Gestational diabetes
Gestational
diabetes appears toward the end of the second or in the third trimester. It refers to high blood sugar that occurs
only during pregnancy. Found in 2% to 4% of pregnancies, it
can affect both the mother and the fetus. In 90% of cases,
gestational diabetes disappears after the baby is born.
During pregnancy, the placenta produces hormones that interfere with the action of insulin. In certain women, this leads to hyperglycemia (high blood sugar), then to diabetes. Women over 35 who are overweight and have a family history of diabetes are more at risk than other women. As well, if a woman gave birth to a baby weighing more than 4 kg (9 lbs) and developed gestational diabetes in a previous pregnancy, she has a higher risk of developing this type of diabetes in a subsequent pregnancy.
Symptoms
Pregnant women generally have no obvious diabetes symptoms, but they sometimes occur : unusual fatigue, excessive thirst and frequent urination. If you develop these symptoms, you should consult your doctor.
Risks
There are many risks when blood sugar is not properly controlled.
For the mother:
- excessive fatigue
- rise in the risk of infection
- extra amniotic fluid, which increases the risk of a premature birth
- risk of a delivery by caesarean section because of a heavier baby
For the baby:
- larger and fatter than normal
- hypoglycemia (low blood sugar) at birth
- jaundice, especially if the infant is premature
- low blood calcium
- difficulty breathing
These complications arise when diabetes is not controlled during pregnancy.
Diagnosis
The Clinical Practice Guidelines for the Management of Diabetes in Canada recommend a diabetes screening test some time between the 24th and 28th weeks of pregnancy.
The screening test for gestational diabetes is a blood test that measures glycemia (blood sugar) one hour after drinking 50 g of glucose. If the result falls between 7.8 and 10.2 mmol/L, the attending physician will request a more elaborate blood test, and recommend that a dietician create an individualized meal plan for the pregnant woman.
If gestational diabetes is diagnosed, a dietician will create an individualized meal plan to control blood sugar levels. If that isn’t sufficient, the doctor will prescribe insulin injections (oral anti-diabetic drugs are not recommended during pregnancy).
Treatment
An individualized meal plan will generally suffice to control blood sugar levels. A healthy diet and lifestyle (rest, sleep and exercise) will often be enough to keep gestational diabetes under control. However, if high blood sugar levels persist, insulin injections will be necessary.
Delivery
Insulin injections stop as soon as birthing contractions begin. During the delivery, the medical team will monitor the mother’s blood sugar, choosing an appropriate treatment based on the readings. The baby’s blood sugar will also be controlled in the hours following its birth.
Gestational diabetes for the mother generally disappears after the baby is born. However, the mother has a higher risk of developing diabetes later, especially if she retains a great deal of her pregnancy weight. To avoid developing type 2 diabetes later, women need to watch their weight, exercise several times a week, have regular blood sugar tests after the birth, and consult their doctor before becoming pregnant again.
Breastfeeding
Breastfeeding, if the mother is able to do it, is recommended, as it is for all infants. The meal plan for a breastfeeding mother is virtually identical to the meal plan for the last trimester of pregnancy.
Source: Diabetes Quebec – March 2004.