Gestational diabetes is a type of diabetes that starts during pregnancy. If
the pregnant woman has diabetes, her body is not able to use the sugar
(glucose) in her blood as well as it should. So the level of sugar in her
blood becomes higher than normal. Gestational diabetes affects about 4% of
all pregnant women ,it usually begins in the fifth or sixth month of
pregnancy (Between the 24th and 28th weeks). Most often, gestational
diabetes goes away after the baby is born.
Causes of gestational diabetes:
Almost all women have some degree of impaired glucose intolerance during
pregnancy because of hormonal changes that occur during pregnancy. That
means that their blood sugar may be higher than normal, but not high enough
to have diabetes. During the later part of pregnancy (the third trimester)
these hormonal changes place pregnant women at risk for gestational
diabetes.
During pregnancy, increased levels of certain hormones made in the placenta
(the organ that connects the baby by the umbilical cord to the uterus) help
shift nutrients from the mother to the developing fetus. Other hormones are
produced by the placenta to help prevent the mother from developing low
blood sugar. They work by stopping the actions of insulin.
Over the course of the pregnancy, these hormones lead to progressive
impaired glucose intolerance, which leads to higher blood glucose level. To
try to decrease the glucose levels. The body makes more insulin to shuttle
glucose into cells.
Usually the mother's pancreas is able to produce more insulin (about three
times the normal amount) to overcome the effect of the pregnancy hormones on
glucose levels. If, however, the pancreas cannot produce enough insulin to
overcome the effect of the increased hormones during pregnancy glucose
levels will rise, resulting in gestational diabetes.
Risk factors:
The following factors increase the risk of developing diabetes during
pregnancy:
1. being overweight prior to becoming pregnant.
2. Having glucose in the urine.
3. Impaired glucose tolerance or impaired fasting glucose (blood glucose
levels are high, but not high enough to be diabetic.)
4. Family history of diabetes. (If the parents or siblings have diabetes)
5. Previously giving birth to a baby over 9 pounds.
6. Previously giving birth to a stillborn baby.
7. Having gestational diabetes with a previous pregnancy.
8. Having too much amniotic fluid (A condition called polyhydramnios)
*Many women who develop gestational diabetes have no known risk factors.
Symptoms:
Usually there are no symptoms, but the following may be occur:
1. Increased thirst
2. Increased urination
3. Weight loss in spite of increased appetite
4. Fatigue
5. Nausea and vomiting
6. Frequent infections including those of the bladder vagina and skin
7. Blurred vision
Note. Although these symptoms are also common later in pregnancy anyway.
Diagnosis:
High-risk women should be screened for gestational diabetes as early as
possible during their pregnancies, all other women will be screened between
the 24th and 28th week of pregnancy.
To screen for gestational diabetes, the pregnant woman will take a test
called the oral glucose tolerance test. This test involves quickly drinking
a sweetened liquid, which contains 50g of glucose. The body absorbs this
glucose rapidly, causing blood glucose level to rise within 30-60 min. a
blood sample will be taken from a vein in your arm 1 hour after drinking the
solution. The blood test measures how the glucose solution was metabolized
(processed by the body) blood glucose greater than or equal to 140 mg/dl is
recognized as abnormal. If the results are abnormal based on the oral
glucose tolerance test, another test will be given after fasting several
hours.
In women at high risk of developing gestational diabetes, a normal screening
test result is followed up with another screening test at 24-42 weeks for
confirmation of the diagnosis.
Treatment:
The goals of treatments are to maintain blood glucose level within normal
limits during the duration of the pregnancy, and ensure the well-being of
the fetus.
1. Close monitoring of the mother and the fetus should continue throughout
the pregnancy.
- Fetal monitoring to assess the fetal size and well-being may include
ultrasound exams and non-stress tests. A non- stress test is a very simple
painless test for the mother and her baby, an electronic fetal monitor (a
machine that hears and displays the baby's heartbeat) is placed on the
abdomen. When the baby moves, His heart rate normally increases 15 to 20
beats above its regular rate.
- Self-monitoring of blood glucose level allows the women to participate in
her care. Monitoring blood glucose levels four times per day (before
breakfast and 2 hours after meals monitoring blood glucose before all meals
may also become necessary) the range include: before breakfast: plasma < 105 mg/dl, 2 hours after meals: plasma < 130 mg/dl
2. Following specific dietary guidelines as instructed by the doctor. The
pregnant woman will be asked to distribute the calories evenly throughout
the day. Follow these eating tips:
A. Eat three small meals and two or three snacks at regular time's
everyday. Do not skip meals or snacks, carbohydrates should be 40% - 45% of
the total calories with breakfast and a bedtime snack containing 15 – 30
grams of carbohydrates.
B. If the mother has morning sickness, she should eat 1-2 servings of crackers, cereal
or pretzels before getting out of bed. Eat small, frequent meals throughout
the day and avoid fatty, fried and greasy foods. If she takes insulin and
has morning sickness, make sure how to treat low blood sugar.
C. Choose foods high in fiber such as whole-grain breads cereals, pasta,
rice, fruits and vegetables. all pregnant women should eat 20 – 35 grams of
fiber a day.
D. Fat should be less than 40% of calories with less than 10% consumed being
from saturated fats
E. The pregnant woman should make sure that she is getting enough vitamins
and minerals in her daily diet.
F. Drink at least 8 cups or 64 ounces of liquids per day.
3. Regular exercise during pregnancy can improve the posture and decrease
some common discomforts such as backache and fatigue. Being fit during
pregnancy means Safe, mild to moderate exercise at least three times a week.
