Gestational Diabetes

What is Gestational Diabetes?

Gestational diabetes is a condition in which the glucose level is elevated and other diabetic symptoms appear during pregnancy in a woman who has not previously been diagnosed with diabetes. Diabetes and all diabetic symptoms disappear following delivery.

Unlike Type 1 diabetes, this form of diabetes is not caused by an absolute lack of insulin, but rather by the effects of hormones released during pregnancy on the insulin that is produced, a condition referred to as insulin resistance.

According to the CDC, approximately 2 to 10 percent of all pregnant women in the U.S. are diagnosed with this condition.

What Causes Gestational Diabetes?

Although the cause is not known, there are some theories as to why this occurs.

The placenta supplies a growing fetus with nutrients and water and also produces a variety of hormones to maintain the pregnancy. Some of these hormones (estrogen, cortisol, and human placental lactogen) can interfere with the effects of insulin. This is called contra-insulin effect, which usually begins about 20 to 24 weeks into the pregnancy.

As the placenta grows, more of these hormones are produced, and insulin resistance becomes greater. Normally, the pancreas is able to make additional insulin to overcome insulin resistance, but when the production of insulin is not enough to overcome the effect of the placental hormones, gestational diabetes results.

What are the Risk Factors?

Although any woman can develop gestational diabetes during pregnancy, some of the factors that may increase the risk include the following:

• Being overweight or obese
• Having a family history of diabetes
• Having a  prior history during previous pregnancies
• Having given birth previously to an infant weighing more than nine pounds
• Age -- women who are age 25 or older are at a greater risk than younger women.
• Race -- women who are Black, Native American, Asian American, Hispanic, or Pacific Islander have a higher risk.
• Having a history of prediabetes

Although increased glucose in the urine is often included in the list of risk factors, it is not believed to be a reliable indicator.

How is Gestational Diabetes Diagnosed?

New Standards of Medical Care in Diabetes-2013 from the ADA recommend screening for undiagnosed Type 2 diabetes at the first prenatal visit in women with diabetes risk factors. In pregnant women not known to have diabetes, testing should be performed at 24 to 28 weeks of gestation.

In addition, women with diagnosed gestational diabetes should be screened for persistent diabetes six to 12 weeks postpartum. Women with a history of gestational diabetes are recommended to be screened at least every three years for the rest of their lives for the development of diabetes or prediabetes.

What is the Treatment?

Specific treatment will be determined by your doctor based on:

• Your age, overall health, and medical history
• Extent of the disease
• Your tolerance for specific medications, procedures, or therapies
• Expectations for the course of the disease
• Your opinion or preference

Treatment focuses on keeping blood glucose levels in the normal range. Treatment may include:

• Special diet
• Exercise
• Daily blood glucose monitoring
• Insulin Injections
• Oral antidiabetic medication

What are the Possible Complications for the Baby?

Unlike Type 1 diabetes, gestational diabetes generally does not cause birth defects. Birth defects usually originate sometime during the first trimester (before the 13th week) of pregnancy. The insulin resistance from the counter-insulin hormones produced by the placenta does not usually occur until approximately the 24th week. Women with this type of diabetes generally have normal blood sugar levels during the critical first trimester.

Complications are usually preventable or manageable. The key to prevention is careful control of blood sugar levels just as soon as the diagnosis diabetes is made.

Infants of mothers with gestational diabetes are vulnerable to several problems at birth, such as low serum calcium and low serum magnesium levels, but, in general, there are two major problems: macrosomia and hypoglycemia:

• Macrosomia: Macrosomia refers to a baby that is considerably larger than normal. All of the nutrients the fetus receives come 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 this 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 that causes the fetus to grow excessively large. This may lead to difficulty in delivery, as the baby may be bigger than the birth canal.
• Hypoglycemia: Hypoglycemia refers to 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 a high level of sugar from its mother, resulting in the newborn's blood sugar level becoming very low. The baby's blood sugar level is checked after birth, and if the level is too low, it may be necessary to give the baby glucose intravenously.

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