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  • Shaken Baby Syndrome

    Tuesday, 21 July 2015 16:28
  • Amniotic fluid problems

    Thursday, 14 May 2015 12:54
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    Friday, 10 April 2015 17:50
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    Wednesday, 11 February 2015 17:20
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  • Antenatal Classes

    Monday, 03 June 2013 09:34
  • Strap-in-the-Future

    Thursday, 30 June 2011 13:52

Gestational Diabetes

Gestational_diabetesGestational diabetes occurs when an increase in certain hormones during pregnancy (including cortisol, estrogen, and human placental lactogen) interfere with the body's ability to manage blood sugar. This condition is known as insulin resistance. Usually the pancreas (the organ responsible for insulin production) is able to compensate for insulin resistance by increasing insulin production. If your pancreas is unable to increase insulin production to counter act the effect of increased hormones, you will experience a rise in blood sugar levels.

Gestational diabetes (GDM) is diagnosed when higher than normal glucose levels first appear during pregnancy. The key to managing a diabetic pregnancy is to achieve and maintain normal blood glucose levels.

Due to a combination of expert medical care and guidance and conscientious self-care, diabetic women have the same chances of having a successful pregnancy and healthy baby as other women. Most women do not remain diabetic after giving birth but a fasting glucose test is recommended at your 6- or 12-week post-partum visit, followed by regular glucose testing to ensure that your sugar levels have returned to normal.

Symptoms

Gestational diabetes often has no symptoms. That is why all pregnant women need to be screened for the condition. Possible symptoms include:

• Blurred vision
• Fatigue
• Frequent infections, including those of the bladder, vagina and skin
• Increased thirst
• Increased urination
• Nausea and vomiting
• Weight loss despite increased appetite

Diagnosis

All women should be screened for gestational diabetes during their pregnancy. This includes taking a medical history, assessing certain risk factors & testing of your urine sample at each visit. If sugar is found in your urine, the Dr may perform an oral glucose tolerance test. This test is usually given between the 24th and 28th week of pregnancy. It involves quickly drinking a sweetened liquid called Glucola, containing 50g of glucose. The glucose is absorbed rapidly, causing the blood glucose levels to rise within 30-60 minutes. After 1 hour, a blood test is performed to establish how the glucose solution was metabolized.

A blood glucose level of 140mg/dL will identify most women with gestational diabetes. If you have a reading of 130mg/dL or higher, your health provider is likely to recommend another diabetes screening test called the 100 gram glucose tolerance test. This test also requires you to drink a cola-like liquid after fasting. Your blood glucose level will then be tested 4 times over a 3-hour period. If 2 out of the 4 blood tests are abnormal, you are considered to have gestational diabetes.

Treatment

The aim of treatment is to keep your blood glucose levels within the normal range during the duration of pregnancy and to ensure that your growing baby is healthy. Special meal plans and scheduled physical activity are essential to the treatment of diabetes. Daily blood glucose testing and medication, insulin injections or an under-the-skin insulin pump may be required. If you need insulin for the first time, you may be hospitalized briefly so that your blood sugar can be stabilized under close supervision. Your medication dosage may need to be adjusted periodically as your pregnancy progresses, as your baby grows, if you are ill, under emotional stress or overdo your carbs. Caution needs to be taken with all other medication, including those that are available over-the-counter, as these can affect your insulin levels.

Consult a dietician to help you develop specific meal and snack plans based on your weight, height and activity level. It is important to have the correct balance of proteins, fats and carbohydrates in order to keep your blood sugar levels stable. Eating regularly is also essential in the management of diabetes.

Getting sufficient calories and nutrients are vital for your baby's wellbeing. Follow your physician's guidelines for weight gain. Sometimes the babies of diabetics grow too large, even if their mothers don't gain weight excessively. Your baby's growth will be monitored frequently by ultrasound.

Ask your health practitioner to recommend exercises that will give you more energy, regulate your blood sugar levels, and help get you into shape for delivery. In general, women with gestational diabetes benefit from 30 minutes of aerobic activity daily, such as walking or swimming. Moderate exercise has been shown to improve the body's ability to process glucose and to help keep blood sugar levels stable. Follow your doctor's recommendations regarding the type, duration and any special precautions to be taken while exercising with gestational diabetes. For example, never exercise in a heated environment and do not allow your pulse to exceed 70% of the maximum safe heart rate for your age (subtract your age from 220 and then multiply this number from .70). You should not exceed this exercise intensity level.

