gestational diabetes

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Gestational Diabetes

 

Definition

Gestational diabetes is a condition that occurs during pregnancy. Like other forms of diabetes, gestational diabetes involves a defect in the way the body processes and uses sugars (glucose) in the diet. Gestational diabetes, however, has a number of characteristics that are different from other forms of diabetes.

Description

Glucose is a form of sugar that is present in many foods, including sweets, potatoes, pasta, and breads. The body uses glucose to provide energy. It is stored in the liver, muscles, and fatty tissue. The pancreas produces a hormone (a chemical produced in one part of the body, which travels to another part of the body in order to exert its effect) called insulin. Insulin is required to allow glucose to enter the liver, muscles, and fatty tissues, thus reducing the amount of glucose in the blood. In diabetes, blood levels of glucose remain abnormally high. In many forms of diabetes, this is because the pancreas does not produce enough insulin.
In gestational diabetes, the pancreas is not at fault. Instead, the problem is in the placenta. During pregnancy, the placenta provides the baby with nourishment. It also produces a number of hormones that interfere with the body's usual response to insulin. This condition is referred to as "insulin resistance." Most pregnant women do not suffer from gestational diabetes, because the pancreas works to produce extra quantities of insulin in order to compensate for insulin resistance. However, when a woman's pancreas cannot produce enough extra insulin, blood levels of glucose stay abnormally high, and the woman is considered to have gestational diabetes.
About 1-3% of all pregnant women develop gestational diabetes. Women at risk for gestational diabetes include those who:
  • are overweight
  • have a family history of diabetes
  • have previously given birth to a very large, heavy baby
  • have previously had a baby who was stillborn, or born with a birth defect
  • have an excess amount of amniotic fluid (the cushioning fluid within the uterus that surrounds the developing fetus)
  • are over 25 years of age
  • belong to an ethnic group known to experience higher rates of gestational diabetes (in the United States, these groups include Mexican-Americans, American Indians, African-Americans, as well as individuals from Asia, India, or the Pacific Islands)
  • have a previous history of gestational diabetes during a pregnancy

Causes and symptoms

Most women with gestational diabetes have no recognizable symptoms. However, leaving gestational diabetes undiagnosed and untreated is risky to the developing fetus. Left untreated, a diabetic mother's blood sugar levels will be consistently high. This sugar will cross the placenta and pour into the baby's system through the umbilical cord. The unborn baby's pancreas will respond to this high level of sugar by constantly putting out large amounts of insulin. The insulin will allow the fetus's cells to take in glucose, where it will be converted to fat and stored. A baby who has been exposed to constantly high levels of sugar throughout pregnancy will be abnormally large. Such a baby will often grow so large that he or she cannot be born through the vagina, but will instead need to be born through a surgical procedure (cesarean section).
Furthermore, when the baby is born, the baby will still have an abnormally large amount of insulin circulating. After birth, when the mother and baby are no longer attached to each other via the placenta and umbilical cord, the baby will no longer be receiving the mother's high level of sugar. The baby's high level of insulin, however, will very quickly use up the glucose circulating in the baby's bloodstream. The baby is then at risk for having a dangerously low level of blood glucose (a condition called hypoglycemia).

Diagnosis

Since gestational diabetes most often exists with no symptoms detectable by the patient, and since its existence puts the developing baby at considerable risk, screening for the disorder is a routine part of pregnancy care. This screening is usually done between the 24th and 28th week of pregnancy. By this point in the pregnancy, the placental hormones have reached a sufficient level to cause insulin resistance. Screening for gestational diabetes involves the pregnant woman drinking a special solution that contains exactly 50 grams of glucose. An hour later, the woman's blood is drawn and tested for its glucose level. A level less than 140 mg/dl is considered normal.
When the screening glucose level is over 140 mg/dl, a special three-hour glucose tolerance test is performed. This involves following a special diet for three days prior to the test. This diet is set up to contain at least 150 grams of carbohydrates each day. Just before the test, the patient is instructed to eat and drink nothing (except water) for 10-14 hours. A blood sample is then tested to determine the fasting glucose level. The patient then drinks a special solution containing exactly 100 grams of glucose, and her blood is tested every hour for the next three hours. If two or more of these levels are elevated over normal, then the patient is considered to have gestational diabetes.

