This diabetes might have been there before pregnancy and could have gone unnoticed by the mom-to-be or it could have developed during pregnancy. In both cases, the future mother must be well informed because gestational diabetes has long-term and short-term impacts on her and her baby.
What is it?
During her pregnancy, the woman is affected by all the hormonal changes needed for the fetus to grow. The hormones secreted by the placenta disturb the capacity of the body to use insulin. As the placenta grows, it produces more hormones that make it harder and harder for the insulin to do its job.
These changes tend to raise the future mom’s glycemia to a point where her need for insulin doubles or even triples compared to what she needed before. If her body is not capable of producing enough insulin, the glucose stays in her blood, her glycemia rises and she develops gestational diabetes. This phenomenon that touches about 5% of all pregnancies usually begins in the last trimester and disappears after birth in 90 percent of the cases.
Women at risk
Many causes are responsible for gestational diabetes: first, the ethnic group of the mother and the amount of food she eats. For example, Indians, African Americans or Maoris from New Zealand are more at risk than European or American Caucasians. Very obese women aged over 30 or who have a family history of diabetes are also predisposed to gestational diabetes. Of course, a woman who has developed diabetes in a previous pregnancy risks developing it again in her future pregnancies.
A woman who is already diabetic and who wishes to become pregnant must consult her doctor before conceiving to create good conditions for a normal pregnancy.
Diagnosis
Even if a pregnant woman doesn’t show any signs of diabetes (thirst, unusual fatigue, frequent urination and loosing weight instead of gaining weight), her blood sugar levels may be too high. A simple urine test during her pregnancy follow-up can detect the presence of glucose. If there have been cases of diabetes in the family, if the woman is overweight or if she already had a baby with a birth weight of more than nine pounds, the doctor will want to look further and ask for a blood test. Ideally, this blood test will be taken around the 28th week of pregnancy to be able to react swiftly.
Screening test
One of the screening tests that we perform between the 24th and 28th week of pregnancy consists in drinking a “juice” that contains 75g of glucose and then taking three blood samples (one immediately after drinking, and twice every hour). Other doctors prefer a unique blood test one hour after the intake of 50 grams of glucose and to test further only if the results are too high.
Treatment
By adopting an appropriate diet and a good lifestyle (sleep, naps, exercise), it is possible to reduce the risk of diabetes. A dietician can give you a diet plan that is suitable to your condition and a list of foods to avoid. If your blood sugar is still too high, an insulin treatment is recommended in 20 to 40 percent of the cases. The injections will stop as soon as you give birth, provided, of course, that the blood sugar gets back to normal.
What about the baby?
Gestational diabetes, whether high or low, can cause the baby to overgrow (macrosomia), which often leads to a C-section because the baby is too heavy. Because the amniotic liquid is more abundant in diabetic women, they could also deliver prematurely. In addition, the child will be predisposed to being overweight and developing type 2 diabetes.
If the fasting blood sugar of the mother is too high, the baby may also suffer from hypoglycemia immediately after birth, as they are more likely to suffer from jaundice or have breathing difficulties. The risk of prenatal mortality is also higher.
Gestational diabetes can also cause maternal hypertension (preeclampsia), which directly affects the baby’s growth. These risks are greatly reduced if the mother receives a treatment to lower her blood sugar levels.
And after?
Women who suffered from gestational diabetes are at greater risk of developing type 2 diabetes. If the woman is overweight and does not exercise, the risks are even higher. Fortunately, the treatment during pregnancy reduces risks and increases the chances to succeed in another pregnancy.
