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If you do
not pass the three-hour glucola test,
it means that you have gestational diabetes. If you
are diagnosed with gestational diabetes, you will be referred to Sweet Success
at Obstetrix Medical Group. The
phone number is (408) 371-7111. At Sweet Success, you will meet with a dietician
to learn about changing your diet during pregnancy. A nurse will teach you
how to check your blood sugar. Most women are able to control their blood sugar
through diet and exercise. A food pyramid
is available. For some, however, medication may be necessary. A preliminary diet
for gestational diabetes is available.
What is gestational diabetes?
Approximately 5 percent of expectant mothers develop gestational diabetes.
During pregnancy, the placenta can produce a hormone that makes the mother
resistant to her own insulin. This results in an elevated glucose level.
Glucose is a small molecule that passes through the placenta and caused the baby
to increase it's insulin production. This results in complications for the
pregnancy as well as the infant.
Neonatal
(baby) complications from an elevated blood sugar may include macrosomia (big
baby). Macrosomia may lead to a shoulder dystocia (shoulders get stuck
resulting in neurologic damage to the baby) with a vaginal delivery or a
cesarean section.
After
delivery, the baby is producing too much insulin and may develop hypoglycemia
which can cause seizures. The baby is also at increased risk for jaundice and
polycythemia (high red blood cell count). The baby's glucose is tested at
delivery with a heel stick blood test. If the sugar level is low, the baby
may need to be given a sugar water bottle or even an IV glucose solution.
Some
studies have found a link between severe gestational diabetes and an increased
risk for stillbirth in the last two months of pregnancy. And finally, having
gestational diabetes makes you about twice as likely to develop
pre-eclampsia as other pregnant women
Will my baby be monitored during my pregnancy to
avoid complications?
You should begin Kick Counts after 28 weeks of pregnancy. Most physicians
will perform nonstress tests during the later part of your pregnancy. You
will also have an ultrasound in to determine a size estimate and make sure the
placenta is not overly mature.
When
will I deliver?
If your diabetes is under good control, most physicians will try to deliver the
baby by it's due date. If you are unable to stay under good control, you
may need to deliver earlier. Nonstress testing will help determine the
delivery time.
What factors would put me at risk for gestational
diabetes?
According to the American Diabetes Association, you're considered at high risk
for this condition (and should be screened early) if:
• You're obese (your body mass index is over 30).
• You have a history of gestational diabetes (you've had the condition in a
previous pregnancy).
• You have a strong family history of diabetes.
Some practitioners will also screen you early if:
• You're found to have sugar in your urine (your urine is tested at each
prenatal visit).
• You've previously given birth to a big baby (some use 8 pounds, 13 ounces as
the cut off; others use 9 pounds, 14 ounces).
• You've had an unexplained stillbirth.
• You've had a baby with a birth defect.
• You have high blood pressure.
How is gestational diabetes managed?
It depends on how serious your condition is. You'll need to keep diligent track
of your glucose levels, using a home glucose meter or strips. Eating a
well-planned diet can help you keep those levels where they should be. The
American Diabetes Association recommends getting nutritional counseling from a
registered dietician who'll help you develop specific
meal and snack plans based on your height,
weight, and activity level.
Studies show that moderate exercise also helps improve your body's ability to
process glucose, keeping blood sugar levels in check. Many women with
gestational diabetes benefit from 30 minutes of aerobic activity, such as
walking or swimming, each day. Exercise isn't advisable for everyone, though, so
ask your practitioner what level of physical activity would be beneficial for
you.
If you're not able to control your blood sugar well enough with diet and
exercise alone, your provider will prescribe insulin shots for you to give
yourself as well. About 15 percent of women with gestational diabetes need
insulin. The concern for your baby is the high sugar, not the
insulin. You may also be a candidate for oral medications (glyburide or metformin) instead of insulin
for gestational diabetes.
Once enrolled in Sweet Success, you will be asked to
monitor your diet. A sample diet can
be downloaded. Please keep a record of your blood sugars. If
your blood sugar is too low, hypoglycemia can occur.
For more information on diabetes, contact
American Diabetes Association
Baby Center
CDC Pregnancy Diabetes Information | 