Treatment

Treatment for gestational diabetes will depend on the severity of the diabetes. Mild forms can be treated with diet (decreasing the intake of sugars and fats, in particular). Many women are put on strict, detailed diets, and are asked to stay within a certain range of calorie intake. Exercise sometimes is used to keep blood sugar levels lower. Patients often are asked to regularly measure their blood sugar. This is done by poking a finger with a needle called a lancet, putting a drop of blood on a special type of paper, and feeding the paper into a meter that analyzes and reports the blood sugar level. In fact self-monitoring of blood glucose helps manage gestational diabetes and prevent complications. When diet and exercise do not keep blood glucose levels within an acceptable range, a patient may need to take regular shots of insulin.
Many babies born to women with gestational diabetes are large enough to cause more difficult deliveries, and they may require the use of forceps, suction, or cesarean section. Once the baby is born, it is important to carefully monitor its blood glucose levels. These levels may drop sharply and dangerously once the baby is no longer receiving large quantities of sugar from the mother. When this occurs, it is easily resolved by giving the baby glucose.

Prognosis

Prognosis for women with gestational diabetes, and their babies, is generally good. Almost all such women stop being diabetic after the birth of their baby. However, some research has shown that nearly 50% of these women will develop a permanent form of diabetes within 15 years. The child of a mother with gestational diabetes has a greater-than-normal chance of developing diabetes sometime in adulthood, also. A woman who has had gestational diabetes during one pregnancy has about a 66% chance of having it again during any subsequent pregnancies. Women who had gestational diabetes usually are tested for diabetes at the postpartum checkup or after stopping breastfeeding.

Prevention

There is no known way to actually prevent diabetes, particularly since gestational diabetes is due to the effects of normal hormones of pregnancy. However, the effects of insulin resistance can be best handled through careful attention to diet, avoiding becoming overweight throughout life, and participating in reasonable exercise. A 2003 report also linked smoking to increased risk of gestational diabetes.

Resources

Periodicals

"Self-monitoring of blood glucose Useful for Managing Gestational Diabetes." Women's Health Weekly (August 7, 2003): 42.
"Smoking Tied to Increased Risk of Gestational Diabetes; Dose Response Relationship." OB GYN News (September 1, 2003): 5.

Organizations

American Diabetes Association. 1701 North Beauregard Street, Alexandria, VA 22311. (800) 342-2383. http://www.diabetes.org.

Key terms

Glucose — A form of sugar. The final product of the breakdown of carbohydrates (starches).
Insulin — A hormone produced by the pancreas that is central to the processing of sugars and carbohydrates in the diet.
Placenta — An organ that is attached to the inside wall of the mother's uterus and to the fetus via the umbilical cord. The placenta allows oxygen and nutrients from the mother's bloodstream to pass into the unborn baby.

diabetes

 [di″ah-be´tēz]
a general term referring to any of various disorders characterized by excessive urination (polyuria); when used alone, the term refers to diabetes mellitus. (See Atlas 4, Part D).
brittle diabetes diabetes that is difficult to control, characterized by unexplained oscillation between hypoglycemia and diabetic ketoacidosis. (This term was formerly much used, but it is not a classification used by the World Health Organization or the American Diabetes Association.)
bronze diabetes hemochromatosis.
central diabetes insipidus a metabolic disorder due to injury of the neurohypophyseal system, which results in a deficient quantity of antidiuretic hormone (ADH or vasopressin) being released or produced, resulting in failure of tubular reabsorption of water in the kidney. As a consequence, there is the passage of a large amount of urine having a low specific gravity, and great thirst; it is often attended by voracious appetite, loss of strength, and emaciation. Diabetes insipidus may be acquired through infection, neoplasm, trauma, or radiation injuries to the posterior lobe of the pituitary gland or it may be inherited or idiopathic.

