• Gestational Diabetes

    (Diabetes, Gestational; GDM; Gestational Onset Diabetes Mellitus [GODM]; Glucose Intolerance During Pregnancy)

    Definition

    Diabetes occurs when there is a higher level of glucose in the blood than is normal. Glucose comes from the breakdown of the food you eat. It travels through your body in the blood. A hormone called insulin then helps glucose move from your blood to your cells. Once glucose is in your cells, it can be used for energy. A problem making or using insulin means glucose cannot move into your cells. Instead, the glucose builds up in your blood. The build-up is called hyperglycemia.
    Gestational diabetes is a type of diabetes that first occurs during pregnancy. The extra glucose can affect the mother and the baby.
    Large Baby Due to Gestational Diabetes
    IMAGE
    Copyright © Nucleus Medical Media, Inc.

    Causes

    The exact cause is unknown.

    Risk Factors

    Factors that may increase the risk of gestational diabetes include:
    • Obesity or being overweight—This can affect the body's ability to use insulin.
    • Gestational diabetes in a previous pregnancy
    • Multiple pregnancy (carrying two or more babies)
    • Family history of diabetes
    • Previous delivery of a large baby
    • Age: 25 or older
    • Race: Hispanic, African-American, Native-American, Asian-American, Indigenous Australian, or a Pacific Islanders
    • Previous stillbirth or too much fluid surrounding a baby during pregnancy
    Also, hormones that help the baby's growth may interfere with insulin.

    Symptoms

    This condition may not cause any symptoms. If symptoms do occur, they may include:

    Diagnosis

    As part of prenatal screening, your doctor will test you for gestational diabetes. If you don't have a history of diabetes, the test will be done at 24-28 weeks of gestation. The doctor will give you a drink that has a special glucose solution in it. The doctor will then measure the level of glucose in your blood. Other tests may be used that require fasting (not eating or drinking anything). If you are high risk for gestational diabetes or have symptoms, your doctor will test you earlier in the pregnancy.

    Treatment

    The goal of treatment is to return blood glucose levels to normal. Treatment may include:

    Diet

    A dietitian can help you develop a healthy meal plan. Guidelines include:
    • Eat a balanced diet. Do not skip meals.
    • Eat plenty of fruits, vegetables, and high fiber foods.
    • Limit the amount of fat you eat.
    • Avoid foods high in sugar (eg, soda, candy, cookies).
    • Manage your portions sizes at each meal.
    • Plan a bedtime snack each night. It should include protein and complex carbohydrates (eg, legumes, potatoes, corn, rice).
    • Keep a record of your food intake. Share this with your doctor.
    Do not gain more weight during pregnancy than your doctor recommends. Excess weight can increase complication in your pregnancy. It will also make it more difficult to control your diabetes.

    Exercise

    Physical activity can make it easier for your body to use glucose. There are some precautions you may need to take or certain exercises you may need to avoid. Ask your doctor about an exercise plan.

    Blood Sugar Testing

    A blood glucose monitor will help you check your glucose levels throughout the day. Knowing your glucose level will help you plan your meals, activities, and medicine. Keep a record of your results. Discuss them with your doctor at your visits.

    Medication

    You may need to give yourself insulin injections to control diabetes. For some pregnant women, oral medicine is recommended, such as:
    • Metformin (eg, Glucophage)
    • Glyburide (eg, DiaBeta, Glucovance)
    After delivery, glucose levels usually return to normal. Your doctor will check your glucose levels to make sure that you no longer have diabetes.

    Prevention

    The following may help prevent gestational diabetes:
    • Do not gain more weight than recommended during pregnancy.
    • Eat a healthy diet.
    • Exercise regularly. Talk to your doctor before starting an exercise program.

    RESOURCES

    The American College of Obstetricians and Gynecologists http://www.acog.org/

    American Diabetes Association http://www.diabetes.org/

    CANADIAN RESOURCES

    Canadian Diabetes Association http://www.diabetes.ca/

    Women's Health Matters http://www.womenshealthmatters.ca/

    References

    Gestational diabetes. ACOG practice bulletin No. 30. Obstet Gynecol. 2001;98:525-538.

    Gestational diabetes. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php Updated July 11, 2012. Accessed August 13, 2012.

    How to treat gestational diabetes. American Diabetes Association website. Available at: http://www.diabetes.org/diabetes-basics/gestational/how-to-treat-gestational.html . Accessed August 13, 2012.

    2/5/2009 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php : Cheng YW, Chung JH, Kurbisch-Block I, Inturrisi M, Shafer S, Caughey AB. Gestational weight gain and gestational diabetes mellitus: perinatal outcomes. Obstet Gynecol. 2008;112:1015-1022. Hillier TA, Pedula KL, Vesco KK, et al. Excess gestational weight gain: modifying fetal macrosomia risk associated with maternal glucose. Obstet Gynecol. 2008;112:1007-1014.

    4/1/2011 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php : Dhulkotia JS, Ola B, Fraser R, Farrell T. Oral hypoglycemic agents vs insulin in management of gestational diabetes: a systematic review and metaanalysis. Am J Obstet Gynecol. 2010;203(5):457.e1-9.

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