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Gestational Diabetes Health Article

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Diagnosis

Since gestational diabetes most often exists with no symptoms detectable by the patient, and since its existence puts the developing baby at considerable risk, screening for the disorder is a routine part of pregnancy care. This screening is usually done between the 24th and 28th week of pregnancy. By this point in the pregnancy, the placental hormones have reached a sufficient level to cause insulin resistance. Screening for gestational diabetes involves the pregnant woman drinking a special solution that contains exactly 50 grams of glucose. An hour later, the woman's blood is drawn and tested for its glucose level. A level less than 140 mg/dl is considered normal.

When the screening glucose level is over 140 mg/dl, a special three-hour glucose tolerance test is performed. This involves following a special diet for three days prior to the test. This diet is set-up to contain at least 150 grams of carbohydrate each day. Just before the test, the patient is instructed to eat and drink nothing (except water) for 10–14 hours. A blood sample is then tested to determine the fasting glucose level. The patient then drinks a special solution containing exactly 100 grams of glucose, and her blood is tested every hour for the next three hours. If two or more of these levels are elevated over normal, then the patient is considered to have gestational diabetes.

Treatment

Treatment for gestational diabetes will depend on the severity of the diabetes. Mild forms can be treated with diet (decreasing the intake of sugars and fats, in particular). Many women are put on strict, detailed diets, and are asked to stay within a certain range of calorie intake. Exercise is sometimes used to keep blood sugar levels lower. Patients are often asked to regularly measure their blood sugar. This is done by poking a finger with a needle called a lancet, putting a drop of blood on a special type of paper, and feeding the paper into a meter which analyzes and reports the blood sugar level. When diet and exercise do not keep blood glucose levels within an acceptable range, a patient may need to take regular shots of insulin.

Many babies born to women with gestational diabetes are large enough to cause more difficult deliveries, and they may require the use of forceps, suction, or cesarean section. Once the baby is born, it is important to carefully monitor its blood glucose levels. These levels may drop sharply and dangerously once the baby is no longer receiving large quantities of sugar from the mother. When this occurs, it is easily resolved by giving the baby glucose.

Prognosis

Prognosis for women with gestational diabetes, and their babies, is generally good. Almost all such women stop being diabetic after the birth of their baby. However, some research has shown that nearly 50% of these women will develop a permanent form of diabetes within 15 years. The child of a mother with gestational diabetes has a greater-than-normal chance of developing diabetes sometime in adulthood, also. A woman who has had gestational diabetes during one pregnancy has about a 66% chance of having it again during any subsequent pregnancies. Women who had gestational diabetes usually are tested for diabetes at the post-partum checkup or after stopping breastfeeding.

Prevention

There is no known way to actually prevent diabetes, particularly since gestational diabetes is due to the effects of normal hormones of pregnancy. However, the effects of insulin resistance can be best handled through careful attention to diet, avoiding becoming overweight throughout life, and participating in reasonable exercise.

BOOKS

Ferris, Thomas F. "Gestational Diabetes." In Harrison's Principles of Internal Medicine, ed. Anthony S. Fauci, et al. New York: McGraw-Hill, 1997.

Lowe, Ernest, and Gary Arsham. Diabetes: A Guide to Living Well. Minneapolis: Chronimed Publishing, 1997.

PERIODICALS

Bartholomew, Sallie P. "Make Way for Baby." Diabetes Forecast 50, no.12 (Dec. 1997): 20+.

Morrison, John C. "Prediction of Continued Glucose Intolerance in Women with Gestational Diabetes." Clinical Diabetes 14, no. 6 (Nov./Dec. 1996): 156.

Pasui, Kristine and Kay F. McFarland. "Management of Diabetes in Pregnancy." American Family Physician 55, no.8 (June 1997): 2731+.

Weller, Kenneth A. "Diagnosis and Management of Gestational Diabetes." American Family Physician 53, no. 6 (1 May 1996): 2053+.

ORGANIZATIONS

American Diabetes Association. 1701 North Beauregard Street, Alexandria, VA 22311. (800) 342-2383. <http://www.diabetes.org>.

Rosalyn Carson-DeWitt, MD

KEY TERMS

Glucose—A form of sugar. The final product of the breakdown of carbohydrates (starches).

Insulin—A hormone produced by the pancreas that is central to the processing of sugars and carbohydrates in the diet.

Placenta—An organ that is attached to the inside wall of the mother's uterus and to the fetus via the umbilical cord. The placenta allows oxygen and nutrients from the mother's bloodstream to pass into the unborn baby.

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