Gestational Diabetes on the rise….…

Gestational Diabetes Mellitus (GDM) has been characterized as carbohydrate intolerance that begins or is first recognized during pregnancy; Pregnancy changes the way insulin works, Some women develop gestational diabetes as a result of this change. The reported prevalence of Gestational diabetes in US is 2–10% of all pregnancies. Several risk factors are linked to gestational diabetes. It also occurs in women who have no risk factors.

What are the Risk Factors linked to GDM?

·        Older than 25 years  when pregnant

·        Overweight  (BMI.>25)

·        History of Gestational diabetes

·        History of given birth to very large baby >9LBS 

·        Family history of diabetes

·        South or East Asian, Hispanic, African American, Native America or Pacific Islander

·        History of polycystic ovary syndrome- PCOS

How do you screen for GDM?

All pregnant women are screened for these risk factors; a lab test can detect gestational diabetes. If you have any of the above risk factors for GDM, your blood glucose level is measured early in pregnancy, If no risk factors, you may be tested between 24 and 28 weeks of pregnancy. The test is safe and simple; first, you drink a liquid that has sugar in it, next, samples of your blood are taken, the glucose level are measured, If the level is high, more tests are done to find out if you have diabetes.

Effects of GDM during Pregnancy

In women with GDM, high blood glucose levels during pregnancy increase the risk of having a very large baby and possible cesarean birth. Preeclampsia also is more common in women with gestational diabetes.

Effects of GDM after Pregnancy

One third of women who had gestational diabetes during pregnancy have diabetes or a milder form called glucose intolerance after giving birth. Up to one half will develop type 2 diabetes later in life. Women who have had gestational diabetes should get regular tests for diabetes after pregnancy.

Management of Diabetes during pregnancy

The goals of GDM treatment are to keep blood glucose levels within normal limits during pregnancy and to make sure the baby is healthy. Doing so requires 1) daily monitoring of glucose levels 2) eating healthy foods, 3) exercising regularly, and 4) taking medication if needed.

·        Daily monitoring of glucose levels: Using a Glucose Meter log your values and discuss with your health care provider at every visit.

·        Eating healthy foods: I am pregnant and have to eat for two… IS A MYTH! A balanced diet is the key to pregnancy, the food you eat directly affects your baby’s nourishment, growth and development, following a diet is as important as taking medication and not eating properly can cause glucose levels to fluctuate too high or too low. The number of calories you need depends on your weight, stage of pregnancy, age, and level of activity. In most cases, the diet will include special meals. Meals and snacks will be spread throughout the day and before bedtime. You may be asked to keep a log of what you eat. Changes may be made to improve glucose control or to meet the needs of the growing baby

·        Exercising regularly: is important as it helps keep glucose levels in the normal range. You and your health care provider will decide how much and what type of exercise you need. Usually, 30 minutes of exercise per day are recommended.

·        Taking medication: When GDM cannot be controlled by exercise and diet your health care provider might put you on medications to keep glucose levels normal.

Prenatal care is also very important; you will have special testing in addition to routine health care, such as Ultrasound, Non Stress Test (NST) and BioPhysical Profile (BPP).

Delivery

Most women with diabetes are able to have a vaginal birth but are more likely to have a cesarean birth than women without diabetes. Labor also may be induced earlier than the due date if problems with the pregnancy arise. After birth, most babies of women with good glucose control do well. Some may need to spend time in a special care nursery. Problems can include low glucose levels, low calcium and magnesium levels in the blood, jaundice (yellow color of the skin), and breathing problems, these problems can be treated soon after birth. If your glucose levels were well controlled during your pregnancy, your baby is less likely to have problems after birth.

Postpartum Care

High blood glucose levels often go back to normal after delivery, however women with GDM should be watched closely after birth and should be tested for diabetes in 6 to 12 weeks postpartum, even if the result are normal, you are more likely to develop type 2 diabetes later in life. The American Diabetes Association recommends that women who have had gestational diabetes and who had a normal postpartum glucose test result be tested for diabetes every 3 years. Be sure to tell any health care providers whom you see that you have had gestational diabetes

Finally...

GDM is a concern in pregnancy, knowing the risk factors and having prenatal screening at 24 – 28 weeks will help detect GDM early