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You may feel frightened and confused by a recent diagnosis of gestational diabetes and concerned about how this diagnosis will affect your lifestyle. The truth is that in most cases of gestational diabetes, careful control of blood sugar levels through diet and exercise may be all that is necessary to ensure a safe, healthy pregnancy.
What is gestational diabetes?
Normally, the pancreas releases insulin in response to the body’s blood sugar levels that converts sugar to a form that can be used for energy by cells. In diabetes, the body makes insufficient amounts of insulin, or cannot use the insulin it makes. Gestational diabetes occurs most frequently in the 2nd trimester. High concentrations of sugar can overwhelm cells, leading to permanent damage to kidneys, eyesight, and the circulatory system. According to the American Diabetes Association, diabetes affects approximately 1% of non-pregnant women of childbearing age, while gestational diabetes occurs in roughly 2-5% of all pregnancies, and usually goes away once the pregnancy is over.
What are the symptoms of gestational diabetes?
Some women may experience no symptoms at all, or may feel extreme hunger or thirst, and fatigue.
What can happen if gestational diabetes is left untreated?
In addition to the kidney, eyesight, and circulatory problems previously mentioned, uncontrolled gestational diabetes can increase a pregnant woman’s chances of preeclampsia (abnormally high blood pressure). Other increased risks to the babies of these women are miscarriage, premature birth, stillbirth, and polyhydramnios or excessive amniotic fluid, which may lead to premature birth. After birth, these babies might experience increased incidence of respiratory problems,low blood sugar, or jaundice.
If treated, gestational diabetes presents little increased risk of birth defects to the fetus, but for women with pre-existing diabetes, there is an increased risk of neural tube birth defects, according to the March of Dimes.
Babies born to women with gestational diabetes may weigh 10 pounds or more at birth. This large size increases the risk of injury to the baby during vaginal birth, as most of the weight gain is centered on the trunk and shoulder area of the newborn.
Who can get gestational diabetes?
Anyone can get gestational diabetes, but women who are overweight, are over 30, or those who have previously had a stillborn or excessively large baby (weighing more than 9 ½ pounds) are at greatest risk. The Center for Disease Control (CDC) reports an increased incidence in certain ethnic groups, such as Pacific Islanders, blacks, Hispanics, and American Indians.
How is gestational diabetes diagnosed?
Screening for gestational diabetes usually takes place between the 24-28th weeks of pregnancy. Most women under 25 are not screened for gestational diabetes, however, since their risk is quite small. Diagnosis is made by means of the Glucose Tolerance Test, which measures blood sugar levels one hour after drinking a beverage containing 50 g of glucose, usually in the form of an orange or cola-flavored soda. Diagnosis is confirmed using a similar test, taking blood samples up to 3 hours after consuming a beverage containing 100 g of glucose following a 12-hour fast. Although the test is harmless, some women may become nauseous after drinking the beverage. Women taking this test should take great care to limit their sugar intake in the days leading up to and the morning of the test, as this can greatly skew the results of the test, increasing the incidence of false positive.
How is gestational diabetes treated?
While some severe cases (10-15% of all cases) may require daily injections of insulin, most gestational diabetes can be controlled by diet and exercise, with careful monitoring of blood sugar levels. Blood sugar levels can be monitored by pricking the finger and squeezing a drop of blood onto a glucose test trip, which changes color to be read manually or is inserted into a monitor for electronic reading. These supplies can be purchased through a pharmacy or medical supply company, and most insurance companies will cover the cost of such equipment.
Low blood sugar is usually the result of not eating or delaying eating, or from taking too much insulin. If blood sugar levels are too low, the body will break down stored body fat for energy, which produces ketones as a by-product. In high concentrations, the presence of ketones may result in ketoacidosis, a potentially life-threatening condition for the fetus. For this reason, the doctor may prescribe a daily check of urine ketone levels in severe cases of gestational diabetes.
Since many factors can affect an individual’s nutritional needs, only a doctor should make specific dietary recommendations for the gestational diabetes patient. Generally speaking, a healthy weight gain is usually 25-30 pounds for woman of average weight. With gestational diabetes, women should eat around 2,200 to 2,500 calories/day, spread out over 3 meals at regular intervals with 1-2 snacks. Women with a pre-existing diabetic condition are usually advised to eat smaller meals more frequently, or to eat more snacks. About half of the calories consumed each day should be in the form of complex carbohydrates, such as grains, fruits, and vegetables, with 10 to 20 percent in the form of protein such as meat, fish, or legumes, and fewer than 30 percent of calories from fat.
Any exercise should be performed only under the supervision of a physician. While exercise in an otherwise healthy woman with gestational diabetes can help control insulin utilization, it can be dangerous in women with certain medical conditions.
How can the risk of gestational diabetes be reduced before pregnancy?
Studies indicate that taking at least 400 micrograms per day of folic acid, a form of Vitamin B, in the prior to and during the first trimester of pregnancy greatly reduces a woman’s chance of having a baby with a certain type of birth defect. This is especially true for women with pre-existing diabetes, since they are at increased risk for these types of birth defects. In fact, a 1991 study by the March of Dimes indicates that if blood sugar is closely controlled prior to pregnancy, the incidence of birth defects and other complications was similar to that of non-diabetic patients.
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