Treatment of pituitary diabetes insipidus consists of administration of vasopressin. A synthetic analogue of vasopressin (DDAVP) can be administered as a nasal spray, providing antidiuretic activity for 8 to 20 hours, and is currently the drug of choice. Patient care includes instruction in self-administration of the drug, its expected action, symptoms that indicate a need to adjust the dosage, and the importance of follow-up visits. Patients with this condition should wear some form of medical identification at all times.
gestational diabetes diabetes mellitus with onset or first recognition during pregnancy, usually during the second or third trimester. In some cases mild, undetected glucose intolerance was present before pregnancy. It often disappears after the end of the pregnancy, but many women with this condition develop permanent diabetes mellitus in later life. Although the disordered carbohydrate metabolism is usually mild, prompt detection and treatment are necessary to avoid fetal and neonatal morbidity and mortality.
maturity-onset diabetes of youth (MODY) an autosomal dominant variety of type 2 diabetes mellitus characterized by onset in late adolescence or early adulthood.
diabetes mel´litus a broadly applied term used to denote a complex group of syndromes that have in common a disturbance in the oxidation and utilization of glucose, which may be secondary to a malfunction of the beta cells of the pancreas, whose function is the production and release of insulin. Because insulin is involved in the metabolism of carbohydrates, proteins, and fats, diabetes is not limited to a disturbance of glucose homeostasis alone. Insulin resistance may also sometimes play a role in the etiology of diabetes. 

The American Diabetes Association sponsored an international panel in 1995 to review the literature and recommend updates of the classification of diabetes mellitus. The definitions and descriptions that follow are drawn from the Report of the Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. The report was first approved in 1997 and modified in 1999. Although other terms are found in older literature and remain in use, their use in current clinical practice is inappropriate. Epidemiologic and research studies are facilitated by use of a common language.

The Expert Committee notes that most cases of diabetes fall into two broad categories, which are called Type 1 and Type 2. There are also other specific types, such as gestational diabetes and impaired glucose homeostasis. See table for definitions of types of diabetes mellitus.
Incidence and Prevalence. It has been estimated that slightly over 6 per cent of the population is affected by some form of diabetes, or 17 million people in the USA and 1.2 to 1.4 million in Canada; many of these individuals are not diagnosed. Diabetes is ranked third as a cause of death, although the life span of patients with diabetes has increased due to improved methods of detection and better management. There is no cure for diabetes at the present time, but enormous strides have been made in the control of the disease. The patient must understand the importance of compliance with the entire treatment plan, including diet, exercise, and in some cases medication. The patient with diabetes is at increased risk for cardiovascular disease, renal failure, neuropathies, and diabetic retinopathy. Research studies such as the Diabetes Control and Complications Trial have indicated that tight control of blood glucose levels resulted in the delay or prevention of retinopathy, nephropathy, and neuropathy.
Diagnosis. The most common diagnostic tests for diabetes are chemical analyses of the blood such as the fasting plasma glucose. Capillary blood glucose monitoring can be used for screening large segments of the population. Portable equipment is available and only one drop of blood from the fingertip or earlobe is necessary. Capillary blood glucose levels have largely replaced analysis of the urine for glucose. Testing for urinary glucose can be problematic as the patient may have a high renal threshold, which would lead to a negative reading for urinary glucose when in fact the blood glucose level was high.
Clinical Manifestations. Diabetes mellitus can present a wide variety of symptoms, from none at all to profound ketosis and coma. If the disease manifests itself late in life, patients may not know they have it until it is discovered during a routine examination, or when the symptoms of chronic vascular disease, insidious renal failure, or impaired vision cause them to seek medical help.

The typical symptoms of diabetes mellitus are the three “polys:” polyuria, polydipsia, and polyphagia. Because of insulin deficiency, the assimilation and storage of glucose in muscle adipose tissues, and the liver is greatly diminished. This produces an accumulation of glucose in the blood and creates an increase in its osmolarity. In response to this increased osmotic pressure there is depletion of intracellular water and osmotic diuresis. The water loss creates intense thirst and increased urination. The increased appetite (polyphagia) is not as clearly understood. It may be the result of the body's effort to increase its supply of energy foods even though eating more carbohydrates in the absence of sufficient insulin does not meet the energy needs of the cells.

