Gestational Diabetes

Testing for Gestational Diabetes

All pregnant women in our practice are tested for gestational diabetes between 24 and 28 weeks of gestation. You will be given a drink (glucola) to take home with you the visit before your test. You may put the glucola in the refrigerator, or drink it over ice. (It tastes better cold). The drink tastes like orange soda with a little extra sugar added. you should drink it over a 5 to 10 minute period approximately one-half hour to three-fourths hour before you will arrive at the lab. (You should leave time for registration at the lab or for the tech to finish with other patients who were there before you). Your blood will be drawn one hour after you started drinking, so be sure to tell the registrar what time you began drinking the glucola. You may eat normally up until the time you drink the glucola, but don't put anything in your mouth after you finish it. (This includes toothpaste and cigarettes). Once the tech draws your blood, you may go back to eating and drinking normally).

If your blood sugar tests high, a nurse will call to help you schedule further testing. This first test was called a "glucose challenge test" and is a screening test. It pinpoints those who should go on for a further, definitive test for gestational diabetes - the "glucose tolerance test". This test lasts about three and one-half hours. You will have nothing to eat or drink after midnight the night before your test (except for water). When you arrive at the lab they will take your blood for a "fasting blood sugar" level. This is for a baseline blood sugar when you haven't had anything to eat or drink for at least eight hours. They will then give you another glucose drink. They will take your blood again at 1 hour, 2 hours, and 3 hours after you began your drink. If your blood sugar is high on two of the four tests, then you will be classified as a gestational diabetic.

What Is Gestational Diabetes?

Gestational diabetes is diabetes, or glucose intolerance, that occurs during the second half of pregnancy. It occurs in approximately 3% of all pregnant women. With the birth of the baby, blood sugars usually return to normal levels.

Your body breaks down food to use as a source of energy. Insulin, a hormone produced by the pancreas, helps the sugar leave the blood and enter the body cells where it will be used as energy. With diabetes, there is not enough insulin to help the sugar enter the cells, so it stays in the bloodstream. In pregnancy, the placenta produces hormones that change the way insulin works. These hormones have an "anti-insulin" effect around the placenta. Your pancreas compensates by producing more insulin. When not enough extra insulin can be produced to cover the increased blood sugar level, you become diabetic. A woman with diabetes only during pregnancy is called a gestational diabetic. She has no trouble producing the required amount of insulin when the placenta is not there to add anti-insulin hormones to the mix. Once the placenta is gone (delivery of the baby), the problem is gone.

Who Gets Gestational Diabetes?

Gestational diabetes can occur even when there are no risk factors. This is why all pregnant women are screened for the condition. The risk of gestational diabetes increases with age, is more likely in women who are obese, have high blood pressure or have close family members with diabetes. If you were a gestational diabetic in one pregnancy, you have a greater chance of being a gestational diabetic in later pregnancies.

How Will My Baby Be Affected?

If you keep your blood sugar in the normal range, you have a good chance of delivering a healthy baby. Your baby will not be diabetic when it is born; the baby is at greater risk of having a low blood sugar than a high blood sugar.

1. Macrosomia - If your blood sugar levels are high, this sugar will cross the placenta to the baby. The baby does not use your insulin, it will work harder to make enough insulin of it's own to cover the high blood sugar. This added insulin and sugar cause your baby to gain weight (fat) and grow very big. This is called macrosomia. A large baby is difficult to deliver, as you can imagine.

2. Hypoglycemia (Low Blood Sugar) - After your baby is born, it will no longer need the large amounts of insulin it has been producing, but it is hard to immediately stop. Your baby may have a rapid drop in blood sugar. Your baby will be monitored for this after delivery. Maintaining normal blood sugar levels for 24 hours before delivery helps to decrease the risk of hypoglycemia.

3. Jaundice - A slightly yellow skin color (jaundice) can be common in newborns. It is caused by a buildup of a chemical called bilirubin. A small amount of buildup is normal and will usually go away by itself. Jaundice, though, can be more severe in babies of mothers with gestational diabetes. Sometimes the babies will need to receive a special light treatment to help in the breakdown of the bilirubin.

