What does it mean to have gestational diabetes

What does having gestational diabetes mean for me and my baby?

Diane Reader, RDN, CDE Nutrition | 2 articles

In the 3 hours you waited through your gestational diabetes test, you’ve replayed every scenario in your head. What if I have gestational diabetes? Is my baby in danger? How does this alter my life? You hope for the best but fear for the worst. And when your results come back, you’ve been diagnosed with gestational diabetes. Gestational diabetes may put a little wrench in your pregnancy plan. But instead of worrying, let’s focus your energy on managing it. Trust me - you can handle it.

What does this mean for me and my baby?

If you have gestational diabetes, it means your glucose levels are too high. Only pregnant women can get gestational diabetes. And roughly 1 in 20 women do get it during their pregnancy. When you are pregnant, your baby shares your bloodstream. So, if the glucose levels in your bloodstream are a little too high, then your baby’s glucose levels are also high. In order to counteract these high glucose levels, your baby’s developing pancreas will work harder to produce more insulin to even things out. This means your baby is getting more calories than they need. And it means they will grow bigger than normal. This could lead to a C-section, traumatic birth or early delivery. After your baby is born and begins using their own bloodstream, rather than depending on yours, the doctor will test your baby’s blood sugar to make sure everything is okay.

Gestational diabetes treatment

Take comfort in knowing gestational diabetes is treatable. Diabetes educators like me are here to help you with the following treatments:

Making changes to how you eat. Good news - most women can manage their gestational diabetes by simply changing their food choices and portion sizes. Bad news – you’re going to have to put away (or significantly reduce) the cookies and ice cream for a while. A dietitian nutritionist will immediately begin working with you to develop a food plan that is nice to your pancreas so it doesn’t have to work so hard to make insulin. This will include eating healthy foods and drinks in six small meals throughout the day.
Testing your blood sugar. In addition to your new diet, you’ll also have to monitor your own blood sugar. You’ll be given a glucose meter and finger stick. First thing in the morning and after your three largest meals, you’ll use the finger stick and place a drop of blood into the glucose meter to test your blood sugar. You’ll continue visiting your diabetes educator to monitor your results.
Giving yourself additional insulin. If your body doesn’t respond to your new eating pattern, then you will need additional insulin. You’ll be given an insulin pen with small, thin needles. One to two times per day, you’ll give yourself a dose of insulin. I know right now you are hesitant, but I promise it doesn’t hurt!
Doing periodic testing after delivery. Because you have gestational diabetes, you have a 50 percent chance of getting type 2 diabetes later in your life. But, developing type 2 diabetes can be prevented by losing weight and daily physical activity. Your doctor will keep monitoring you. You’ll be tested for diabetes 6-8 weeks after you’ve delivered your baby, again in one year and then every three years. If you don’t get diabetes within 10 years, your chances of getting the disease are very low.

Being diagnosed with gestational diabetes is difficult news to hear. But, it’s treatable and your health care team is ready to provide support to get you through this. It may even be the kick start you need to make lifestyle changes to keep you and your family healthy.

Gestational Diabetes | CDC

Follow a healthy eating plan to nourish you and your baby.

Gestational diabetes is a type of diabetes that can develop during pregnancy in women who don’t already have diabetes. Every year, 2% to 10% of pregnancies in the United States are affected by gestational diabetes. Managing gestational diabetes will help make sure you have a healthy pregnancy and a healthy baby.

What Causes Gestational Diabetes?

Gestational diabetes occurs when your body can’t make enough insulin during your pregnancy. Insulin is a hormone made by your pancreas that acts like a key to let blood sugar into the cells in your body for use as energy.

During pregnancy, your body makes more hormones and goes through other changes, such as weight gain. These changes cause your body’s cells to use insulin less effectively, a condition called insulin resistance. Insulin resistance increases your body’s need for insulin.

All pregnant women have some insulin resistance during late pregnancy. However, some women have insulin resistance even before they get pregnant. They start pregnancy with an increased need for insulin and are more likely to have gestational diabetes.

About 50% of women with gestational diabetes go on to develop type 2 diabetes, but there are steps you can take to prevent it. Talk to your doctor about how to lower your risk and how often to have your blood sugar checked to make sure you’re on track.

Symptoms and Risk Factors

Gestational diabetes typically doesn’t have any symptoms. Your medical history and whether you have any risk factors may suggest to your doctor that you could have gestational diabetes, but you’ll need to be tested to know for sure.

Testing for Gestational Diabetes

It’s important to be tested for gestational diabetes so you can begin treatment to protect your health and your baby’s health.

Gestational diabetes usually develops around the 24^th week of pregnancy, so you’ll probably be tested between 24 and 28 weeks.

If you’re at higher risk for gestational diabetes, your doctor may test you earlier. Blood sugar that’s higher than normal early in your pregnancy may indicate you have type 1 or type 2 diabetes rather than gestational diabetes.

Prevention

Before you get pregnant, you may be able to prevent gestational diabetes by losing weight if you’re overweight and getting regular physical activity.

Don’t try to lose weight if you’re already pregnant. You’ll need to gain some weight—but not too quickly—for your baby to be healthy. Talk to your doctor about how much weight you should gain for a healthy pregnancy.

Treatment for Gestational Diabetes

You can do a lot to manage your gestational diabetes. Go to all your prenatal appointments and follow your treatment plan, including:

Checking your blood sugar to make sure your levels stay in a healthy range.
Eating healthy food in the right amounts at the right times. Follow a healthy eating plan created by your doctor or dietitian.
Being active. Regular physical activity that’s moderately intense (such as brisk walking) lowers your blood sugar and makes you more sensitive to insulin so your body won’t need as much. Make sure to check with your doctor about what kind of physical activity you can do and if there are any kinds you should avoid.
Monitoring your baby. Your doctor will check your baby’s growth and development.

If healthy eating and being active aren’t enough to manage your blood sugar, your doctor may prescribe insulin, metformin, or other medication.

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Gestational diabetes in pregnancy - treatment and diagnosis of diabetes in pregnant women in Moscow, Clinical Hospital on Yauza

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Contents

IMPORTANT!

The information in this section should not be used for self-diagnosis or self-treatment. In case of pain or other exacerbation of the disease, only the attending physician should prescribe diagnostic tests. For diagnosis and proper treatment, you should contact your doctor.

Specialists of the Yauza Clinical Hospital diagnose and treat gestational diabetes and its complications. For a comfortable pregnancy and the safety of the expectant mother and baby, we exercise strict control over the blood sugar level of a pregnant woman, if necessary, prescribe a specially designed diet and medications.

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About 7% of pregnant women have manifestations of gestational diabetes. In 50% of cases, the disease is asymptomatic
Gestational diabetes in pregnancy significantly increases the risk of pregnancy complications for both mother and fetus
Perinatal mortality increases by 2-3% with a combination of diabetes mellitus and pregnancy

Pregnancy diabetes (gestational diabetes) is an increase in blood glucose that first occurs during pregnancy but is not high enough to warrant a diagnosis of diabetes mellitus. These are hidden disorders of carbohydrate metabolism that threaten to develop into diabetes mellitus.

Pregnant blood glucose norm

During pregnancy, all women experience changes in insulin sensitivity and glucose tolerance. This is fine. The difference between the norm and pathology in the degree of change.

Blood tests for diabetes during pregnancy - norm and pathology

If the test of venous blood taken on an empty stomach shows a glucose level of more than 5.1 mmol / l, this is the norm for pregnant women.
From 5.1 to 7.0 mmol / l - gestational diabetes.
If 7.0 mmol / l or more - diabetes mellitus.
Testing capillary blood (taken from a fingerstick) for the diagnosis of gestational diabetes mellitus is not recommended.
If during an oral glucose tolerance test (when 75 g of glucose is taken orally during the study) after an hour the glucose level is more than 10. 0 mmol/l, and after two hours the blood glucose level is in the range of 7.8-8.5 mmol/l - then for pregnant women this is a normal indicator.

To better understand what gestational diabetes, or diabetes in pregnancy, is, you need to talk a little about hormonal changes in the body in pregnant women.

Causes of gestational diabetes

Hormonal changes that occur during pregnancy are associated with increased production of large amounts of steroid hormones. Some of them, such as cortisol and progesterone, have a significant effect on cell receptors, increasing their resistance to insulin.
This leads to an increase in blood glucose levels and requires a significant increase in insulin production by the pancreas. In cases where the compensatory capacity of the pancreas is not enough, sugar metabolism gets out of control and a condition called gestational diabetes or gestational diabetes develops.
This condition occurs quite often. Between 3 and 10% of pregnant women develop pathological insulin resistance leading to gestational diabetes.
Unlike diabetes mellitus diagnosed before pregnancy, pathological insulin resistance that occurs during pregnancy does not cause fetal malformations and in most cases does not require insulin treatment. But, nevertheless, uncompensated gestational diabetes can significantly complicate the course of pregnancy.

Specialists of the Yauza Clinical Hospital diagnose, treat and prevent diabetes in pregnant women and its complications, such as impaired fetal growth. The doctors of the Clinical Hospital on the Yauza strictly control the blood sugar level of a pregnant woman, if necessary, prescribe a specially designed diet. This ensures a comfortable pregnancy and the safety of the expectant mother and baby.

Pregnancy diabetes - consequences for the child

Large disproportionate fruit. The most important and frequent complication of gestational diabetes is fetal growth failure. Developing in conditions of increased blood glucose levels, which penetrate the fetoplacental barrier, the fetus is forced to compensate for the increased sugar level with its own insulin. Due to the fact that the structure of insulin and growth hormone are very similar, high levels of insulin stimulate the growth of the fetus. The problem is that a large fetus develops. In such a fetus, body proportions differ from those of normally developing newborns, in which the volume of the head is larger than the volume of the shoulder girdle. In fetuses with uncompensated gestational diabetes, the size of the shoulder girdle predominates, and the size of the abdomen increases. This leads to the fact that during childbirth after the fetus's head passes through the birth canal, the shoulders can get stuck (shoulder dystocia) and the child, along with the mother, can be severely injured or die.

Polyhydramnios or oligohydramnios. In addition, in gestational diabetes, the balance of the amount of amniotic fluid can be disturbed and either polyhydramnios or oligohydramnios develops. This is a serious risk factor for intrauterine fetal death or premature birth.

Underdevelopment of the lungs. In gestational diabetes, the lungs of the fetus mature later, as the production of surfactant (a special lubrication of the inner walls of the alveoli, where oxygen is exchanged in the lungs) is disrupted. Therefore, premature birth in gestational diabetes is especially dangerous.

Hypoglycemia and metabolic disorders in the fetus. Due to the constant increased production of its own insulin during pregnancy, immediately after birth, the child is in a state of hypoglycemia with electrolyte imbalance, which threatens his life.

All this dictates the need for the earliest possible detection of gestational diabetes in pregnant women, the level of sugar in the blood of a pregnant woman and to prevent the development of complications.

Diagnosis of diabetes in pregnant women at the Yauza Clinical Hospital

Signs of diabetes in pregnant women

Gestational diabetes in pregnancy is not usually associated with the classic symptoms of diabetes, such as thirst or excessive urination (polyuria).

Pregnancy tests for diabetes mellitus

First phase. At the first visit of a pregnant woman to a doctor at any time, she is tested for glucose levels in venous blood - fasting glucose, regardless of food intake, glycated hemoglobin. This is the first phase of research to detect diabetes mellitus or gestational diabetes in pregnant women. If diabetes mellitus is detected, the patient is referred for observation and treatment to an endocrinologist.

Second phase. For a period of 24-28 weeks, all patients who did not show identified disorders of carbohydrate metabolism at the first study are called for a glucose tolerance test (PGTT) to detect "hidden diabetes". This is done because the occurrence of gestational diabetes is associated with the development of insulin resistance under the influence of hormones produced by the placenta. Therefore, in the vast majority of cases, gestational diabetes develops in the second half of pregnancy after 24 weeks, when there is a peak in the production of placental hormones.

Glucose tolerance test

It is carried out to detect pathological insulin resistance, characteristic of latent diabetes in pregnant women. Pregnant women undergo a two-hour test, only in the laboratory.
During the 3 days leading up to the test, the woman should eat her usual diet, including carbohydrates (>150 g of carbohydrates per day), maintain her usual physical activity. The evening before testing, dinner should include 30-50 grams of carbohydrates.
On the day of the study, before the analysis, you should not smoke and take medications that can affect the level of glucose (vitamins, glucocorticoid hormones, iron preparations, which include carbohydrates, beta-agonists, beta-blockers). You can drink water.
Venous blood is taken on an empty stomach (after 8-14 hours of fasting, usually in the morning, before breakfast).
Then the patient takes a glucose solution (75 g).
And they take blood in an hour and two after the sugar load. Normally, the level of glucose in the blood after a sugar load should not exceed an hour later - 10 mmol / l, after 2 hours - 8.5 mmol / l.
If manifest diabetes mellitus is detected, the patient is referred to an endocrinologist, gestational diabetes mellitus is treated by an obstetrician-gynecologist or therapist.

Glucose tolerance test contraindications

Strict bed rest for a pregnant woman (until doctor's approval).
Pronounced toxicosis of pregnant women (with nausea and vomiting).
Acute infectious or inflammatory disease.
Exacerbation of chronic pancreatitis.
Dumping syndrome (syndrome of resected stomach).

Prenatal diabetes monitoring

Blood glucose monitoring, self-monitoring diary

When diagnosing gestational diabetes, it is necessary to establish strict control of sugar levels throughout the subsequent pregnancy and during childbirth. To do this, regularly examine the blood for sugar (glucose). In addition, the patient conducts self-monitoring using a glucometer.

It is recommended that a pregnant woman keep a diary of observations in which to record:

blood glucose level (normal <5.1 mmol/l),
the presence of ketone bodies in the urine, which is determined by test strips sold in a pharmacy (normally, ketone bodies are absent),
blood pressure readings (normal <130|80 mmHg),
fetal movements,
body weight,
diet.

Expert ultrasound

Conducting an expert ultrasound examination reveals signs of intrauterine suffering of the fetus (diabetic fetopathy), polyhydramnios. Most often, this is a sign of chronically elevated blood glucose levels, penetrating into the blood of the fetus. This requires urgent correction of the diet and normalization of the level of glycemia (blood sugar). If necessary, insulin therapy.

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Treatment of gestational diabetes

Diet for gestational diabetes

In most cases, it is sufficient to follow a special diet recommended by a nutritionist based on the body mass index of the pregnant woman and her taste preferences. The effectiveness of diet therapy is determined by the maintenance of normal blood glucose levels. Diet in pregnancy diabetes recommends:

Avoid simple carbohydrates - sweets, pastries, white bread, honey, sugar, jam, sweet drinks and fruits, ice cream.
Limit complex carbohydrates - cereals (semolina, rice - exclude), potatoes, corn, legumes, durum wheat pasta. Distribute their intake evenly over several meals throughout the day to eliminate starvation (causes the formation of ketone bodies).
Eat enough protein - meat, fish, seafood, poultry, mushrooms, eggs, hard cheese, dairy and sour-milk products of medium fat content (3-5%).
It is necessary to enrich the diet with fiber and vitamins - greens, vegetables (except for boiled carrots and beets), sweet and sour berries (excluding grapes).
Correctly choose fats, do not exceed their amount recommended by the doctor - vegetable oils (add to ready-made meals), nuts, seeds. Animal fats (butter, sausages) - limit.
When cooking, boil, stew, steam and bake dishes. Don't fry. Do not deep fry.

A detailed menu for a pregnant woman with gestational diabetes will be compiled by a doctor, taking into account the individual characteristics of each particular woman.
It is not worth using table No. 9 in its pure form for pregnant women with diabetes mellitus due to a significant restriction of its calorie content.
In detail, what you can eat with diabetes in pregnant women will be told by the doctor at an in-person consultation.

Pharmacotherapy

In cases where the diet fails to achieve the desired control of the level of glycemia in the blood, there are signs of a negative effect on the fetus - they resort to prescribing drugs - insulin. In case of diabetes in pregnant women, antidiabetic drugs in tablets should not be used. Insulin therapy is prescribed by an endocrinologist. Pregnant women with diabetes who are on insulin therapy are jointly managed by an endocrinologist, an internist and an obstetrician-gynecologist.

Physical activity

Patients are recommended regular physical activity - walking in the fresh air (at least 150 minutes per week), swimming.

Prenatal diabetes - childbirth

With a compensated course of gestational diabetes, normal development of the fetus and the condition of the woman, childbirth is carried out in time in a natural way. The question of early delivery, caesarean section may arise if there are relevant indications from the mother or fetus.

Specialists of the Yauza Clinical Hospital have included mandatory fetal development screenings and tests to diagnose sugar metabolism disorders in the pregnancy monitoring program. Recommendations are given on a special diet for women with manifestations of gestational diabetes. If necessary, strict glycemic control is carried out throughout pregnancy, ensuring its successful completion and the birth of a healthy child.

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Gestational diabetes during pregnancy

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Gestational Diabetes

What Causes Gestational Diabetes?

Doctors don't know exactly what causes gestational diabetes, but they have some ideas about it.

