Tuesday, March 26, 2013

How Could I Get Gestational Diabetes?

I am often asked if the screening test for gestational diabetes is always appropriate. Especially if the patient is fit and healthy with no family history. It seems an unnecessary inconvenience and there is also the suggestion that in this case, a little bit of denial is a good thing. Not so. Gestational diabetes is a phenomenon associated with pregnancy only; it affects how sugar is used during your pregnancy and high sugar is not optimal in any pregnancy. It generally resolves itself shortly after delivery but does indicate that you are at increased risk for type II diabetes. There is no way we know of now to prevent GDM ( gestational diabetes mellitus ) however, as we are told over and over that starting a pregnancy in the best possible condition is always optimal: eat foods that are high in fiber, low in fat and calories, colorful fruits and vegetables, lean proteins. Lose excess weight before pregnancy. Exercise, 30m inutes of moderate activity on most days of the week
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We are not exactly sure yet what the cause may be but we do know that in pregnancy the hormones do change the action of insulin in the cells and thus blood sugars rises. If blood sugars exceeded the expected rise seen after meals, we know that the pregnancy must be modified and  monitored closely. Certain factors have been identified as risk factors even though we really don't know what causes it and we have no way to prevent it. Women who are older than 25, with a personal or family history of type II diabetes or higher than normal blood sugars, with a BMI of 30 or over ( overweight ), already with a baby over 9 pounds, with a history of a stillbirth and who are not of white ancestry all have greater potential for developing GDM.

GDM is diagnosed via the standard glucose tolerance test. One hour is a screen and if numbers indicate, then a three hour test is administered. Generally this test is done in the beginning of the third trimester but occasionally earlier based on previous history. Once GDM is diagnosed it is important to learn blood sugar testing and monitoring and appropriate diet and activity levels to control the disease. Often additional monitoring  is accomplished utilizing a perinatologist as well as your obstetrician to ensure that the baby is growing and developing normally and that you are not developing complications, such as high blood pressure or pre-eclampsia

There are special classes for gestational diabetics that will teach nutrition based on an individualized meal plan that takes your weight, preferences, activity level and blood sugar levels into account.  You will be taught why exercise is important, which activities are best for you and at what intensity to build towards. Exercise lowers blood sugar levels so food intake is regulated based on the sugars you test and report at various times during your day. Once and a while medications may be added to your individual regime. Your treatment plan will include non-stress testing, biophysical profiles and fetal kick counts.

Perhaps your delivery will be scheduled before 40 weeks, Breast- feeding may help the avoidance of later type II diabetes and can help you with your post- pregnancy weight loss goals. Breast- feeding may also reduce your child's risk for later obesity and type II diabetes. Your blood sugar will be tested after delivery, and at your post partum check ups. Then your blood sugar should be tested regularly at appropriate physical exams.

I guess none of us would choose to develop GDM,  however there can be a bright silver lining with this disease. It is temporary and often gives us insight into new and better life- style choices that affect the rest of our lives and our families lives as well. As with anything associated with our precious pregnancies, early prenatal care is the key.

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