Last month I discussed pre-gestational diabetes, and this month I want to talk about gestational diabetes. You may recall that gestational diabetes is diabetes only in pregnancy. Gestational diabetes accounts for 90% of all diabetes in pregnancy and affects 7% of all pregnancies. As obesity and sedentary lifestyle increase, the incidence of gestational diabetes increases.
Women with gestational diabetes develop carbohydrate intolerance in the third trimester, which is why screening is between 24-28 weeks gestation. Blood glucose testing is done in the morning prior to eating (fasting), and 2 hours after breakfast, lunch, and dinner. Women who are diagnosed with gestational diabetes may be advised to adjust diet and exercise habits. If diet and exercise does not yield adequate glucose control, your provider may recommend a medication in the form of a pill or insulin, depending on your needs.
In addition to treatment and glucose monitoring, patients with gestational diabetes will require growth ultrasounds and fetal well-being testing in the form of non-stress testing or a biophysical profile. It’s crucial that patients with gestational diabetes adhere to the medications as prescribed and keep appointments for ultrasounds and fetal well-being testing as gestational diabetes is not without risks for both mom and baby.
Risks to the mom include a higher risk of blood pressure complications in pregnancy, requiring treatment or early delivery. Patients with gestational diabetes also have a higher risk of requiring a cesarean delivery and are exposed to the risks of surgery. Lastly, these patients have a 50% chance of developing diabetes later in life.
Risks to the baby include marcosomia, or a significantly larger than average baby. We sometimes mistake that a healthy baby is a chubby baby – but these babies can be at serious risks. Larger babies suffer from neonatal hypoglycemia, or low blood glucose levels soon after birth. This happens because all of the excess insulin from the mom’s system crosses through the placenta and continues to work after the baby is born, but the source of excess glucose is lost leading to low neonatal glucose. Additional risks occur at the time of delivery and include shoulder dystocia, bone or nerve injuries from a difficult delivery, need for an operative delivery, and hyperbilirubinemia requiring treatment, delayed discharge or readmission.
I’ve encountered patients who will provide false glucose values during their appointments or be hesitant to increase the dose of their current diabetes medication. It’s important to understand that treatment of gestational diabetes leads to a healthy mom and baby. Be honest with your provider about your questions and concerns related to treatment and management of gestational diabetes. We understand that there will be days when you attend a party or eat at a restaurant and this may prevent you from eating appropriately – that’s ok! What matters is that overall you create healthier food and exercise habits, take your medications as prescribed, monitor your glucose levels, and keep your appointments.
If you’re diagnosed with gestational diabetes, think of it as an opportunity to improve your overall health and the heath of your baby. Communicate with your provider about any obstacles you may have with sticking to your diet, taking your medications, or keeping your appointments. Most importantly, don’t let this prevent you from enjoying your pregnancy and the birth of your new baby.
Dr. Parin Patel, is an OB/GYN Resident Physician, University of Texas Medical Branch; the District XI Toy Advocacy Fellow and President of the American Medical Women’s Association (AMWA) Resident Division