Gestational diabetes (gestational diabetes mellitus) is a form of diabetes diagnosed during pregnancy. While the condition is estimated to affect nearly 20 percent of all pregnant women, gestational diabetes occurs in women who were not diabetic before they became pregnant and, in many cases, do not remain diabetic after they give birth. Only about half of the patients diagnosed with gestational diabetes have risk factors for the disorder.
Risk Factors for Gestational Diabetes
Hormonal variations that occur during pregnancy can interfere with insulin function, causing the pregnant woman's blood glucose levels to decrease. Although the precise reasons that some women suffer gestational diabetes and some do not are unclear, the following are risk factors for the condition:
- Being older than 25
- Having a family history of diabetes
- Having given birth to a large baby (over 9 pounds)
- Having given birth to a baby with a birth defect
- Being hypertensive
- Have an excess of amniotic fluid
- Having had a miscarriage or stillbirth
- Being overweight prior to pregnancy
- Gaining too much weight during pregnancy
- Having polycystic ovarian syndrome
Members of certain racial or ethnic groups are at increased risk for gestational diabetes, including those of Hispanic, African-American, Native American, Southeast Asian, or Pacific Islander descent.
Symptoms of Gestational Diabetes
Most patients do not show any symptoms of gestational diabetes. The discovery of the condition is typically made during routine prenatal testing.
When patients do show symptoms of gestational diabetes, these symptoms may include one or more of the following:
- Frequent thirst
- Increased urination
- Blurred vision
- Nausea and vomiting
- Frequent dermatological, vaginal or bladder infections
One significant sign of gestational diabetes may be increased appetite coupled with weight loss.
Diagnosis of Gestational Diabetes
In most cases, gestational diabetes begins approximately midway through the period of gestation. Under normal circumstances, doctors check all patients in their 24th to 28th week of pregnancy. If a particular patient is at high risk for the disorder, testing may be done earlier. Testing for gestational diabetes consists of an oral glucose tolerance test. If a women is found to be experiencing the disorder, she will be instructed to keep track of her glucose level at home by testing the glucose levels in her blood.
Treatment of Gestational Diabetes
Treatment of gestational diabetes is focused on keeping the patient's glucose levels within the normal range during pregnancy and to make sure that the fetus remains healthy and develops normally. This is accomplished through fetal monitoring and through the use of a nonstress test. The latter employs an electronic fetal monitor placed on the woman's abdomen to check the baby's heartbeat in reaction to movements.
In addition to keeping careful track of the baby's development and well-being, the obstetrician will instruct patients with gestational diabetes to eat a diet low in sugar, moderate in fat and protein, and high in complex carbohydrates, fruits and vegetables. If such a diet does not control glucose levels sufficiently, the patient may be prescribed oral diabetes medicine or insulin therapy, but dietary changes are usually sufficient to manage the condition.
Risks of Gestational Diabetes
Although gestational diabetes is usually resolved without difficulty, it can pose significant risks to both the mother and the child. Mothers who experience gestational diabetes are at increased risk of developing hypertension during pregnancy and half will develop diabetes within 10 years after giving birth. Women with gestational diabetes are also at greater risk of giving birth to a large baby, increasing the possibility of birth trauma or delivery by Caesarean section.
Infants born to mothers with gestational diabetes have to be monitored closely since they are are increased risk for:
- Elevated blood glucose levels
- Periods of hypoglycemia
- Chemical imbalances at birth
- Abnormally high red blood cell count
- Respiratory distress
- Growth abnormalities
Women can lower their risk for gestational diabetes and its complications by keeping themselves to a normal body mass index (BMI) before and during pregnancy, and by getting early and consistent prenatal care.