Gestational diabetes is a condition affecting about four percent of all pregnant females in the U.S. which is easily treated when detected early. It is a type of diabetes that is caused by the blockage of insulin by hormones produced by the placenta, as opposed to the juvenile diabetes which produces no insulin and the adult onset diabetes which is acquired through an unhealthy lifestyle. In pregnancy, the placenta produces hormones, namely cortisol, estrogen, and human placental lactogen that help in the protection of the fetus and the mother. Unfortunately, these hormones are also responsible for hindering the glycolytic effect of insulin, thus leading to an increase of glucose in the blood. As the pregnancy progresses, more insulin is being blocked until the pancreas has exhausted all its present supply of insulin. This in turn will allow glucose to build up in the blood supply and lead to having gestational diabetes, or insulin resistant diabetes.
Gestational diabetes affects any woman during their pregnancy, although there are some who are predisposed to having this condition, such as those who are obese, with family and relatives with diabetes and women over the age of twenty five. Previous births of extremely large infants, stillborn babies, or babies with congenital defects are also risk factors for gestational diabetes.
All pregnant women should be screened for gestational diabetes to rule out its complications later in the pregnancy. There are two types of tests available: the oral glucose screening test (OGST) and the oral glucose tolerance test (OGTT). With the OGST, the patient is given a 50 gram glucose drink, and blood extraction will be done an hour after. A value that is less than 140 mg/dl indicates a normal value. If the value obtained falls over 140, the doctor might suggest the patient to undergo the oral glucose tolerance test. In this test, blood is initially extracted from the patient after a ten to fourteen hour fast, no food or water intake, which is usually done overnight. Then she is given a 100 gram glucose drink after which blood is again extracted an hour later, and twice more with an hour interval. The normal fasting blood glucose level is 80 mg/dl while the other values must indicate a constant decrease in the blood glucose level until it reaches fasting level once more. A high level of blood glucose is indicative of gestational diabetes and must be controlled at once to avoid any complications.
Complications that arise from gestational diabetes are macrosomia and having a hypoglycemic baby. Macrosomia is a condition of having an abnormally large baby due to the increased storage of fat from the excessive glucose taken from the mother's blood. If this happens, a caesarean section is apparent. Gestational diabetes can also cause a newborn baby to be hypoglycemic because of an increased amount of insulin in the baby's bloodstream since it is used to the high levels of glucose in the mother's blood. A hypoglycemic baby should be treated at once with a glucose intravenous drip, usually with the addition of other electrolytes.
The cure for gestational diabetes is the cessation of those hormones that block it. This only happens when the patient gives birth, which may be several weeks from the time it was detected. Women who are predisposed should be checked early for their levels of glucose, lest they be affected by gestational diabetes. If you are diagnosed to have gestational diabetes, you are advised to lower down your blood glucose levels by eating a healthy diet. This means that the carbohydrates that you eat should be limited to be able to maintain normal blood glucose levels. Exercise is also suggested as part of the daily routine to lower blood sugar although it is not recommended in high risk pregnancies. The glucose levels in the blood should be monitored at least three times a day, after every meal. For those taking insulin, they also have to test themselves before meals to be able to keep blood glucose levels normal.
Keeping regular appointments with your obstetrician-gynecologist is advisable for pregnant women, more so if you have gestational diabetes, since they are also more prone to having an increase in blood pressure. During appointments, they will be taking your blood pressure and urine sample to test for the presence of protein. They will also be asking you to list down all you ate for the past week to check if you were able to meet your daily vitamin and carbohydrate requirement. This will also be correlated with your weight.
Your doctor might also request you to have an ultrasound to check on the growth of the fetus, if its size corresponds with its age in weeks. It also checks fetal movements and the amount of amniotic fluid in your womb. A non-stress test is also advised for those pregnant women taking insulin for gestational diabetes, usually done near their expected date of delivery. This is to monitor the fetal heart rate.
Insulin injections are given to pregnant women diagnosed with gestational diabetes if within two weeks of dieting and exercising would not bring down blood glucose levels to normal. These are stopped when the baby is delivered because of the loss of those inhibiting hormones.
Dieting is not advised for most pregnant women since it can stunt the growth of the child. The average woman will usually gain an average of thirty pounds during the whole pregnancy although for obese women, gaining fifteen pounds is fine when you are pregnant. The doctor might even advise you to diet since you may be at risk of developing gestational diabetes.
For the duration of the birth process, close observation is done on both the mother and the baby since complications may arise at this time due to gestational diabetes. Blood glucose levels are taken at least every hour to check if they fall within normal limits. Insulin will be given if high results were obtained and a glucose IV if lower than normal. The heart rate of the fetus is also monitored to see his condition inside the womb, to determine if a caesarean section will be needed although almost all women with gestational diabetes were able to have natural childbirth.
After delivery, they will check for the last time the glucose levels in your blood, just to be sure that it has gone back to normal. As with the newborn, glucose levels will also be checked for hypoglycemia, low calcium, increased bilirubin and RBC.
The treatment of pregnant women with gestational diabetes is for them to give birth. Unfortunately, gestational diabetes may occur again for the succeeding pregnancies and lead to a non-insulin dependent type of diabetes later on in life.