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Gestational Diabetes Health Article

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Definition

Gestational diabetes mellitus (GDM) is a condition that occurs during pregnancy. Like other forms of diabetes, GDM involves a defect in the way the body processes and uses sugars (glucose) in the diet. Gestational diabetes, however, has a number of characteristics that are different from other forms of diabetes. This form of diabetes does not include women who are diabetic before they become pregnant. Gestational diabetes usually occurs in the second and third trimesters of the pregnancy.

Description

Glucose is a form of sugar that is present in many foods, including sweets, potatoes, pasta, and breads. The body uses glucose to provide energy. It is stored in the liver, muscles, and fatty tissue. The pancreas produces a hormone (a chemical produced in one part of the body that travels to another part of the body in order to exert its effect) called insulin. Insulin is required to allow glucose to enter the liver, muscles, and fatty tissues, thus reducing the amount of glucose in the blood. In persons with diabetes, blood levels of glucose remain abnormally high. The inability of the pancreas to produce enough insulin is the cause of these high levels of glucose.

In gestational diabetes, the pancreas is not at fault. The problem is in the placenta. During pregnancy, the placenta provides the baby with nourishment. It also produces a number of hormones that interfere with the body's usual response to insulin. This condition is referred to as "insulin resistance." The development of insulin resistance is primarily caused by a substance called lactogen, which is produced during pregnancy, and from increased blood levels of the hormones progesterone and estrogen. The blood levels of these substances tend to peak in the second and third trimester of the pregnancy, which is when GDM is most likely to occur. Most pregnant women do not develop GDM because the pancreas works to produce extra quantities of insulin to compensate for insulin resistance. However, when a woman's pancreas cannot produce enough extra insulin, blood levels of glucose remain abnormally elevated, and the woman is considered to have GDM. It is believed that some women with borderline blood sugar problems before pregnancy are more likely to have long-term blood sugar regulation problems after developing GDM.

As of January 2001, about 200,000, or 7%, of pregnant women in the United States develop GDM every year. Women at risk for GDM include those who:

are overweight
have immediate family members with a history of Type II diabetes
have previously given birth to a large (over 9 lbs [4 kg]) baby
have previously had a baby who was stillborn, or born with a birth defect
have an excess amount of amniotic fluid (the cushioning fluid within the uterus that surrounds the developing fetus)
are over 25 years of age
belong to an ethnic group proved to experience higher rates of GDM. (In the United States, these groups include Hispanic-Americans, American Indians, and African-Americans, as well as individuals from Asia, India, and the Pacific Islands.)

have had GDM during a previous pregnancy

have persistent evidence of excess glucose in the urine

have a history of chronic drug abuse involving agents such as corticosteroids

Causes and symptoms

Most women with GDM have no recognizable symptoms. However, leaving GDM undiagnosed and untreated is dangerous to the developing fetus. Left untreated, a woman with diabetes will have consistently high blood sugar. This sugar will cross the placenta and the unborn baby's pancreas will respond to this high level of sugar by constantly producing large amounts of insulin. The insulin will allow the cells of the fetus to take in glucose, where it will be converted to fat and stored. A fetus that has been exposed to consistently high levels of sugar may be abnormally large. Such a baby may grow so large that he or she cannot be born through the vagina, but will instead need to be born through a surgical procedure (cesarean section).

Furthermore, when the baby is born, the baby will still have an abnormally large amount of insulin circulating in the blood. After birth, when the mother and baby are no longer connected via the placenta and umbilical cord, the baby will no longer be receiving the mother's high level of sugar. The baby's high level of insulin, however, will very quickly use up the glucose circulating in the its bloodstream, predisposing the baby to a dangerously low level of blood glucose (i.e., a condition called hypoglycemia).

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