Gestational diabetes

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.

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diabetes /di·a·be·tes/ (di″ah-be´tēz) any disorder characterized by excessive urine excretion. When used alone, the term refers to diabetes mellitus.

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adult-onset diabetes mellitus  type 2 d. mellitus.

brittle diabetes  type 1 diabetes mellitus characterized by wide, unpredictable fluctuations of blood glucose values and difficult to control.

bronze diabetes , bronzed diabetes hemochromatosis.

central diabetes insipidus  diabetes insipidus due to injury of the neurohypophyseal system, with a deficient quantity of antidiuretic hormone being released or produced, causing failure of renal tubular reabsorption of water.

gestational diabetes , gestational diabetes mellitus that with onset or first recognition during pregnancy.

growth-onset diabetes mellitus  type 1 d. mellitus.

diabetes insi´pidus  any of several types of polyuria in which the volume of urine exceeds 3 liters per day, causing dehydration and great thirst, as well as sometimes emaciation and great hunger.

insulin-dependent diabetes mellitus  (IDD) (IDDM) type 1 d. mellitus.

juvenile diabetes mellitus , juvenile-onset diabetes mellitus type 1 d. mellitus.

ketosis-prone diabetes mellitus  type 1 d. mellitus.

maturity-onset diabetes mellitus  type 2 d. mellitus.

diabetes mel´litus  (DM) a chronic syndrome of impaired carbohydrate, protein, and fat metabolism owing to insufficient secretion of insulin or to target tissue insulin resistance. It occurs in two major forms: type 1 d. mellitus and type 2 d. mellitus, which differ in etiology, pathology, genetics, age of onset, and treatment.

nephrogenic diabetes insipidus  inherited or acquired diabetes insipidus caused by failure of the renal tubules to reabsorb water in response to antidiuretic hormone, without disturbance in the renal filtration and solute excretion rates.

non–insulin-dependent diabetes mellitus  (NIDD) (NIDDM) type 2 d. mellitus.

preclinical diabetes  former name for impaired glucose tolerance.

renal diabetes  see under glycosuria.

subclinical diabetes  former name for impaired glucose tolerance.

Type I diabetes mellitus  type 1 d. mellitus.

type 1 diabetes mellitus  one of the two major types of diabetes mellitus, characterized by abrupt onset of symptoms (often in early adolescence), insulinopenia, and dependence on exogenous insulin; it is due to lack of insulin production by the pancreatic beta cells. With inadequate control, hyperglycemia, protein wasting, and ketone body production occur; the hyperglycemia leads to overflow glycosuria, osmotic diuresis, hyperosmolarity, dehydration, and diabetic ketoacidosis, which can progress to nausea and vomiting, stupor, and potentially fatal hyperosmolar coma. The associated angiopathy of blood vessels (particularly microangiopathy) affects the retinas, kidneys, and arteriolar basement membranes. Polyuria, polydipsia, polyphagia, weight loss, paresthesias, blurred vision, and irritability also occur.

Type II diabetes mellitus  type 2 d. mellitus.

type 2 diabetes mellitus  one of the two major types of diabetes mellitus, peaking in onset between 50 and 60 years of age, characterized by gradual onset with few symptoms of metabolic disturbance (glycosuria and its consequences) and control by diet, with or without oral hypoglycemics but without exogenous insulin required. Basal insulin secretion is maintained at normal or reduced levels, but insulin release in response to a glucose load is delayed or reduced. Defective glucose receptors on the pancreatic beta cells may be involved. It is often accompanied by disease of blood vessels, particularly the large ones, leading to premature atherosclerosis with myocardial infarction or stroke syndrome.

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diabetes (dībē´tēz),

n a deficiency condition involving carbohydrate metabolism and characterized by increased urination.

diabetes, bronzed,

n the combination of hemochromatosis and diabetes mellitus. The skin takes on a bronzed appearance as a result of the deposition of an iron-containing pigment in the skin.

diabetes, gestational

(jestāshnl),
n the term describing patients who acquire glucose intolerance when pregnant.

diabetes insipidus

(insip´ids),
n 1. a metabolic disturbance characterized by marked urinary excretion and great thirst but no elevation of sugar in the blood or urine.
n 2. a pituitary dysfunction characterized by an insufficient output of antidiuretic hormone, leading to polyuria and polydipsia.

diabetes, juvenile,

n an older term for diabetes mellitus occurring in children and adolescents, usually of a more severe and rampant nature than diabetes mellitus in adults, with consequent difficulty of regulation. Now considered a form of type 1 diabetes mellitus.

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Patient discussion about 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.

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. Can gestational diabetes really be diagnosed without the 3 hour test? My doctor's office only did the one hour test and said I have gestational diabetes. Since I've been testing myself for a couple of days (four times a day) my average is in the 90's. Do you think it was really fair to diagnose me without giving me the 3 hour test and what can I do about it? I don't think I have it but they seem to think that one test is enough.

A. It can be diagnosed with only one test, but that result has to be quite high. Considering that diagnosis can prevent you from getting life insurance, I would insist that the doctor do a proper test or move to a different doctor.