Gestational Diabetes and Pregnancy

Posted On: September 25, 2015 By Daniel Saltzman, MD

Gestational Diabetes and pregnancy is a situation where women develop blood sugars that are higher than normal in pregnancy.  This is becoming more frequent in the United States, and it currently encompasses around 6-9% of all pregnant women.  Years ago, it was only 2-3% of all pregnancies.  The major reason the rate has increased is because we have an obesity epidemic in America.  To put this in perspective, roughly 60% of all pregnant women in the United States today are either overweight or obese, and a significant percentage of those women go on to develop gestational diabetes in their pregnancies.

Signs and Symptoms of Gestational Diabetes During Pregnancy

There are several signs and symptoms of gestational diabetes during pregnancy. One of the most common that we are concerned about is high blood sugar, because elevated blood sugar in the mother’s blood translates into higher blood sugars in the baby’s blood. High blood sugars in the fetus’ blood can cause a number of problems.  One of the most common problems is that these babies can be much bigger in size at birth; macrosomia is the medical term for this condition.  Just like in their mothers, an excess intake of sugar can lead to weight gain in the fetus.

Diabetes and Pregnancy Complications

The concern for macrosomic fetuses is that the mother is at a much higher risk for needing a cesarean section in order to safely deliver the baby.  A vaginal birth of a macrosomic baby (that is a baby over 8 pounds 13 ounces) is at higher risk risk of traumatic birth injury, or being injured during the birth process, which is why these babies frequently require cesarean sections. A few common injuries that can occur during vaginal birth of a macrosomic fetus are broken bones, as well as injury to nerves in the shoulder and arms from shoulder dystocia.  A shoulder dystocia is where the baby’s head comes out but the shoulders get stuck, and can lead to a syndrome where the baby can lose function of an arm.  This syndrome involving nerve damage to the arm is called an Erb’s palsy.

A few other complications can occur after the baby is born.  They include the baby’s blood sugar being too low or having jaundice, a condition where there is a yellow tint in the newborn’s skin and eyes, both of which can require the baby to stay in the Neonatal Intensive Care Nursery (NICU).  If blood sugars are very high, this can lead to a stillbirth, which is a term we use when a baby dies before being born.

How We Treat Diabetes and Pregnancy

At Maternal Fetal Medicine Associates, we take rigorous efforts to make sure that blood sugars are in a normal range for all pregnant women with diabetes.  Our process involves all pregnant women getting screened during the pregnancy.  Typically, we administer the screening early in the third trimester (between 24 and 28 weeks).  The screening test involves giving the woman a sugar drink, and having their blood drawn an hour after consuming the drink to see if her system has adequately processed the glucose load.  If it is too high, they have to move on to a more definitive three-hour sugar test, where they get their blood drawn four times.  Based on the results of the three-hour test, we can determine whether they have gestational diabetes.  At that point, we put patients on a special diabetic diet to manage their carbohydrate intake.  It’s actually a very healthy diet to make sure that people do not overeat, and eat the right foods in the right quantities to prevent their blood sugars from becoming too high.

The diet we recommend is important for a safe and healthy pregnancy.  It includes removing or limiting foods that are high in carbohydrates like regular sodas, ice cream, cake, bread, rice or spaghetti.

Adjusting to the diet is a hard adaptation.  However, we assist patients through this process via regular meetings with our MFM physicians and diabetic counselors.  In some cases, diet alone is not enough to control blood sugar, and we have to treat the mother with medication.  The medication we use is either a pill that helps lower the blood sugar, or in some cases, we give them insulin which is the hormone that our bodies make to control our blood sugar.  Insulin is taken by injection.

Women who are pregnant are more likely to develop diabetes due to hormonal changes caused by pregnancy.  As fetuses always want sugar to be available to them, the placenta actually makes a hormone to raise the amount of sugar in the mother’s blood.  This hormone blocks the action of the hormone insulin which we normally make to lower our blood sugar.  To counteract this process, pregnant women normally need to make more insulin than required in the non-pregnant state.  About 6-9% of pregnant women cannot make the extra insulin required, and therefore, become diabetic.

Carnegie Imaging for Women blogs are intended for educational purposes only and do not replace certified professional care. Medical conditions vary and change frequently. Please ask your doctor any questions you may have regarding your condition to receive a proper diagnosis or risk analysis. Thank you!

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