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Gestational Diabetes

Some pregnant women have trouble controlling their blood sugar. This is often due to gestational diabetes. Blood sugar (glucose) provides energy for the body. The amount of “sugar” in your blood is kept in a normal range by insulin, a hormone that keeps blood sugar at a steady state. Normally, your body makes enough insulin to keep up with the amount of sugar. With gestational diabetes, insulin cannot keep up with demand, and this results in a higher than normal blood sugar level. Gestational diabetes usually starts in the later half of the second trimester.

Risk factors for gestational diabetes include:

women over age 30
a family history of adult onset diabetes
previous delivery of a large baby
obesity
previous stillbirth.

Routine screening for gestational diabetes (with a glucose tolerance test) is suggested around 26- 28 weeks. If your clinician feels that you may be at increased risk for gestational diabetes, an earlier screening may be recommended.

Gestational diabetes rarely causes problems in the mother. However, mothers may experience similar problems in other pregnancies and they are more likely to develop adult-onset diabetes later in life. Since 50% of women who have gestational diabetes develop adult onset diabetes, your health care provider may monitor your blood sugars during the postpartum period (after you deliver) and regularly thereafter.

The effects in the baby are more of a concern. The higher sugar levels in the mother excite insulin production in the fetus. The fetus becomes accustomed to making extra insulin. This may cause the fetus to have a lower than normal blood sugar after birth. In addition, a baby that gets too much sugar from its mother during pregnancy may grow large for its age, and this may make vaginal delivery difficult.

What should you do if you have gestational diabetes?

Dietary management
You may need to see a dietician or nutritionist for a healthy diet plan for pregnancy.

Fingerstick blood sugars
You will need to check your blood sugars, often 4 to 5 times per day. This is usually done with a drop of blood, pricked from your finger or toe, and tested on a strip of special paper. This can be read electronically on a glucometer or compared against a chart of colors that indicate your approximate blood sugar level.

Insulin
In situations where diet alone does not keep the blood sugar in control, insulin injections may be required.

Growth and development
Your health care provider will also want to monitor your baby’s growth and development more closely. You may have regular non-stress tests and biophysical profiles.

Fetal movements
A fetal movement chart may also be recommended so that you can keep track of “kick counts” – a sign of fetal well being.