4. Stillbirth - In very rare cases, when gestational diabetes is not detected, or the blood sugars are not controlled, a stillbirth may occur. For this reason, it is important to follow the gestational diabetic diet and your provider will monitor your baby more closely near the end of your pregnancy.

How Can I Keep My Baby Healthy?

Once you have been diagnosed with gestational diabetes, you will be referred to a professional dietician for diabetic counseling. You should begin immediately by avoiding sugary foods. The dietician will help you formulate a diet taking into consideration your weight, stage of pregnancy, and level of activity. In most cases, the diet consists of three small meals and snacks spread throughout the day.

Different kinds of foods have different effects on your blood sugar levels. Carbohydrates have the greatest effect on your blood sugar level. Not all carbohydrates are equal, though. There are complex carbohydrates, such as whole grain breads, tortillas, rice, whole grain crackers, and beans; and simple carbohydrates, such as cake, pie, candy, cookies and jams. Complex carbohydrates are absorbed slowly and do not cause a rapid change in blood sugar. They are also high in fiber. Simple carbohydrates are quickly absorbed and cause a high rise in the blood sugar level. They are to be avoided.

Proteins, such as meat, fish, eggs, tofu and cheese, cause only a small rise in the blood sugar level and are digested slowly.

Fats, such as butter, oils, mayonnaise, salad dressings, bacon, cream cheese, and nuts, contain the most calories and may add to your weight gain. Fats are hidden in many foods; you should check the labels of prepared foods.

Will I Need Insulin?

Chances are, no, you will not need insulin. Occasionally, though, there will be a woman whose diet alone does not control her blood sugar. She may need to use insulin for a short time during pregnancy. Although the idea of injecting yourself may seem scary, the needle is tiny and your goal of a healthy baby will be further within reach. As noted before, though, most gestational diabetics can control their blood sugar with diet alone and won't need insulin.

What About Exercise?

Exercise is an important part of any healthy pregnancy. It helps you stay fit for labor and delivery and reduces stress. Exercise is especially important for gestational diabetics since it also helps you maintain a normal blood sugar level. You should always clear your exercise program with your healthcare provider. Swimming and walking are good for women who have not been active.

What Monitoring May Be Done During My Pregnancy?

During the final weeks of pregnancy, we will follow your baby with fetal monitoring. These non-stress tests help detect signs of problems the baby may be having late in pregnancy. An electronic fetal monitor is attached to your abdomen and the heartbeat and activity of the baby are measured and recorded.

An ultrasound may be performed to check on the growth and development of the baby.

You may be asked to monitor kick counts. The baby moves about the same amount each day. You may be asked to monitor this movement and report to the office if the baby is not moving as much as usual.

Does This Mean I Will Need A Cesarean Section?

Most women with gestational diabetes carry their babies full term. We will want to deliver your baby as close to the due date as possible, to avoid the risk of delivering too early before the baby's lungs are mature. With proper dietary control, your birth should be uneventful. With gestational diabetes, though, there is the risk your baby could be too large for the opening in your pelvis. If there is a risk of a cesarean section, your provider will discuss this with you at a visit to the office.

What Will Happen With My Baby After Delivery?

Your baby's blood sugar level will be tested right after birth. If the blood sugar level is normal, nothing more will need to be done. If your baby's blood sugar level is low, the baby will be given sugar water to drink.

Will My Diabetes Really Go Away After Delivery?

For 92% of gestational diabetics, their blood sugar levels return to normal. Six percent have mild problems with blood sugar control and 2% will remain diabetic. (Some of these women may have been diabetic before pregnancy, but never diagnosed as such). You should be tested again 6 weeks after the delivery of your baby.

If you are overweight, you have a 60% chance of developing adult-onset diabetes later in life. If you are at the correct weight for your height, you decrease your chances significantly.

You remain at risk for developing gestational diabetes with future pregnancies.

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