Fatigue and muscle weakness occur because the glucose needed for energy simply is not metabolized properly. Weight loss in type 1 diabetes patients occurs partly because of the loss of body fluid and partly because in the absence of sufficient insulin the body begins to metabolize its own proteins and stored fat. The oxidation of fats is incomplete, however, and the fatty acids are converted into ketone bodies. When the kidney is no longer able to handle the excess ketones the patient develops ketosis. The overwhelming presence of the strong organic acids in the blood lowers the pH and leads to severe and potentially fatal ketoacidosis.

The metabolism of body protein when sufficient amounts of insulin are not available causes an elevated blood urea nitrogen. This first occurs because the nitrogen component of protein is discarded in the blood when the body metabolizes its own proteins to obtain the glucose it needs.

Persons with diabetes are prone to infection, delayed healing, and vascular disease. The ease with which poorly controlled diabetic persons develop an infection is thought to be due in part to decreased chemotaxis of leukocytes, abnormal phagocyte function, and diminished blood supply because of atherosclerotic changes in the blood vessels. An impaired blood supply means a deficit in the protective defensive cells transported in the blood. Excessive glucose allows organisms to grow out of control.

Another manifestation of diabetes mellitus is visual disturbance due to increased osmolarity of the blood and accumulation of fluid in the eyeball, which changes its shape. Once the diabetes is under control, visual problems should abate. Persistent vaginitis and urinary tract infection also may be symptoms of diabetes in females.
Sequelae. The long-term consequences of diabetes mellitus can involve both large and small blood vessels throughout the body. That in large vessels is usually seen in the coronary arteries, cerebral arteries, and arteries of the lower extremities and can eventually lead to myocardial infarction, stroke, or gangrene of the feet and legs. atherosclerosis is far more likely to occur in persons of any age who have diabetes than it is in other people. This predisposition is not clearly understood. Some believe that diabetics inherit the tendency to develop severe atherosclerosis as well as an aberration in glucose metabolism, and that the two are not necessarily related. There is strong evidence to substantiate the claim that optimal control will mitigate the effects of diabetes on the microvasculature, particularly in the young and middle-aged who are at greatest risk for developing complications involving the arterioles. Pathologic changes in the small blood vessels serving the kidney lead to nephrosclerosis, pyelonephritis, and other disorders that eventually result in renal failure. Many of the deaths of persons with type 1 diabetes are caused by renal failure.

Visual impairment and blindness are common sequelae of uncontrolled diabetes. The three most frequently occurring problems involving the eye are diabetic retinopathy, cataracts, and glaucoma. photocoagulation of destructive lesions of the retina with laser beams can be used to delay further progress of pathologic changes and thereby preserve sight in the affected eye.

Another area of pathologic changes associated with diabetes mellitus is the nervous system (diabetic neuropathy), particularly in the peripheral nerves of the lower extremities. The patient typically experiences a “stocking-type” anesthesia beginning about 10 years after the onset of the disease. There may eventually be almost total anesthesia of the affected part with the potential for serious injury to the part without the patient being aware of it. In contrast, some patients experience debilitating pain and hyperesthesia, with loss of deep tendon reflexes.

Other problems related to the destruction of nerve tissue are the result of autonomic nervous system involvement. These include impotence, orthostatic hypotension, delayed gastric emptying, diarrhea or constipation, and asymptomatic retention of urine in the bladder.

Although age of onset and length of the disease process are related to the frequency with which vascular, renal, and neurologic complications develop, there are some patients who remain relatively free of sequelae even into the later years of their lives. Because diabetes mellitus is not a single disease but rather a complex constellation of syndromes, each patient has a unique response to the disease process.
Management. There is no cure for diabetes; the goal of treatment is to maintain blood glucose and lipid levels within normal limits and to prevent complications. In general, good control is achieved when the following occur: fasting plasma glucose is within a specific range (set by health care providers and the individual), glycosylated hemoglobin tests show that blood sugar levels have stayed within normal limits from one testing period to the next, the patient's weight is normal, blood lipids remain within normal limits, and the patient has a sense of health and well-being.

The protocol for therapy is determined by the type of diabetes; patients with either type 1 or type 2 must pay attention to their diet and exercise regimens. Insulin therapy may be prescribed for patients with type 2 diabetes as well as any who are dependent on insulin. In most cases, the type 2 diabetes patient can be treated effectively by reducing caloric intake, maintaining target weight, and promoting physical exercise.

Diet. In general, the diabetic diet is geared toward providing adequate nutrition with sufficient calories to maintain normal body weight; the intake of food is adjusted so that blood sugar and serum cholesterol levels are kept within acceptable limits. Overweight diabetic patients should limit caloric intake until target weight is achieved. In persons with type 2 diabetes this usually results in marked improvement and may eliminate the need for drugs such as oral hypoglycemic agents.

The patient, physician, nurse, and dietician must carefully evaluate the patient's life style, nutritional needs, and ability to comply with the proposed dietary prescription. There are a variety of meal planning systems that can be used by the patient with diabetes; each has benefits and drawbacks that need to be evaluated in order to maximize compliance. Two of the most frequently used ones are the exchange system (see accompanying table) and the carbohydrate counting system.

In the exchange system, foods are divided into six food groups (starch, meat, vegetable, fruit, milk, and fat) and the patient is taught to select items from each food group as ordered. Items in each group may be exchanged for each other in specified portions. The patient should avoid concentrated sweets and should increase fiber in the diet. Special dietetic foods are not necessary. Patient teaching should emphasize that a diabetic diet is a healthy diet that all members of the family can follow.

The carbohydrate counting system focuses on matching the unit of insulin to the total number of grams of carbohydrate in food eaten. This system is the most accurate method for calculating insulin to food intake.

It is especially important that persons with diabetes who are taking insulin not skip meals; they must also be sure to eat the prescribed amounts at the prescribed times during the day. Since the insulin-dependent diabetic needs to match food consumption to the available insulin, it is advantageous to increase the number of daily feedings by adding snacks between meals and at bedtime.

Exercise. A program of regular exercise gives anyone a sense of good health and well-being; for persons with diabetes it gives added benefits by helping to control blood glucose levels, promoting circulation to peripheral tissues, and strengthening the heart beat. In addition, there is evidence that exercise increases the number of insulin receptor sites on the surface of cells and thus facilitates the metabolism of glucose. Many specialists in diabetes consider exercise so important in the management of diabetes that they prescribe rather than suggest exercise.

Persons with diabetes who take insulin must be careful about indulging in unplanned exercise. Strenuous physical activity can rapidly lower their blood sugar and precipitate a hypoglycemic reaction. For a person whose blood glucose level is over 250 mg/dl, the advice would be not to exercise at all. At this range, the levels of insulin are too low and the body would have difficulty transporting glucose into exercising muscles. The result of exercise would be a rise in blood glucose levels.

Insulin Therapy. Exogenous insulin is given to patients with diabetes mellitus as a supplement to the insufficient amount of endogenous insulin that they produce. In some cases, this must make up for an absolute lack of insulin from the pancreas. Exogenous insulin is available in various types. It must be given by injection, usually subcutaneously, and because it is a potent drug, the dosage must be measured meticulously. Commonly, regular insulin, which is a fast-acting insulin with a short span of action, is mixed with one of the longer-acting insulins and both types are administered in one injection.

Human insulin (Humulin) is produced by recombinant DNA technology. This highly purified biosynthetic insulin reduces the incidence of allergic reactions and the changes in subcutaneous tissues (lipodystrophy) at sites of injection.

Recently, battery-operated insulin pumps have been developed that can be programmed to mimic normal insulin secretion more closely. A person wearing an insulin pump still must monitor blood sugar several times a day and adjust the dosage, and not all diabetic patients are motivated or suited to such vigilance. It is hoped that in the future an implantable or external pump system may be perfected, containing a glucose sensor. In response to data from the sensor the pump will automatically deliver insulin according to changing levels of blood glucose.

Oral Agents. Oral antidiabetic drugs (see hypoglycemic agents) are sometimes prescribed for patients with type 2 diabetes who cannot control their blood glucose with diet and exercise. These are not oral forms of insulin; they are sulfonylureas, chemically related to the sulfonamide antibiotics. Patients receiving them should be taught that the drug they are taking does not eliminate the need for a diet and exercise program. Only the prescribed dosage should be taken; it should never be increased to make up for dietary indiscretions or discontinued unless authorized by the physician.
Patient Education. Successful management of diabetes requires that the patient actively participate in and be committed to the regimen of care. The problem of poor control can cause serious or even deadly short-term and long-term complications, with devastating effects on the patient's longevity and sense of well being. There are many teaching aids available to help persons with diabetes understand their disease and comply with prescribed therapy. In general, a patient education program should include the following components:

1. Monitoring of blood glucose status. In the past, urine testing was an integral part of the management of diabetes, but it has largely been replaced in recent years by self monitoring of blood glucose. Reasons for this are that blood testing is more accurate, glucose in the urine shows up only after the blood sugar level is high, and individual renal thresholds vary greatly and can change when certain medications are taken. As a person grows older and the kidney is less able to eliminate sugar in the urine, the renal threshold rises and less sugar is spilled into the urine. The position statement of the American Diabetes Association on Tests of Glycemia in Diabetes notes that urine testing still plays a role in monitoring in type 1 and gestational diabetes, and in pregnancy with pre-existing diabetes, as a way to test for ketones. All people with diabetes should test for ketones during times of acute illness or stress and when blood glucose levels are consistently elevated.

2. Home glucose monitoring using either a visually read test or a digital readout of the glucose concentration in a drop of blood. Patients can usually learn to use the necessary equipment and perform finger sticks. They keep a daily record of findings and are taught to adjust insulin dosage accordingly. More recent glucose monitoring devices can draw blood from other locations on the body, such as the forearm.

3. Pathophysiology of diabetes mellitus, including functions of the pancreas and the long-term effects of uncontrolled diabetes.

4. Insulin administration (if appropriate), including types of insulin and syringes, rotation of sites of injection, injection techniques, and pump therapy instructions.

5. Signs and symptoms ofhyperglycemiaandhypoglycemia, and measures to take when they occur. (See accompanying table.) It is important for patients to become familiar with specific signs that are unique to themselves. Each person responds differently and may exhibit symptoms different from those experienced by others. It should be noted that the signs and symptoms may vary even within one individual. Thus it is vital that the person understand all reactions that could occur. When there is doubt, a simple blood glucose reading will determine the actions that should be taken.

6. Oral antidiabetic agents, including information about drug-drug interactions, proper administration, and potential side effects.

7. Personal hygiene and activities of daily living, including general skin care, foot care, treatment of minor injuries to avoid infection, a formal exercise program as well as exercise at school or at work, recreational activity, and travel.

8. Identification tag and card and needed medical information.

9. Information on what to do on “sick days” when nausea, vomiting, or respiratory infection can interfere with the usual meals and exercise.

10. Importance of keeping appointments and staying in touch with a health care provider for consultation and assessment. Periodic evaluation of the binding of glucose to hemoglobin (glycosylated hemoglobin or hemoglobin A1C testing) can give information about the effectiveness of the prescribed regimen and whether any changes need to be made. The ADA position statement on tests of glycemia in diabetes recommends routine testing for all patients with diabetes. It should be a part of the initial assessment of the patient, with subsequent measurements every three months to determine if the patient's metabolic control has been reached and maintained.
See illustration.
Complications of diabetes mellitus. From Damjanov, 2000.
nephrogenic diabetes insipidus a rare form caused by failure of the renal tubules to reabsorb water; there is excessive production of antidiuretic hormone but the tubules fail to respond to it. Characteristics include polyuria, extreme thirst, growth retardation, and developmental delay. The condition does not respond to exogenous vasopressin. It may be inherited as an X-linked trait or be acquired as a result of drug therapy or systemic disease.
pituitary diabetes insipidus central diabetes insipidus.

