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Diabetes & Pregnancy Home:
Preconception planning |
Pregnancy
in diabetes |
 Gestational
Diabetes
Gestational Diabetes
About three to
five percent of all pregnant women develop gestational diabetes during pregnancy. It is different from
type 1 diabetes, in which the body produces no insulin and insulin must
be injected, and from the more common type 2 diabetes. Patients with type 2
diabetes suffer from varying levels of insulin resistance and may control blood glucose
levels through diet and exercise, with oral medication, or with insulin
injections.
Gestational diabetes
usually develops about midway through a pregnancy, at about 20 to 24 weeks, and
is caused by the changes in hormones in your body during pregnancy. In addition
to supplying your baby with nutrients and water from your circulation, the
placenta produces a number of hormones vital to the pregnancy. Some of these
have a blocking effect on insulin. As the placenta grows larger,
the more hormones are produced, and the greater the insulin resistance becomes. In most women, the
pancreas is able to make additional insulin to overcome this insulin resistance.
When the pancreas makes all the insulin it can, and there still isn't enough
to overcome the effect of the placenta's hormones, gestational diabetes
results.
Any woman might develop
gestational diabetes during pregnancy. Factors that have been identified as
increasing the risk for gestational diabetes are obesity, a family history of
diabetes, having given birth to a very large infant
previously, having had a stillbirth or a child with a
birth defect, or having too much amniotic fluid. Women older than 25
are at greater risk than younger ones.
Gestational diabetes
usually clears up as soon as the baby is born, since when the placenta is
removed, the hormones it was producing - which were causing the insulin
resistance -- are also removed. Once again your insulin is permitted to
work normally without resistance, and you should no longer have any problems
with blood glucose levels.
Although this type of
diabetes disappears when the baby is born, some women who have gestational
diabetes go on to develop diabetes when they get older. Some studies have
reported that almost 40 percent of women who have gestational diabetes will go
on to develop type 2 diabetes. So, if you have gestational diabetes, you will
need to be screened for type 2 diabetes every year.
One of the major concerns
about diabetes in pregnancy is the harmful effect that high blood glucose levels
can have on the developing baby. In women who don't have their blood glucose
levels controlled at near normal levels during the first trimester, there is a
higher incidence of miscarriage and birth defects. However, since gestational
diabetes doesn't appear until well after that critical period, there is little
likelihood of those types of problems in gestational diabetes.
Although most women with this
condition are treated with diet, some may need insulin. Gestational diabetes
can't be treated with pills because it is not known what effects those
medications may have on the baby.
Your healthcare provider may
recommend that you see a diabetes specialist, and you will need to take
additional steps to control your blood glucose levels for the duration of your
pregnancy. The following steps can help you achieve a smooth pregnancy and a
healthy baby:
- Following an appropriate meal plan
- Frequent self-monitoring of blood glucose
(SMBG)
- Administering insulin injections and knowing how
to adjust the doses depending on results of SMBG
- Controlling/treating hypoglycemia
- Adding or maintaining an appropriate level of
physical activity
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Important steps to achieve a smooth
pregnancy
| 1) |
Following an appropriate meal
plan |
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Your eating patterns are
especially important now, since you want to control blood glucose levels
and also assure that both you and your baby are getting adequate nutrition
during your pregnancy. Your doctor will provide you with a personalized
meal plan as part of your diabetes self-management program. This plan will
be geared toward helping you maintain normal blood glucose levels. It will
incorporate these fundamental patterns that have been proven to help keep
glucose under control in people with diabetes:
- Avoid sugar and foods
high in sugar
- Emphasize complex
carbohydrates, such as vegetables, cereal, grains, beans, peas, and
other starchy foods
- Emphasize foods high
in fiber
- