Pregnancy and Gestational Diabetes

What is Gestational Diabetes?

Gestational diabetes is the most common medical condition complicating pregnancy today. 5% of pregnancies in England, 25% of pregnancies in Asia, and 4% of pregnancies in the United States have complications with gestational diabetes (Stewart, 2014) (Chasan-Taber, 2012). In the United States alone that’s about 200,000 cases annually (Chasan-Taber, 2012). Two-thirds of women with type 2 diabetes had gestational diabetes when pregnant (Chasan-Taber, 2012).

The World Health Organization (WHO) defines gestational diabetes as “carbohydrate intolerance resulting in hyperglycemia of variable severity with onset or first recognition during pregnancy” (Hunt, 2014). What this means is that a woman who typically have normal glucose tolerance lack the insulin in their third or fourth trimester for both her and the child living inside her. During the third and fourth trimester, both mother and child have an increased demand for insulin. Most women have a pancreas that can handled the need to increase natural insulin. Those that can’t have hyperglycemia (high glucose levels in their blood).

What causes gestational diabetes?

According to Buchanan, et al (2012) there are three reasons women have gestational diabetes.

  1. Less than 10% of women have immune markers that point to type 1 diabetes but did not develop type 1.
  2. About 5% have a genetic disposition to type 2 diabetes.
  3. Last and most prevalent is due to obesity and chronic insulin resistance.

Care for the mother after the birth of a baby is dependent on which of the three reasons gestational diabetes occurred. Your doctor will know what direction to take. Follow his guidelines.

What are the risks for women with gestational diabetes?

Below are risks to women who have gestational diabetes. This does not mean women with gestational diabetes will have issues such as these. But they are at a higher risk and research shows there is a tendency for some of these issues to occur.

  • Women with gestational diabetes are at a high risk of developing diabetes later in life.
    • 10% develop diabetes soon after pregnancy.
    • 20% – 60% develop diabetes within 5 – 10 years after delivery (if specific interventions are not taken to reduce the risk of diabetes). Research shows that not all women will get diabetes but the majority will.
  • Other risks are due to complications with having diabetes. I will not go into this in this article, I have written other articles that provide those risks.

What are the risks to offspring?

There are several risks to the unborn baby even after birth.

  • Increased risk of obesity during childhood and adolescents.
  • Gestational diabetes can influence fetal development.
  • Higher risk of spontaneous abortions and congenital anomalies.
  • Excessive fetal growth.
  • Neonatal hypoglycemia (low blood glucose).
  • Polycythemia (increased concentration of hemoglobin in the blood)

What if I have gestational diabetes?

  1. Most OB/GYN specialists test for gestational diabetes early and throughout pregnancy. This is important for the welfare of the baby. Following your doctor’s advice on care if you have developed gestational diabetes is critical.
  2. Make sure your doctor also refers you to a dietician to help you get the nutrients you and your child need.
  3. Your doctor should provide you with a glucose meter. Use it often. Check your glucose first thing in the morning, one hour after each meal and at bedtime. Write down the date & time, and the glucose level and share it with your doctor.
  4. There is research stating that insulin(injection), if needed, is better than MetFORmin(pill) because insulin does not cross the placenta and MetFORmin does. Check with your doctor.

What Next?

If you have or had gestational diabetes, eat healthy. Exercise. If you are overweight, loose the weight. Being overweight adds to the risk of type 2 diabetes. Make sure your child does the same. If you can prolong or keep from getting diabetes the better off you and your child are. If you have questions or comments, please let me know.

References:

Stewart, Z.A. (2014). Gestational Diabetes. Medicine, 43(1), 44-77. Doi:10.1016/mpmed.2014.10.010

Hunt, K.F. (2014). Gestational Diabetes. Obstetrics, Gynaecology and Reproductive Medicine, 24(8), 238-244. Doi:10.1016/j.ogrm.2014.05.005

ScD, Chasan-Taber, L. (2012). Gestational Diabetes, Is It Preventable?. American Journal of Lifestyle Medicine, 6(5), 395-406. Doi:10.1177/1559827611434401

Buchanan, T. A., Xiang, A. H., & Page, K. A. (2012). Gestational diabetes mellitus: Risks and management during and after pregnancy. Nature Reviews Endocrinology, 8(11), 639-649. doi:http://dx.doi.org/10.1038/nrendo.2012.96

7 thoughts on “Pregnancy and Gestational Diabetes

  1. Thank you for the very useful information, Hillard. I am wondering whether pregnant women used to be tested for diabetes when I was expecting my son, 17 years ago. The reason why I wonder is because I believe I am now intolerant to carbohydrates – is this possible, Hillard, that a gestational diabetes may result in intolerance later in life? Also, Hillard, can you get rid of diabetes whilst expecting, if this is diagnosed at any stage, and bring insuline levels back under control?
    Thank you again 🙂

    1. I know when my children were born (they are now in their early-to-mid 20s) my ex-wife was checked for and had gestational diabetes, and she was not overweight. So doctors have been checking for this for a long time due to the health and growth of the baby. A large percentage of women (up to 60%) who have gestational diabetes, develop diabetes in their lifetime. While pregnant, doctors usually recommend a dietician to women to help control glucose levels but I have not heard of reversal of gestational diabetes while pregnant. But in most cases, gestational diabetes goes away after pregnancy because the pancreas is only working for one person instead of two. I hope this helps.

      Hillard Mellin, MBA

  2. This is some really great information. It seems like the most important aspect is knowing that you have this issue. and then following all the doctors orders while eating and exercising regularly. Hopefully, more people with this read this article and take care of themselves and live a healthier, happier life.

  3. This is a great post! I had no idea this was such a big problem. People should be educated about issues like this because I feel they often go unattended. I will definitely keep this in mind when I have kids in the future.

  4. I am so glad this is on the forefront of patient care. Many complications can be avoided by catching it early! Is it true that if a woman is pregnant at an older age she is more likely to develop G. Diabetes?

  5. This is so useful information for me in that condition. I am 4 months pregnant and I have not yet tested myself for diabetes. Should I get gestational diabetes to check?

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