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| |    Gestational Diabetes by Marjorie Greenfield, M.D. reviewed by Marjorie Greenfield, M.D. Pregnancy can cause a woman who has perfectly normal blood sugar to become temporarily diabetic, a condition known as gestational diabetes. This situation comes about, in part, because hormones from the placenta interfere with the action of insulin, the hormone responsible for regulating blood sugar. During a nondiabetic pregnancy, the mother-to-be increases her production of insulin to compensate for this pregnancy-related insulin resistance. However, there are women who are unable, for whatever reason, to increase their production of insulin to compensate for this normal event, and they develop gestational diabetes as a result. This condition is more common in mothers-to-be who are overweight or in the older age range, or who have a family history of diabetes mellitus. How do I know if I have gestational diabetes? Most women with gestational diabetes have no symptoms or findings that would alert them to this condition, so every expectant mom is routinely tested for gestational diabetes early in the third trimester. The screening test involves drinking a supersweet sugar solution and having your blood drawn an hour later. Testing may be done earlier if the mother-to-be shows signs of diabetes, such as spilling sugar into her urine. This would show up on the urine sample that the mom provides at each prenatal visit. Other reasons for early testing include if the woman has a strong family history of diabetes, if she is carrying more than one baby, if she is extremely overweight, or if she had diabetes in a prior pregnancy. Since many women who develop gestational diabetes don't test positive until the third trimester, those who are tested early should be retested at the routine testing time, around 24 to 28 weeks. Treatment of gestational diabetes Some gestational diabetics can be treated with only a strict low-carbohydrate diabetic diet; however, many mothers must monitor their blood sugar levels at home, and some must take insulin injections in order to assure that their blood sugars are within a safe range. Most research indicates that the babies do best if the mother's blood sugar levels are less than 105 before breakfast and below 120 the rest of the day. Keeping active and exercising regularly may help to control blood sugars. Pregnant women who don't already follow an exercise program of some sort--for example, swimming a few times a week or going on daily walks--should check with their doctor before taking up strenuous activity. In addition to measuring the mother's blood sugar levels at regular intervals, some diabetic pregnancies require extra tests to check on the baby, such as ultrasounds and nonstress heart-rate monitoring. Although the diagnosis of gestational diabetes can be distressing (and it certainly requires more work and self-discipline for the duration of the pregnancy), keep in mind that the prospects are very good for those who successfully keep their blood sugar under control. Maintaining a normal sugar range has been shown to offset most of the risks of gestational diabetes so that both mother and baby come through the pregnancy happy and healthy. Evaluation of the gestational diabetic mother after childbirth About half of all gestational diabetics become true diabetics within 20 years. Current guidelines for postpartum care include testing all mothers who had diabetes in pregnancy around six weeks after childbirth and continuing to watch for overt diabetes over time. For overweight women, weight loss may help prevent diabetes later in life.
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