Pregnancy Week by Week : Week 23 (part 3)

Gestational Diabetes

Some women develop diabetes only during pregnancy; it is called gestational diabetes. It occurs when pregnancy hormones affect the way your body makes or uses insulin, a hormone that converts sugar in food into energy the body uses.

If your body doesn’t make enough insulin or if it doesn’t use the insulin appropriately, sugar in the blood rises to an unacceptable level. This is called hyperglycemia and means you have too much sugar in your blood. Occasionally, hormones made by the placenta can alter the actions of insulin, and gestational diabetes occurs. Several other factors can affect your blood-sugar levels, including stress, the time of day (glucose values are often higher in the morning), the amount of exercise you do and the amount of carbohydrates in your diet.

Gestational diabetes affects about 10% of all pregnancies. After birth, nearly all women who experience the problem return to normal, and it disappears. However, if gestational diabetes occurs with one pregnancy, there’s almost a 90% chance it will happen in future pregnancies. In addition, some women who develop gestational diabetes may develop type-2 diabetes within 10 years. Your best protection is to stay within the recommended weight-gain limits your healthcare provider gives you.

We believe gestational diabetes occurs for two reasons. One is the mother’s body produces less insulin during pregnancy. The second is the mother’s body can’t use insulin effectively. Both situations result in high blood-sugar levels. Risk factors for developing gestational diabetes include:

• over 30 years old

• obesity

• family history of diabetes

• gestational diabetes in previous pregnancy

• previously gave birth to baby who weighed over 9½ pounds

• previously had a stillborn baby

• being Black/African American, Latina/Hispanic, Asian, Native American or Pacific Islander

A woman’s weight when she was born may also be an indicator of her chances of developing gestational diabetes. One study showed women who were in the bottom 10^th percentile of weight when they were born were 3 to 4 times more likely to develop gestational diabetes during pregnancy.

Symptoms and Treatment for Gestational Diabetes. Good control of gestational diabetes is important. If left untreated, it can be serious for you and your baby. You will both be exposed to a high concentration of sugar, which is not healthy for either of you. You might experience polyhydramnios (excessive amounts of amniotic fluid). This may cause premature labor because the uterus becomes overdistended. Symptoms of gestational diabetes include:

• blurred vision

• tingling or numbness in hands and/or feet

• excessive thirst

• frequent urination

• sores that heal slowly

• excess fatigue

If you have gestational diabetes, you’re at higher risk of problems. If your blood-sugar level is high, you may get more infections during pregnancy. You are also more likely to develop gum disease, which may raise your resistance to insulin. Treating it may help lower your risk of developing pregnancy complications.

Experts believe a woman with gestational diabetes may overfeed her fetus and cause baby to store more fat after birth. Treating the problem may help reduce your baby’s risk of being obese in later life. You may also have a long labor because baby is big. Sometimes a baby can’t fit through the birth canal, and a Cesarean delivery is required.

Treatment of gestational diabetes includes regular exercise and increased fluid intake. Diet is essential in handling the problem. If your gestational diabetes is controlled by diet alone, monitor yourself very closely. Controlling your gestational diabetes can lower the risk of delivering an oversize infant.

Your healthcare provider will probably recommend a six-meal, 2000-to 2500-calorie-per-day eating plan. You may also be referred to a dietitian. Research shows women who receive dietary counseling, blood-sugar monitoring and insulin therapy (when needed) do better during pregnancy than women who receive routine care.

Eating a diet low in fat and high in fiber may help reduce your risk of getting gestational diabetes. If your intake of vitamin C is low, it may increase your risk.

Insulin therapy is the first choice when medicine is necessary to treat the problem. In some cases, oral medications, such as glyburide or Metformin, are used.