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Understanding Gestational Diabetes
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Proper Management of Gestional Diabetes Assures a Successful Pregnancy

Pregnant Woman

In all pregnancies, there is increasingly more stress on the pancreas and demand for extra insulin. in some women, the pancreas is unable to supply enough insulin to meet these increased demands. This condition is called gestational diabetes. It usually is a temporary condition that goes away after delivery.

Approximately 3 to 5 percent of all pregnant women in the United States are diagnosed as having gestational diabetes. These women and their families have many questions about this disorder. Some of the most frequently asked questions are: What is gestational diabetes and how did I get it? How does it differ from other kinds of diabetes? Will it hurt my baby? Will my baby have diabetes? What can I do to control gestational diabetes? Will I need a special diet? Will gestational diabetes change the way or the time my baby is delivered? Will I have diabetes in the future?

Does gestational diabetes affect the baby?

One of the major problems a woman with gestational diabetes faces is a condition the baby may develop called "Macrosomia." Macrosomia means "large body" and refers to a baby that is considerably larger than normal. All of the nutrients the fetus receives comes directly from the mother's blood. If the maternal blood has too much glucose, the pancreas of the fetus senses the high glucose levels and produces more insulin in an attempt to use the glucose. The fetus converts the extra glucose to fat. Even when the mother has gestational diabetes, the fetus is able to produce all the insulin it needs. The combination of high blood glucose levels from the mother and high insulin levels in the fetus results in large deposits of fat which causes the fetus to grow excessively large, a condition known as macrosomia. Occasionally, the baby grows too large to be delivered through the vagina and a cesarean delivery becomes necessary. The obstetrician can often determine if the fetus is macrosomic by doing a physical examination. However, in many cases a special test called an ultrasound is used to measure the size of the fetus.

In addition to macrosomia, gestational diabetes increases the risk of hypoglycemia (low blood sugar) in the baby immediately after delivery. This problem occurs if the mother's blood sugar levels have been consistently high causing the fetus to have a high level of insulin in its circulation. After delivery the baby continues to have a high insulin level, but it no longer has the high level of sugar from its mother, resulting in the newborn's blood sugar level becoming very low. Your baby's blood sugar level will be checked in the newborn nursery and if the level is too low, it may be necessary to give the baby glucose intravenously. Infants of mothers with gestational diabetes are also vulnerable to several other chemical imbalances such as low serum calcium and low serum magnesium levels.

Does gestational diabetes affect labor and delivery?

Most women with gestational diabetes can complete pregnancy and begin labor naturally. Gestational diabetes, by itself, is not an indication to perform a cesarean delivery, but sometimes there are other reasons your doctor may elect to do a cesarean. For example, the baby may be too large (macrosomic) to deliver vaginally, or the baby may be in distress and unable to withstand vaginal delivery. You should discuss the various possibilities for delivery with your obstetrician so there are no surprises.

Careful control of blood sugar levels remains important even during labor. If a mother's blood sugar level becomes elevated during labor, the baby's blood sugar level will also become elevated. High blood sugar in the mother produce high insulin levels in the baby. Immediately after delivery high insulin levels in the baby can drive its blood sugar level very low since it will no longer have the high sugar concentration from its mother's blood. Women whose gestational diabetes does not require that they take insulin during their pregnancy, will not need to take insulin during their labor or delivery. On the other hand, a woman who does require insulin during pregnancy may be given insulin by injection on the morning labor begins, or in some instances, it may be given intravenously throughout labor. For most women with gestational diabetes there is no need for insulin after the baby is born and blood sugar level returns to normal immediately. The reason for this sudden return to normal lies in the fact that when the placenta is removed the hormones it was producing (which caused the insulin resistance) are also removed. Thus, the mother's insulin is permitted to work normally without resistance. Your doctor may want to check your blood sugar level the next morning, but it will most likely be normal.

What are the affects of gestional diabetes on the mother?

97% of women with gestional diabetes will have normal blood sugar following child birth. The release of the excess demands on the system allows the blood glucose and insulin to come into balance. Your blood sugar will be tested after delivery, and should be tested again at your six week check-up.

It is likely that gestational diabetes will return if you get pregnant again. You should inform your doctor and have regular blood glucose tests.

Diabetes is likely to return later if you do not control our weight. It is also wise to adjust you eating habits to avoid frequent over eating or frequent eating of large amounts of sweet foods. These habits, over a period of time, may cause problems with your natural insulin.
Diabetes May Return to
60% of women who are overweight.
Fewer than 25% of women who are of normal weight

Do not try to lose weight now because weight loss during pregnancy can cause problems for you or your baby. If you are over weight, wait untill after delivery to lose excess pounds. You should monitor your weight gain and only gain the amounts suggested by your doctor.

If you have gestational diabetes, your chances of getting diabetes later are increased. You should have your blood sugar tested throughout your life. You need to be aware of the diabetic symptoms, and most important, you should maintain a normal body weight for your height and build.

For more information call: The American Diabetes Association, 1-800-232-3472

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