Gestational Diabetes

By Mary Walter Loughery

One of the most common complications of pregnancy, gestational diabetes normally occurs during the second trimester, when the placenta begins producing hormones. One of these hormones may block the action of insulin in the mother, making her "insulin resistant". Since the mother's insulin isn't as efficient, it may be difficult for the sugar to be utilized by the cells and may cause her blood sugar to rise. The high blood sugar stimulates the baby to make more insulin which moves sugar into the baby's cells, causing him/her to gain extra weight. If unregulated, these changes can have serious and harmful effects on both mother and child.

First, the baby may grow very large as a result of increased amounts of sugar he/she is getting from the mother. After birth, many of these babies experience hypoglycemia, a severe drop in blood sugar. The newborn will be likely be carefully monitered in the Neo-Natal Unit and supplemented with formula as needed until the blood sugar stabilizes. Some other problems include Respiratory Distress Syndrome (partially due to premature delivery and to infants with underdeveloped lungs) and jaundice. Others may also be sleepy or weak. The mother is also at an increased risk of developing toxemia, or Pregnancy-Induced Hypertension, which may result in high blood pressure and edema (swelling). There are several risk factors which increase a woman's chances of developing gestational diabetes:

• obesity
• history of glucose intolerance
• family history
• history of sugar in urine
• previous birth > 9 Lbs.
• over 25 years of age
• poor obstetrical history
• severe stress is prone to GD
• previous diagnosis of GD

Women who have been diagnosed with gestational diabetes have a fifty percent chance of developing Adult Onset Diabetes Mellitus (type 2) within ten years.

Today, as a matter of routine, women are tested for GD at twenty eight weeks, or sooner if their physician suspects it. Patients are given a "Glucose Challenge Test", in which oral glucose is ingested and blood sugar levels are measured an hour later. If the blood sugar is above the acceptable level, the patient will be given an additional test, in which they consume a larger amount of oral glucose, and levels are measured at one, two and three hour intervals after consumption. Patients are often requested, before the test, to "load up" with additional sugar by consuming several chocolate bars for three days before the Glucose Tolerance Test. If GD is diagnosed, the patient will see a dietician to jointly devise a diet specifically developed for their medical condition and level of gestational diabetes. The diet's goal will be to control blood sugar levels, while providing adequate calories and nutrients to support both the patient and her growing baby. Frequent monitoring of blood sugar will allow the physicain to determine whether the mother can continue the duration of her pregnancy with the diet alone, or if insulin is required. In most cases, diet alone will suffice, but in some instances, several injections will be necessary to maintain favourable blood sugar levels. The need for insulin will usually increase throughout the pregnancy, but almost always disappears after delivery. Patients with GD will be carefully monitered through ultrasound and fetal heart monitoring to ensure that the pregnancy is progressing normally.

With proper medical care as mentioned above, the risk of problems associated with gestational diabetes can be greatly reduced. If you are concerned about gestational diabetes, talk with your obstetrition, the diabetes educator at your local hospital, or one of the associations who's mandate is diabetes education.