Gestational Diabetes (GD) in Pregnancy

Glucose monitoring in pregnancy

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Gestational diabetes (GD) is high blood sugar or glucose levels during pregnancy. About 6% of pregnant women in the U.S. will be diagnosed with gestational diabetes. In the U.S., universal screening is performed via blood testing between 24 and 28 weeks' gestation. If you need additional screening with a glucose tolerance test (GTT) it will be done at this point.

What Causes Gestational Diabetes?

The absolute cause of gestational diabetes is still being researched. Pregnancy is associated with insulin resistance due to placental secretion of various diabetogenic hormones. Gestational diabetes developed during pregnancy when the pancreas cannot accommodate for insulin resistance.

When your body is unable to make and use the insulin in pregnancy it is called gestational diabetes. When you don't have that ability to use insulin, you cannot process glucose (sugar) in the blood.

Therefore the blood has a high level of sugar. There are some women who had diabetes prior to pregnancy. This is not considered gestational diabetes, but a woman who has diabetes and is pregnant.

What Happens to the Baby?

Gestational diabetes tends to occur in later pregnancy, and problems associated with gestational diabetes are not the same as for those with pre-existing diabetes in pregnancy.

The real issue is untreated or poorly controlled gestational diabetes. Because your body isn't able to process insulin and your blood sugar goes up, your baby's blood sugar also goes up. This forces your baby's pancreas to work overtime to reduce his blood sugar. Added energy (sugar) is stored as fat. The extra fat can lead to macrosomia, or a large baby. This has the potential to make delivery more difficult, including increasing the likelihood of cesarean section. Talk to your doctor about your preferences for care.

A baby who is born after a pregnancy with gestational diabetes has a greater incidence of low blood sugar or hypoglycemia. These babies have more breathing difficulties at birth. Later in life, these babies are at a greater risk for obesity and subsequently type 2 diabetes.

Treating Gestational Diabetes

Treatment for gestational diabetes will be started immediately upon diagnosis. The goal is to keep your blood sugars low to give you and your baby the best shot at a healthy pregnancy and birth. Your treatment will usually include some of the following:

  • Diet. A nutritionist can help you learn how to make dietary choices that keep your blood sugars at acceptable levels. This meal planning advice will include how to snack well and plan meals.
  • Blood sugar monitoring. How often you test your blood sugar through finger pricks will depend on the protocol used in your practice, but it is typically several times a day. You will be taught how to do this on your own.
  • Medication, including insulin injections. Not everyone will need to use insulin. Many people are able to control blood sugar with diet and exercise alone. Your practitioner will monitor your blood sugar to determine if you need additional help from insulin injections.
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