It is easy to monitor your blood sugar levels at home. The most common method involves pricking your finger and putting a drop of your blood on a machine that will give you a glucose reading. The amount of "glycosylated hemoglobin" in your blood may also be monitored. Research has shown that elevations in this substance are indicative of poorly controlled blood glucose levels.

Your health care provider will closely monitor both you and your baby throughout the pregnancy. Foetal monitoring to keep track of your baby's growth and overall health often includes ultrasounds and non-stress tests. The purpose of an ultrasound (also known as a biophysical profile) is to compare the pattern of your baby's heartbeat to movements, and finds out if your baby is thriving. During a non-stress test an electronic foetal monitor is placed on your abdomen. The machine hears and displays your baby's heartbeat. When your baby moves, it is normal for their heart rate to increase by 15-20 beats above its regular rate.

Rest is crucial, especially during the third trimester. Try elevating your legs or taking a nap in the afternoon. Your doctor may recommend early maternity leave if you have a demanding job.

Because the babies of diabetic mothers often grow too large for a full term vaginal delivery, their placentas frequently deteriorate early (robbing them of vital oxygen and nutrients in the last few weeks) and because they are subject to acidosis (abnormal acid-base balance in the blood); they are often delivered early at 38 or 39 weeks. On the basis of several tests, you physician will decide if it is necessary to induce labour or perform a caesarian.

Risk factors:

According to the American Diabetes Foundation, you are considered to be high risk for the condition if:
  • You are obese (have a BMI higher than 30)
  • You have experienced gestational diabetes in a previous pregnancy
  • You have sugar in your urine
  • You have a strong familial history of diabetes

Early screening may be required if:
  • You have previously given birth to a big baby
  • You have had an unexplained stillbirth
  • You have had a baby with a birth defect
  • You have hypotension (high blood pressure)
  • You are over the age of 35

Complications:

If left untreated, gestational diabetes can cause serious complications for newborns, such as:

If your blood sugar levels are too high, excessive glucose may build up in your baby's bloodstream. As a result, your baby's pancreas produces more insulin to process the extra glucose. A combination of too much glucose and insulin can cause your baby to gain extra weight, particularly in their upper body. This condition is known as macrosomia. Having a large baby increases the chance of problems during delivery such as shoulder dystocia, in which the baby's head enters the birth canal but their shoulders get stuck.
Having a very large baby also increases the necessity for a C-section or other assistance during delivery. For example, requiring forceps or vacuum delivery.
Experiencing a rapid drop in blood sugar (hypoglycemia) after birth, which may require an IV injection of sugar solution. Feeding, especially breastfeeding as soon as possible after birth can help control hypoglycemia.
Are at an increased risk of developing jaundice.
Have a greater chance of developing breathing problems. The lungs of babies whose mother's have diabetes tend to mature a little later).
Babies who have excessive fat stores due to high maternal sugar levels during pregnancy often continue to be overweight in later life.

Most women's blood sugar returns to normal after delivery. However, if you have experienced gestational diabetes you have an increased risk of:

Developing high blood pressure during pregnancy (hypotension).
Giving birth to an overly large baby can lead to injuries in the vaginal area or require a large episiotomy for mom.
Developing gestational diabetes in subsequent pregnancies.
Developing type II diabetes later in life.

Gestational diabetes is generally a temporary form of diabetes, that is not harmful to mother or baby, if it is properly controlled. Good diet, weight control and regular exercise will help reduce your risk.

References

Baby Centre. Gestational Diabetes. Baby Centre, L.L.C. http://www.babycenter.com/0_gestational-diabetes_2058.bc?page=1  Accessed August 28, 2012.

Diabetes Australia. Gestational Diabetes. http://www.diabetesaustralia.com.au/en/  National Diabetes Service Scheme (NDSS). Updated June 21, 2012. Accessed August 24, 2012.

Murkoff HE, Eisenberg A, Hathaway SE, eds. What to expect when you're expecting. London, GB: Simon & Schuster; 1997.

PubMed Health. Gestational Diabetes- Glucose tolerance during pregnancy. A.D.A.M., Inc. http://www.ncbi.nlm.nih.gov/pubmedhealth/  Reviewed September 12, 2011. Accessed August 25, 2012.

WebMD. Health & Pregnancy: Pregnancy and Gestational Diabetes Screening. WebMD, LLC. http://www.webmd.com/baby/guide/default.htm  Reviewed July 10, 2012. Accessed August 24, 2012.