to say, all women with gestational diabetes must test their blood glucose, usually several times a day, before meals, and either one or two hours after meals.
- Glucose goals are "tighter" during pregnancy, as defined by the American Diabetes Association Clinical Practice Recommendations.
- Goals recommended:
- Pre-meal: less than or equal to 95 mg/dl
- 1-hour after meals: less than or equal to 140 mg/dl
- 2-hours after meals: less than 120 mg/dl
- Note however that some experts recommend stricter goals, with pre-meal readings under 90 mg/dl and 1-hour after meals under 120. Be sure to discuss treatment goals with your diabetes team.
Risks
Birth defects are not caused by gestational diabetes, but the main potential problem is having a very large baby (over 9 pounds), which might require a caesarian delivery. Also, there is a risk that the baby might have low blood sugar right after it is born, or breathing problems, as well as problems with obesity later in life and an increased risk for developing type 2 diabetes.
After Delivery
Gestational diabetes almost always disappears after the baby is born, but many women will develop type 2 diabetes as they get older. It has been estimated that if a woman is normal weight after delivery, she still has a 25% chance of developing diabetes later on; if she is overweight, the risk increases to 60%. Thus, all women with a history of gestational diabetes are urged to maintain a healthy lifestyle with regular activity, and to have a yearly glucose screening to make sure they haven't developed type 2 diabetes.
So you are correct in your motivation to attain normal weight after you deliver. Regarding whether or not you need to maintain the same diet that you are following during pregnancy: you should not have to be as strict-i.e. during pregnancy, many women are advised to limit their carbohydrates especially at the breakfast meal. However I would encourage you to consult your dietitian again after you deliver, so you can obtain individualized counseling to best meet your needs.
Related Links
American Diabetes Association (ADA)
http://www.diabetes.org
Center for Disease Control
http://www.cdc.gov/ncbddd/bd/diabetespregnancy.htm
National Institute of Child Health and Human Development (NICHD)
http://www.nichd.nih.gov
Important Notice: The responses provided by the team of Diabetes Educators are based on their personal experiences and expertise as practicing diabetes healthcare professionals, and are not to be considered diabetes management advice from Abbott Laboratories. Remember that information provided by the team of Diabetes Educators is for general background purposes and is not intended as a substitute for medical diagnosis or treatment by a trained professional. You should always consult your physician about any healthcare questions you may have, especially before trying a new medication, diet, fitness program, or approach to healthcare issues.
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