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During pregnancy, rising levels of placental hormones cause a resistance to insulin actions.
Usually, the body will compensate by producing increased amounts of insulin. However, age,
obesity, family history, and pancreatic reserve are factors which may make a woman susceptible
to gestational diabetes.
Testing involves a visit to the laboratory. One hour after drinking a sweet cola, either at
home or at the laboratory, a blood sample will be drawn and analyzed.
The test is abnormal or positive if the glucose level is 135 mg./dl. or higher. Any reading
below 135 mg./dl. is considered within normal limits, and the mother is at very low risk for
developing gestational diabetes.
A positive screen, 135 mg./dl. or higher, requires further evaluation with a three-hour
glucose tolerance test. The preparation for this test is more involved. A three-day, high
carbohydrate preparation diet is required for the most accurate results. Then, after an
overnight fast, a blood sample is drawn. The mother drinks a solution containing glucose and,
after each hour for three consecutive hours, a blood sample is drawn. A diagnosis of
gestational diabetes is made if at least two of the blood glucose levels are elevated over the
norm.
Mothers with gestational diabetes need to understand the following points:
- What is gestational diabetes and what are the potential risks to me and my baby?
- What are my individual dietary needs?
- What does a balanced exercise program consist of?
- Self-monitoring of blood glucose.
- How to record fetal movement.
- The use of insulin treatment if needed.
Treatment for gestational diabetes includes dietary counseling and blood glucose monitoring.
The goal is to maintain a glucose level of between 60-120 mg./dl. A referral to the
Diabetes Center is made for nutritional counseling. The diet is well-balanced, carefully controlling
carbohydrate, fat and protein eaten in three meals and two or three snacks daily.
Approximately 5 percent of women with gestational diabetes cannot adequately control their
glucose levels by dietary management alone and need insulin therapy.
If gestational diabetes is treated appropriately, there is little difference between the
outcome of a pregnancy complicated with gestational diabetes and one where blood sugar levels
have been normal. However, untreated gestational diabetes has significant consequences. Fetal
and neonatal mortality rates of up to 20% have been reported by researchers. Complications may
include large birth weight babies, post delivery low blood sugar for babies and blood chemical
imbalance. Children of gestational diabetic mothers may be at greater risk for obesity and
development of glucose intolerance later in life.
Sometimes gestational diabetes does not show up until later, somewhere around the 32nd week of
pregnancy. If after an elevated gestational diabetes screen, the three-hour glucose tolerance
test has only one elevated blood sugar level, care options will be individualized.
An important component of the plan of care is exercise. Walking after a meal can work to
decrease blood sugar levels. Other good forms of exercising are swimming, prenatal exercise
classes, and stationary biking.
Gestational diabetes is not of itself an indication for early delivery or cesarean section.
The timing and route of delivery will be individualized, and the plan carefully worked out
between the mother and her doctor.
After the baby is born, what are the consequences of gestational diabetes for the mom? At the
six-week postpartum checkup, a follow-up blood test will be done to be sure mom's blood sugar
levels have returned to normal. Life-time periodic blood sugar surveillance is needed because
the risks of becoming a diabetic is greater. With the next pregnancy, blood sugar screening is
done at the first OB visit and at 28 weeks.
Note: This information applies only to Lansing OB/GYN Associates.
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