Every pregnancy I dread the gestational diabetes test (yes, there’s been four). First, there’s the “no eating” beforehand… ‘nuff said (kidding… kinda). Yes, I shudder at the thought and I never even had gestational diabetes! But I have had plenty of friends who have. So can gestational diabetes be prevented? Breezy Mama turned to a favorite go-to expert Dr. Gafori of IGO Medical Group to find out, plus gestational diabetes symptoms, if a woman is at risk for diabetes after giving birth, what can happen if it goes untreated and more.
Why does gestational diabetes (GDM) occur?
The placenta secretes hormones that can put a mother at risk of diabetes…these include placental lactogen, growth hormone, and corticotropin releasing hormone. Then, add in, increased weight gain and decreased activity in pregnant women and you may have a recipe for gestational diabetes. Most women have good enough pancreatic function to counteract this and prevent diabetes, but others do not and will develop gestational diabetes.
Is there a way for a woman to avoid gestational diabetes or is going to happen regardless?
Risk factors for diabetes: Age greater than 35, History of delivering a baby that weighed more than 9 lbs, ethnicity (hispanic, african-american, native american, south or east asian, and pacific islanders), personal history of moderately elevated blood sugar, family history of diabetes, polycystic ovarian syndrome, hypertension, and of course obesity!! Excessive weight gain in early to mid pregnancy also puts you at increased risk of developing gestational diabetes. So, eat well and exercise to decrease your chances of developing gestational diabetes!!!!! Also, being close to your ideal weight prepregnancy helps to decrease the risk of developing GDM.
What are the signs and symptoms of gestational diabetes?
Signs and symptoms of diabetes include increased thirst and increased urination. Gestational diabetes does not cause any noticeable symptoms….and almost all pregnant women complain of increased thirst and urination. All pregnant women are typically screened for GDM during weeks 24 to 28 of their pregnancy. Some women with increased risk of diabetes will also be screened at their first visit of the pregnancy.
What is recommended after a woman is diagnosed with gestational diabetes?
Nutritional counseling with the goal of healthy eating that leads to normal blood sugars and adequate weight gain is the main recommendation. Typically this includes a restriction of carbohydrate intake and strict calorie intake. A dietician that works with your ob/gyn or your perinatologist (high risk specialist) will typically help the patient to come up with a diet that is appropriate for their starting weight. The patient is also taught to check their blood sugars in the morning before meals and 1 or 2 hours after their meals. A good exercise regimen is also a very important part of controlling blood sugar by increasing tissue sensitivity to insulin . In 75% of women these changes will be enough to lead to normal sugar levels. The remainder of women will need either oral medications or insulin treatment for sugar control.
What are signs of diabetes in the baby when the mother is diagnosed?
Fortunately, GDM does not usually cause birth defects because the disease does not come into play until the early 3rd trimester. On the other hand, uncontrolled diabetes with high blood sugar during the first trimester can cause birth defects. GDM can lead to macrosomia (large baby) which can lead to difficult delivery and risk to the baby and low blood sugar in the baby at birth.
What are the chances of getting diabetes after the baby is born for a woman who has gestational diabetes while pregnant?
There is a 10 percent chance of developing diabetes immediately post delivery. However, there is a risk that may be as high as 30 to 40% of developing diabetes in the 20 years after delivery.
What is the difference between type one and type 2 diabetes?
This is a complicated question. Gestational diabetes is diagnosed during pregnancy typically between 24 to 28 weeks. Diabetes diagnosed before this time is considered overt diabetes which could be type I or type II. More and more women are diagnosed with overt diabetes because of poor diet and obesity. Diagnosing overt diabetes is important because these women may have abnormal blood sugar during the first trimester of pregnancy when organogenesis occurs (organs develop). These early high sugars can cause congenital anomalies and put the mother at risk for long term diabetic complications which include retinopathy (eye) and neuropathy (nerves). Early treatment can prevent these complications from happening.
Type I Diabetes is insulin dependent diabetes, a chronic condition that can occur early in life because the pancreas does not produce enough insulin. Insulin is the hormone that allows sugar to enter cells to produce energy. Type II Diabetes is more common and occurs when the body becomes resistant to the effects of insulin or doesn’t make enough insulin.
Should a woman with gestational diabetes test her glucose after the baby is born?
90% of women with GDM will have normal sugars after delivery. But, they are at increased risk of developing diabetes in their lifetime. Anywhere from 30-60% of these women will develop GDM with their subsequent pregnancies. It is recommended that women with GDM have their blood sugars checked in the hospital after delivery and then they should undergo a 2 hour glucose tolerance test at approximately 8 weeks postpartum. Many women have a “honeymoon” phase immediately after delivery in which they have normal blood sugar.
What are some of the complications of gestational diabetes?
Adverse outcomes associated with diabetes in pregnancy include preeclampsia, hydramnios (excess amniotic fluid), macrosomia (large baby), enlarged organs in the baby (ex. liver and heart), trauma during birth (increased risk if the baby is also large), increased need for c-section, death of baby secondary to problems which include respiratory issues, hypoglycemia (low sugar), high calcium states, high bilirubin.
Anything else you’d like to share?
Long-term consequences of diabetes for the infant include increased risk of childhood diabetes and higher rates of hyperreactivity. So, a healthy diet and a good exercise regimen before, during, and after pregnancy help to ensure a healthy baby and a healthy mother. Working to be at your ideal weight before conceiving helps too!
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About Dr. Gafori:
Valerie Gafori MD, FACOG is a board certified obstetrician/gynecologist. She completed her undergraduate degree in Physics at MIT, her masters degree in Biology at Stanford University, and medical degree at UMDNJ: New Jersey Medical School. She completed her residency in OB/GYN at George Washington University and joined a private practice in Washington DC for one year before she moved to La Jolla. She is now in private practice in La Jolla, California with IGO Medical Group. She has special interests in minimally invasive surgery and gynecology.