gestational diabetes

n.
A form of diabetes mellitus that develops or is first recognized during pregnancy and, if untreated, can lead to complications such as preeclampsia and high birth weight. It is associated with an increased risk of subsequent development of type 2 diabetes.

ges·ta·tion·al di·a·be·tes

(jes-tā'shŭn-ăl dī-ă-bē'tēz)
High blood sugar in a pregnant female never known to have diabetes; affects about 4% of all pregnant women; cause unknown, but may be related to the placental hormones blocking insulin action.

gestational diabetes

maternal, asymptomatic, glucose intolerance of pregnancy; usually remits after delivery; likely to recur in subsequent pregnancies; can predict type 2 diabetes in later life

Patient discussion about gestational diabetes

Q. What complications have you had with gestational diabetes? I have just found out that I have gestational diabetes and I am over 37 weeks pregnant. It has gone undiagnosed and we have found out that I why my baby is so large. She is already 8 pounds 12 ounces based on the ultra sound. My concerns are now with my baby and I want her to be healthy. Any personal experiences would be great!

A. Thanks for the help..

Q. What is Gestational Diabetes? What is Gestational Diabetes?

A. Gestational diabetes is a condition where you have high blood glucose (sugar) levels and it happens for the first timing during your pregnancy. About 7% of all pregnant women in the U.S. are diagnosed with gestational diabetes.

Q. How do I prevent Gestational diabetes? The first pregnancy I developed Gestational diabetes at the 26 week. How do I prevent it from happening?

A. There are no guarantees when it comes to preventing gestational diabetes — but the more healthy habits you can adopt before pregnancy, the better. Because the risk factors are the same as diabetes type 2 – the same measures should be taken- Eat healthy foods, Get more physical activity, Lose excess pounds.

More discussions about gestational diabetes
References in periodicals archive ?
The Pathway program now supports 11 scientists pursuing collaborative, multi-disciplinary approaches and applying expertise from other fields to type 1 diabetes, type 2 diabetes, gestational diabetes, obesity and topics relevant to both type 1 and type 2 diabetes.
The fully adjusted analysis controlled for the following: maternal age, origin, and marital status; previous stillbirth, miscarriage, or ectopic pregnancy; birth year; socioeconomic status; medical complications in the first live birth, including multiples, diabetes, gestational diabetes, placental abruption, placenta previa, and hypertensive disorders; and gestational age at birth and birth weight.
The test is useful as an aid in diagnosis of primary muscle-manifesting respiratory chain deficiencies, nonalcoholic fatty liver disease and other conditions related to type 2 diabetes, gestational diabetes and obesity.
A sample of 50,416 women who gave birth to one child were included in the study and those experiencing preeclampsia, hypertension, diabetes, gestational diabetes or placenta previa were excluded.
Diabetes sourcebook; basic consumer health information about type 1 and type 2 diabetes, gestational diabetes, and other types of diabetes and prediabetes.
Despite early reports of adverse effects in those exposed to metformin (8,9), the growing number of data suggests that metformin is a safe choice of treatment in pregnant women with type 2 diabetes, gestational diabetes and PCOS (10-12).
Diabetes, gestational AND (prenatal diagnosis OR mass screening OR early diagnosis)
Women who had used antihypertensive drugs before pregnancy and those who had multiple births, preexisting chronic hypertension, diabetes, gestational diabetes, cardiovascular disease or chronic renal disease were excluded, because these characteristics are associated with both preeclampsia or gestational hypertension and birth weight.
Erin began her career as a dietitian at Mercy Suburban Hospital where she gained experience counseling in oncology, cardiac rehab, diabetes, gestational diabetes, and outpatient weight management.
SAN DIEGO - Although women who delay pregnancy to age 40 years and older face an increased risk for adverse outcomes, reducing prepregnancy body mass index may reduce their risk for cesarean delivery, gestational diabetes, gestational hypertension / preeclampsia, and preterm delivery, results from a large study demonstrated.
He said a third type of diabetes, gestational diabetes mellitus (GDM), develops during some cases of pregnancy but usually disappears after pregnancy.
Investigators have ruled out diabetes, gestational diabetes, a lack of folic acid or zinc intake, and ethnic distinctions.

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