Diabetes linked with pregnancy creates multiple risks

LOIS SCHUMACHER

December 04, 2008 at 11:09AM AKST

Gestational diabetes affects approximately 4 percent of all pregnant women in the United States, according to the American Diabetes Association. Gestational diabetes can increase the risk of complications during pregnancy and delivery, and even raise the risk that the unborn child will develop type 2 diabetes as an adult.

Fortunately, gestational diabetes can be managed.

Gestational diabetes is a type of diabetes that occurs during pregnancy and usually ends after pregnancy. It affects the blood sugar levels of both the mother and fetus.

Diabetes refers to diseases in which the body either does not produce enough insulin, or does not use insulin as it’s supposed to.

Insulin, a hormone secreted by the pancreas, is the key to blood sugar control. Without insulin, sugar in the blood can’t enter the body’s muscle cells and produce energy for the body. Insulin attaches to the body’s cells and allows sugar from the blood to enter the cell. Without this hormone to act as a gateway to cells, sugar levels build up in the blood.

The cause of gestational diabetes is not known. The American Diabetes Association explains rise in blood sugar levels as a result of the placenta — the organ that nourishes the baby — producing large amounts of different hormones. Hormones are great for the baby’s growth, but may block how insulin works in the mother’s body. Gestational diabetes develops when the mother’s pancreas is unable to produce enough insulin to keep her blood sugars within a normal range.

Gestational diabetes usually occurs during the 24th week of pregnancy, when the placenta starts making large amounts of hormones.  

Most moms are screened for gestational diabetes during prenatal check-ups. A test called a glucose challenge during the later weeks of the second trimester (24-28 weeks of pregnancy) is performed. This requires drinking a glucose solution and checking the blood sugar one hour later. A blood sugar level of 140 milligrams per deciliter or higher may indicate gestational diabetes. Another test, called a glucose tolerance test, is done to confirm gestational diabetes.

A glucose tolerance test requires a person to eat normally for three days prior to the test and then stop eating after the evening meal the night before the test. The next morning a blood sample is taken to test blood sugar level. After the first blood draw, the person drinks a large amount of glucose water. Blood sugar levels are then drawn by the lab at one hour, two hour and three hours.

Determining if and when to do these tests depends on the individual’s risk for gestational diabetes, such as family history, previous gestational diabetes, weight, age and ethnicity.  

Problems times two
Gestational diabetes can cause problems for both mom and the baby if not well controlled. A high blood sugar level during the second and third trimester of pregnancy may cause problems for the baby such as being too large, which can cause injuries during delivery; having a low blood sugar after delivery, causing a risk for seizures; an increase risk for yellow skin, caused by liver problems; and an increase risk for lung problems, making it difficult for the baby to breath.

Possible problems for the mother include preeclampsia (high blood pressure), urinary tract infections or challenges in ability to have a vaginal birth.

Problems related to gestational diabetes may be avoided with blood sugar control. Women with gestational diabetes need to work with their health care provider, diabetes educator and a registered dietitian to create a plan to maintain blood sugar levels. Self-testing of blood sugar levels before and two hours after a meal can determine how exercise or how the amount and types of food eaten affect the blood sugar. Goals for blood sugar levels during a pregnancy include: morning, less than 105mg/dl, and two hours after a meal, less than 130mg/dl. If blood sugar levels are above that goal, it may suggest a need for more exercise, a change in the type or amount of food eaten or the need for medication.

Two most important ways to ensure blood sugars are under control are exercise and healthy food choices. Exercise lowers blood sugar levels by making the body more sensitive to insulin and allows the insulin to work more efficiently. Before starting an exercise program women need to check with their health care provider. Some people may have special restrictions.

Healthy food choices for mom and baby are necessary during pregnancy. The amount and types of food eaten is important to maintaining consistent blood sugar levels all day. A dietitian can help expecting moms create a meal plan that works best for them. If mom is getting all the nutrients her body needs, then the baby also gets all the nutrients it needs for proper growth and development. The American Diabetes Association recommends a diet in complex carbohydrates, those high in fiber, such as beans and starchy vegetables, whole grain breads, fruits and vegetables.

Sometimes exercise and healthy food choices alone are not enough to keep blood sugar levels within range. If blood sugar levels are too high, some moms will need to take oral medicine or insulin injections to lower blood sugar levels during the pregnancy. This depends on blood sugar levels.

Lois Schumacher is a registered nurse, certified diabetes educator and the diabetes program coordinator at Bristol Bay Area Health Corp. She can be reached at lschumacher@bbahc.org, 907-842-9293, or 800-478-5201.