Gestational
DiabetesGestational diabetes involves a metabolic change in pregnancy
where the carbohydrate metabolism is changed due to a relative lack of insulin.
This pregnancy diabetes has occurred as a result of profound hormone changes during
pregnancy. The question is whether this pregnancy related diabetes was pre-existing
or whether it only came on with the pregnancy. Diabetes and pregnancy do not mix.
The reason for this is that uncontrolled diabetes would lead to fetal abnormalities,
if the diabetes had preexisted. Once the organ development in the fetus
has taken place by 10 to 12 weeks into the pregnancy, the particular danger
of congenital defects is no longer there, but uncontrolled diabetes would
now affect the
growth of the fetus. Babies of mothers who have uncontrolled diabetes
grow faster and for this reason are large babies at birth. This leads to a high
Caesarian section rate with its possible complications. Other gestational diabetes
complications are a higher rate of hypertension, premature labor, increased infection
rates in mother and baby and neonatal hypoglycemia (= in the baby), particularly
when prematurely born. Some of the malformations of the fetus associated with
uncontrolled diabetes are: neural tube defects, congenital heart defect and other
congenital malformations incompatible with life. This is the reason why gestational
diabetes is usually followed by special centers (prenatal and neonatal) where
prenatal genetic counseling and treatment is given. ADVERTISEMENT
Studies have shown that when careful follow-ups are done with gestational
diabetes pregnancies, the outcome can be the same as with regular pregnancies.
However, it takes a multi disciplinary team of experts to help a diabetic patient
to prepare for pregnancy or to help the newly diagnosed gestational diabetic.
A gestational diabetic diet is taught to the patient, which will normalize the
sugar metabolism. The goal is to reach the normal blood sugars in pregnancy.
If the fasting blood sugars are in the range of 76 mg/dL ( 4.2 mmol/L) and the
2 hour postprandial (after meals) blood sugar tests are less than 120 mg/L ( less
than 6.6 mmol/L), the baby will develop normally. The goal of the therapist is
to use human insulin to regulate the carbohydrate metabolism and mimic the normal
situation during pregnancy as closely as possible. In gestational diabetes in
particular there is no room for hypoglycemic attacks from accidental insulin overdosage
as this could lead to death of the fetus in the uterus. To avoid this from
happening, the patient and the family should be instructed how to inject glucagon
(the natural pancreatic hormone to balance insulin) subcutaneously. This is only
necessary when the woman with gestational diabetes is in a state of confusion
or unconsciousness and her blood glucosometer reading done by a relative is less
than 40 mg/dL ( 2.2 mmol/L ). The neonatologist will teach the patient how
to keep the blood sugar levels from fluctuating too much (avoiding highs and lows)
and at the same time to keep the hemoglobin A1C levels below 8%. This
way malformations and complications can be kept at a minimum. All this makes it
very clear that the patient needs to be followed closely by an aggressive treatment
team who will teach the patient how she can keep her diabetes controlled. See
your doctor and ask for a referral to such a multi disciplinary diabetes team. More
info on gestational
diabetes here.
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