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Gestational diabetes

Definition


Disease: Gestational diabetes Gestational diabetes
Category: Endocrine and metabolic diseases

Disease Definition:

Gestational diabetes is the type of diabetes that occurs only during pregnancy. In this condition, the way the body uses sugar (glucose) is affected, which is the body's main source of fuel. This type of diabetes could threaten the health of the unborn baby and it could also cause high blood sugar levels, which aren't likely to cause any problems for the mother.

 

Gestational diabetes could be managed by taking medications when necessary, exercising regularly and eating healthy foods. In order to ensure a healthy pregnancy and a healthy start for the baby, the mother should take care of herself during pregnancy.

 

Usually, gestational diabetes is short-lived, and soon after delivery blood sugar levels return to normal.
 

Work Group:


Symptoms, Causes

Symptoms:

Mostly, gestational diabetes does not cause any noticeable signs or symptoms. However, in some rare cases it could cause increased urination and excessive thirst.

 

When a woman first thinks about trying to get pregnant, she should seek health care if it's possible, so that she could be evaluated for risks of gestational diabetes. The gestational diabetes will be addressed as part of regular prenatal care once the woman becomes pregnant. She may need more frequent checkups in case she develops gestational diabetes. During the last three months of pregnancy these problems are most likely to occur, and the woman's blood sugar levels will be carefully monitored. She may also be referred to an endocrinologist, a diabetes educator, a registered dietitian or other health professionals who specialize in diabetes management; so that they could help her learn how to manage her blood sugar level during pregnancy.

 

The woman's blood sugar will be checked right after delivery and again in six weeks, in order to make sure that her blood sugar level has returned to normal after the baby is born. It is generally a good idea to have the blood sugar level tested regularly once a woman has gestational diabetes. The results of tests that are done soon after she delivers her baby will determine the frequency of blood sugar level tests.
 

Causes:

It is still not clear why some women develop gestational diabetes. Understanding how glucose is normally processed in the body could help in understanding how gestational diabetes occurs.

 

The pancreas produces a substance called insulin. The sugar molecules, which are called glucose, from the food that is eaten, will flow into the bloodstream. Insulin will help glucose move from the bloodstream into cells in the body, where it will be used as energy.

 

The placenta that surrounds the growing baby during pregnancy produces high levels of a variety of hormones. Most of these hormones impair the action of insulin in the tissues, which causes the blood sugar levels to rise. Modest elevation of blood sugar after meals is quite normal during pregnancy.

 

The placenta produces more and more insulin-interfering hormones as the baby grows. In the case of gestational diabetes, these hormones provoke a rise in blood sugar to a level that could affect the growth and development of the baby. Usually, gestational diabetes develops in the second half of pregnancy. Even though in some rare cases it could develop as early as the 20th week, but usually, not until later in the pregnancy.
 

Complications

Complications:

Usually, women with gestational diabetes deliver healthy babies. However, uncontrolled blood sugar levels could be caused along with problems for the mother and the baby in case gestational diabetes is not carefully managed.

 

COMPLICATIONS THAT COULD AFFECT THE BABY:

In case a woman gestational diabetes, these are some of the complications that her baby may be at an increased risk of:

Low blood sugar (hypoglycemia):

In some cases, when a mother has gestational diabetes, the baby could develop hypoglycemia, which is low blood sugar. Seizures in the baby could be provoked by severe episodes of this problem. The baby's blood sugar level could return to normal by prompt feedings and sometimes an intravenous glucose solution.

Excess growth:

Extra glucose crosses the placenta and triggers the baby's pancreas to make extra insulin. This could cause macrosomia, which is when the baby grows too much. Very large babies are more likely to become wedged in the birth canal, require a C-secion birth or sustain birth injuries.

Jaundice:

In case a baby's liver isn't mature enough to break down a substance called bilirubin that is formed when the body recycles old or damaged red blood cells, jaundice occurs, which is the yellowish discoloration of the skin and whites of the eyes. Jaundice requires careful monitoring despite the fact that it usually isn't a cause of concern.

Respiratory distress syndrome:

This syndrome, which is a condition that makes breathing difficult, is possible in case the baby was delivered early. Babies with respiratory distress syndrome may need help with breathing until their lungs become stronger. Babies whose mothers have gestational diabetes have more breathing problems than those whose mothers don't have this problem, even at the same gestational age.

