The Practical Aspects

Managing gestational diabetes

Introduction

Gestational diabetes is any degree of glucose intolerance with onset or first recognition during pregnancy. It affects two to four per cent of all pregnancies and involves an increased risk of developing diabetes for both mother and child.

Meaning

Gestational diabetes means diabetes mellitus (high blood sugar) first found during pregnancy. In most cases, gestational diabetes is managed by diet and exercise and goes away after the baby is born.

Diabetes and Pregnancy

In the normal body, insulin helps glucose move into the cells so that it can be used as fuel. During pregnancy, the placenta produces many vital hormones, some of which, like estrogen, cortisol, and human placental lactones (HPL), block the effects of insulin. Most pregnant women's pancreases have the ability to produce enough extra insulin to overcome the influence of these blocking hormones. Those pregnant women whose pancreases do not produce enough extra insulin have ongoing elevations of their blood sugar, or gestational diabetes.

The insulin-blocking hormones begin to take effect at 20-24 weeks of pregnancy. The larger the placenta grows, the more hormones are produced, and the greater the insulin resistance becomes. When the placenta is delivered, the blocking hormones are eliminated, and the blood sugar usually returns to normal.

Women at Risk

While any pregnant woman can develop gestational diabetes, those at increased risk:

• A family history of diabetes in parents or brothers and sisters
• Gestational diabetes in a previous pregnancy
• The presence of a birth defect in a previous pregnancy
• Obesity in the woman, BMI greater than 29
• Older maternal age (over the age of 30)
• Previous stillbirth or spontaneous miscarriage
• A previous delivery of a large baby (greater than 9 pounds)
• A history of pregnancy induced high blood pressure, urinary tract infections, hydramnios (extra amniotic fluid), etc.
• Women with too much amniotic fluid (polyhydramnios)
• Women of Hispanic, First Nations, or of African-American decent

Risk for babies born to mothers with Gestational Diabetes

• Macrosomia (large, fat baby)
• Shoulder dystocia (birth trauma)
• Neonatal hypoglycemia (low blood sugar in the newborn)
• Long-range implications are an increased risk for obesity and diabetes
• Prolonged newborn jaundice
• Low blood calcium
• Respiratory distress syndrome

Prevention

Adult-onset diabetes can be prevented through healthy eating and regular exercise. In all, 85% of people with diabetes have adult-onset diabetes. It usually occurs in people over 40 years of age, especially those who are overweight. One can significantly reduce his/her risk of developing diabetes by maintaining a healthy body weight, engaging in regular physical activity, and eating well.

How Is Gestational Diabetes Diagnosed?

Gestational diabetes is usually diagnosed between the 24th and 28th week of pregnancy when insulin resistance usually begins. If you have had gestational diabetes before, or if your doctor is concerned about your risk of developing gestational diabetes, the test may be performed before the 13th week of pregnancy.

Cure?

A cure for Diabetes has not been found yet. However, it can be controlled. The ways to control diabetes are: maintaining blood glucose levels, blood fat levels and weight. Controlling diabetes is very important and should be supervised by a medical doctor. When diabetes is controlled, it will help prevent serious complications such as: infections, kidney damage, eye damage, nerve damage to feet and heart disease.

Blood glucose monitoring:

In patients requiring insulin therapy, the ideal frequency of glucose monitoring has not been established. A common practice is to check the glucose level four times daily. A first morning glucose level can rule out fasting hyperglycemia, and additional one- or two-hour postprandial values can ensure adequate control.

Postprandial testing is preferable to testing after a meal (dinner).Gestational diabetes is diagnosed when a patient has two or more abnormal values on a fasting 100-g, three-hour glucose tolerance test.

There is neither objective evidence nor a clinical guideline to support a frequency for glucose monitoring in patients with diet-controlled gestational diabetes. In these patients, an acceptable practice is to use the four-times-a-day schedule on two days per week and begin more intensive treatment if two values per week exceed the limits.

Diet

The ideal diet for women with gestational diabetes remains to be defined, and current recommendations are based on expert opinion. The ADA recommends nutrition counseling (with a registered dietitian, if possible) and a diet that adequately meets the needs of pregnancy but restricts carbohydrates to 35 to 40 percent of daily calories. Caloric restriction should be approached with caution.

Exercise for managing Gestational Diabetes

Exercise can play a significant role in managing blood glucose levels in women who develop gestational diabetes and in women with type II diabetes who becomes pregnant. Because contracting muscles help stimulate glucose transport, exercise can help women control gestational diabetes without insulin.

According to the recommendations, active women who have gestational diabetes may continue moderate exercise. Also, regular exercise in previously sedentary women shows promise for normalizing blood glucose levels. Many women with gestational diabetes have, in fact, led an inactive life. And because of the increased awareness of wellness and fetal well-being, pregnancy may be the most practical and convenient time to introduce lifestyle modifications such as regular exercise.

Additional studies, however, are needed to determine the effects of cardiovascular fitness training on fetal outcome and on ketone production. For now, exercise prescriptions should be individualized and conducted under careful medical supervision until their effectiveness is established.