However, every pregnant woman should consult with her doctor before
beginning an exercise program
Since both insulin and exercise lower blood glucose, the mother should
follow additional exercise to avoid a low blood glucose
reaction:
- Always carry any kind of sugar with her when exercising such as glucose
tablets or hard candy.
- eat one serving of fruit or the equivalent of 15gm of carbohydrate for
most activities lasting 30 min. if the pregnant woman exercises 2 hours or
more after a meal, eat the snack before exercise.
4. Monitoring weight gain: The recommend amount of weight gained during
pregnancy depends on the pre-pregnancy weight, whether there are more than
one fetus and the trimester. Typically, more weight gain is expected during
the second and third trimester and recommended intakes of calories should
increase at that time.
Gaining the right amount of weight during pregnancy by eating a healthy,
balanced diet is a good sign that the baby is getting all the nutrients he
or she needs and is growing at a healthy rate.
It is not necessary to "eat for two" during pregnancy. It's true that
pregnant woman needs extra calories from nutrient-rich foods to help her
baby grow, but she generally need to consume 200 to 300 more calories than
she did before she became pregnant to meet the needs of her growing baby.
She must ask the doctor how much weight she should gain during pregnancy. A
woman of average weight before pregnancy can expect to gain 25 to 35 pounds
during pregnancy. She may need to gain more or less weight, depending on
what her doctor recommends.
In general, the pregnant woman should gain about 24 pounds during first 3
months of pregnancy and 1 pound a week for the remainder of the pregnancy.
Based on the mother blood glucose monitoring results, the doctor will tell
her if she needs to take insulin in the form of injections during pregnancy.
Insulin is a hormone that controls blood glucose if insulin is prescribed
for her, she may be taught to perform the insulin injection procedure.
As the pregnancy progresses, the placenta will make more pregnancy hormones
and larger doses of insulin may be needed to control the mother's blood
glucose. the doctor will adjust her insulin dosage based on her blood
glucose level.
When using insulin, a "low blood glucose reaction", or hypoglycemia, can
occur if the mother do not eat enough food, skip a meal, do not eat at the
right time of day or if she exercises more than usual.
Hypoglycemia is a serious problem that needs to be treated right away. If
the pregnant woman thinks that she has a low blood glucose reaction, she
should check her blood glucose. If the blood glucose is less than 60 mg/dl,
eat a sugar – containing food, such as 1/2 cup of orange or apple juice, 1
cup of skim milk, 4-6 pieces of hard candy (not sugar – free), 1/2 cup
regular soft drink; or 1 tbsp of honey, brown sugar or corn syrup. 15 min
after eating one of the foods listed above, check your blood glucose if it
is still less than 60 mg/db, eat another one of the food choices above. If
it is more than 45 min until the next meal, eat a bread and protein source
to prevent another reaction. Record all low blood glucose reactions in the
logbook, including the date, time of day the reaction occurred and how she
treated it.
Complications:
Diabetes in pregnant women can affect the developing baby throughout the
pregnancy:
A – In early pregnancy: maternal diabetes can result in
1. Birth defects affect major organs such as the brain and heart.
2. Increased rate of miscarriage.
B – During the 2nd and 3rd trimester:
1. Maternal diabetes can lead to over – nutrition and excess growth of the
baby.
2. Having a large baby increases risks during labour and delivery.
3. Large babies often requires caesarean deliveries and if he or she is
delivered vaginally, they are at increased risk trauma to their shoulder
C - After Birth:
1. The baby may have low blood sugar (hypoglycemia) after birth. This is
because the baby's pancreas makes extra insulin in response to the mother's
high blood sugar level. Shortly after birth, the baby may continue to make
extra insulin even though high level of blood sugar is no longer present.
After the pregnancy, the newborn blood sugar level is checked regularly.
Sometimes babies are given an early feed of a sugar (glucose) solution
through a drip (fed directly into a vein) to correct low blood sugar.
2. It is more likely that the newborn baby will develop jaundice (yellowing
of the skin and whites of the eyes). This is not serious and usually fades
over a few weeks, without the need for medical treatment.
3. There may be an increased risk of the baby developing type II diabetes or
being overweight later in life.
4. There is an increase risk that the baby will be born with congenital
problems, such as heart defect. Sometimes infants can be born with
respiratory distress syndrome, in which the baby has problems breathing
because his or her lungs have not matured as normal. This usually clears up
with time.
5. There is also a slightly higher chance of stillbirth or death as a
newborn, but if it is detected and the glucose level was managed, death is
rare.
D - Effects on the mother
Gestational diabetes is not an immediate threat to the woman's health. Most
women with gestational diabetes whose blood sugar levels stay within the
safe range, Deliver their babies without complications. However, in some
women it can result in high blood pressure. Women who get gestational
diabetes are more likely to develop gestational diabetes in future
pregnancies, and are at a higher risk of developing type II diabetes later
in life.
In almost every case, gestational diabetes disappears on it's own after
delivery, in which her blood glucose level return to normal about 6 weeks
after childbirth. To be sure, the doctor may check the mother's blood sugar
levels a few times after the birth, and some doctors recommend an oral
glucose tolerance test 6-8 weeks after delivery to checks for diabetes.
Women who have had gestational diabetes have a 60% increased risk of
developing type two diabetes later in life. By maintaining an ideal body
weight, following a healthy diet and exercising, she will be able to reduce
the risk of developing type 2 diabetes.