Developmental problems:

In case a woman gestational diabetes, her baby could be at an increased risk of attention problems, hyperactivity disorders or problems with motor skill development including jumping, walking, or other activities that require balance and coordination

Type 2 diabetes and obesity later in life:

A baby will have an increased risk of developing obesity and type 2 diabetes later in life in case his/her mother has gestational diabetes.

 

In some very rare cases, gestational diabetes could result in the death of the baby either before or shortly after birth, especially if gestational diabetes was left untreated.

 

COMPLICATIONS THAT COULD AFFECT THE MOTHER:

Gestational diabetes could increase a woman's risk of:

Urinary tract infections:

Because of the excess glucose in the urine, women who have gestational diabetes will experience twice the number of urinary tract infections during pregnancy than other pregnant women.

Preeclampsia:

This is a condition in which a woman's blood pressure is high and there is excess protein in her urine after the 20th week of pregnancy. This condition could lead to serious and life-threatening complications for the mother as well as the baby in case it is left untreated.

Future diabetes:

In case a woman has gestational diabetes, then she is likely to have it again with a future pregnancy. Additionally, she will probably develop diabetes, mostly type 2, when she gets older. In order to reduce the risk of future type 2 diabetes she should make healthy lifestyle choices, including eating healthy and exercising. Less than 25% of women with a history of gestational diabetes who reach their ideal body weight after delivery develop type 2 diabetes.
 

Treatments:

In order to keep the baby healthy and avoid complications during delivery, a woman should control her blood sugar level. She may consider:

Blood sugar monitoring:

In order to make sure that she's keeping her blood sugar within a healthy range, a woman may be asked checking her blood sugar level a few times a day, such as first thing in the morning and after meals. In order to test the blood sugar, a drop of blood should be drawn from a finger with a small needle called a lancet, and the blood should be placed on a test strip, which will be inserted into a blood glucose meter. This device measures and displays blood sugar level.

 

During labor, the woman's blood sugar level will also be monitored. The baby could release high levels of insulin in case the mother's blood sugar rises, which could cause her blood sugar level to drop right after giving birth.

Diet:

One of the best ways to control blood sugar level is eating the right kind and amount of food. This could also help prevent excessive weight gain during pregnancy, which could put the woman at a higher risk of complications.
A healthy diet should consist of more fruits, vegetables and whole grains; all in all, foods that are high in nutrition and low in fat and calories in addition to limiting carbohydrates including sweets. However, there is not one single diet that is healthy for every woman. A woman should consult a registered dietitian or a diabetes educator, so that depending on her blood sugar lever, weight, height, exercise habits and food preferences, he could create a meal plan especially for her.

Exercise:

By transporting sugar to the cells where it's used for energy, exercise lowers blood sugar level. Sensitivity to insulin is also increased by exercise, meaning that less insulin will be needed to transport sugar to the cells. Exercise could help a pregnant woman prepare for labor and delivery. Some of the discomforts of pregnancy could also be prevented by regular exercise, including muscle cramps, constipation, difficulty sleeping, swelling and back pain.

 

On most days of the weeks, a woman should aim for moderate aerobic exercise with her doctor's OK. She should also start slowly and build up gradually in case She hasn't been active for a while. Some of the good choices of exercise during pregnancy include cycling, walking and swimming. Housework, gardening and other ordinary activities also count.

Medication:

In order to lower the blood sugar level, a woman may need insulin injections in case diet and exercise are not enough. To reach a consistently safe blood glucose level, about 15% of pregnant women who have gestational diabetes will need insulin therapy. An oral medication such as glyburide could also be an option for some women.

 

The baby of a woman with gestational diabetes will also need close observation.
The baby's growth and development will be monitored with repeated ultrasounds or other tests. Labor may be induced in case a woman doesn't go into labor by her due date, or earlier. The risk of complications may increase in case the baby is delivered after the due date.

 

As mentioned before, a woman's risk of developing type 2 diabetes later in life increases in case she has gestational diabetes. In order to reduce or eliminate this risk, she should maintain healthy lifestyle habits, including a healthy diet and exercise.
 

Prognosis:

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