Gestational Diabetes: Managing High Blood Sugar During Pregnancy
In women with gestational diabetes, pregnancy hormones prevent insulin from functioning properly. When this happens, the body cannot convert glucose (sugar) to energy, causing it to build up in the blood and creating extremely high blood sugar levels.
When not managed properly, gestational diabetes can harm both mother and baby. For newborns, gestational diabetes can increase the risk of macrosomia (high birth weight due to exposure to high blood glucose levels), birth injury due to shoulder dystocia, respiratory difficulties, low blood sugar and jaundice. For mothers, it can increase the risk of difficult delivery due to shoulder dystocia, increased amniotic fluid (polyhydramnios), pregnancy-related high blood pressure and preterm labor.
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Gestational Diabetes |
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Screening
Women are typically screened for gestational diabetes during the fifth or sixth month of pregnancy. First, a one-hour screening test is performed. A positive test result indicates that an additional diagnostic test is needed—a three-hour Oral Glucose Tolerance Test (OGTT). About 85 percent of women with a positive test result in the first screening will have a normal OGTT.
The OGTT determines how the body breaks down blood sugar. To perform the test, a blood sample is drawn to determine the fasting glucose level, and then a woman drinks a sugar-based liquid and blood is taken every hour for up to three hours. Blood glucose levels above normal limits can be used to diagnose gestational diabetes.
Symptoms
Generally, gestational diabetes does not cause specific symptoms, but women may experience excessive weight gain, increased hunger or thirst, more frequent urination or recurrent vaginal infections. However, all of these symptoms can be side-effects of pregnancy, so screening is very important.
Prevention
Women can decrease their risk for gestational diabetes before pregnancy by exercising regularly, eating a wide variety of foods from different food groups, and establishing a healthy weight.
Management through Diet and Exercise
Women with gestational diabetes can control their blood glucose levels through diet and exercise. A physician or dietician can design an individualized diet based on calorie needs, weight, stage of pregnancy and baby’s growth rate. Eating fruits and vegetables and a diet low in fat and protein and high in complex carbohydrates can lower blood sugar levels.
A safe exercise plan can also lower blood sugar levels. Upper-body cardiovascular exercise that puts little stress on core muscles can positively affect glucose levels, which often decrease within four to six weeks of starting an exercise program.
Medical management
If a woman cannot decrease her blood sugar level through diet and exercise, her doctor may prescribe insulin. About 10 to 15 percent of women with gestational diabetes require regular insulin injections. If medication is prescribed, the pregnancy is monitored very closely to ensure the fetus is healthy. A physician may suggest a non-stress test with an electronic fetal monitor (a machine that hears and displays the baby’s heartbeat) to determine if the heart rate exhibits a healthy response to movement and an ultrasound to monitor the growth of the baby.
You may be at increased risk for gestational diabetes if you are pregnant and: |
- Older than 25
- Overweight before the pregnancy*
- Have a family history of diabetes*
- Had gestational diabetes with another pregnancy
- Gave birth to a baby who was very large, had a birth defect, or was stillborn*
- Have too much amniotic fluid
- Have hypertension*
- Have glucosuria* (glucose in your urine)
*If you have these risk factors, you may be tested earlier than 24 weeks for the disease.
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Patients diagnosed with gestational diabetes may benefit from visiting one of Penn’s diabetes centers to discuss nutrition, exercise and treatment options.
Penn Rodebaugh Diabetes Center
The Rodebaugh Diabetes Center offers a family-oriented approach to patient care, providing a variety of services to help patients and their families manage diabetes and develop a healthy, normal lifestyle. A multidisciplinary team of diabetes specialists work with each patient to provide comprehensive individualized care using advanced clinical therapies and the latest research.
Diabetes Education Center at Pennsylvania Hospital
The Diabetes Education Center provides superior, individualized care for inpatients and outpatients. Taking a multi-disciplinary approach to provide the best treatment options, the diabetes care team includes primary care doctors, endocrinologists, ophthalmologists, nutritionists, podiatrists, social workers and physical medicine therapists. The center also offers a wide range of educational programs to assist with disease management.
For more information about Penn Ob/Gyn Care call 800-789-PENN (7366).
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