The placenta supports and nourishes the baby as it grows. Hormones from the placenta help the baby develop. But these same hormones also block the action of insulin, reducing its effectiveness. Gestational diabetes occurs when your body is no longer able to produce and use all the insulin it needs during pregnancy, resulting in high blood glucose levels if left untreated.

Some women are at higher risk of developing gestational diabetes. The following factors increase the risk of developing gestational diabetes:

Overweight before pregnancy
Too much weight gain during pregnancy (more than the recommended amount)
Age over 25
History of gestational diabetes
Presence of diabetes in close relatives
African American, Asian, Hispanic or Native American origin

How is gestational diabetes diagnosed?

Most women who receive good medical care during pregnancy are regularly screened for gestational diabetes between the 24th and 28th weeks of pregnancy. If you are at high risk of developing gestational diabetes, your doctor may test you earlier and/or more than once during your pregnancy.

During the test for gestational diabetes, your doctor will ask you to drink a sugary drink, and you will have a blood sample taken before and after you drink the drink. If the results show that the blood glucose level at the specified time is above the recommended limits, the diagnosis of gestational diabetes is confirmed. Your doctor will tell you about a plan for treating gestational diabetes.

Why is it important to treat gestational diabetes?

A mother instinctively protects her child. It is important for the health of both mother and child that treatment for gestational diabetes be started as soon as the diagnosis is made. If left untreated, gestational diabetes can cause problems that include the following:

An increased chance of having a large baby weighing more than 4 kg - this condition is called macrosomia. It increases the likelihood
- complications and injuries during vaginal delivery;
- cesarean section. (K-section)
Your baby is at high risk for preterm labor and breathing problems (respiratory distress)
Your baby is at high risk for low blood sugar (hypoglycemia) shortly after birth
You are more likely to have preeclampsia (high blood pressure and liver or kidney problems)

Following your doctor's instructions and carefully managing your gestational diabetes can greatly reduce your risk of developing these complications.

What to expect with a diagnosis of gestational diabetes?

If you have been diagnosed with gestational diabetes:

Your doctor will recommend a healthy carbohydrate-controlled diet and exercise. In many cases, these measures will be sufficient to control blood glucose levels throughout pregnancy.
You may need help from a dietitian in developing a healthy eating plan. A nutritionist can teach you how to control the amount and types of carbohydrates in your food so that you can manage your blood glucose levels while still meeting the needs of your growing child. You may also be asked to keep a food journal and monitor your weight.
You may need to check your blood glucose daily with a glucometer. Ask your doctor or diabetes consultant to recommend a glucometer that is right for you. Checking and tracking your blood glucose levels will help you and your doctor manage your gestational diabetes.

As a rule, blood glucose levels should be checked at least 4 times a day, usually on an empty stomach, and then 1-2 hours after a meal. Your doctor or healthcare professional will tell you how often you should test and what your target blood glucose range is. Remember to record your blood glucose measurements, including the time and results of the test, before or after a meal, and how long after a meal the test was taken.

Light exercise during pregnancy will help your body make better use of its own insulin and help control blood glucose levels. Types of exercise that can be safely performed by pregnant women include brisk walking and swimming. Talk to your doctor for advice on safe exercise during pregnancy.

At your appointment, the midwife can check your blood pressure and take a urine sample. You will also talk to your doctor about your blood glucose test results, how you eat, how much exercise you do, and how much weight you have gained. Your growing child will also be closely monitored. All this will help determine if the prescribed treatment plan for gestational diabetes is working and if it needs to be adjusted.

If dietary changes and exercise don't help control your blood glucose, your doctor may prescribe medication—pills or insulin—for the rest of your pregnancy.

Medications (pills, insulin)

Just because your doctor prescribes pills or insulin does not mean that you have failed to manage your gestational diabetes. In some cases, your body may simply not be able to produce enough insulin on its own that your body needs as your baby grows. It is very important to follow your doctor's advice to protect yourself and your baby. You may be able to stop taking antidiabetic drugs after the baby is born.

If your doctor prescribes insulin to treat gestational diabetes, you can get it by injection or by other means, such as an insulin pump. Someone in your family can learn this with you and help you take your insulin as prescribed by your doctor. Fortunately, today, thanks to insulin syringes with small, thin needles, injections are virtually painless. Your doctor will tell you when and how much insulin you should take each time, and may recommend adjusting your insulin intake during your pregnancy.

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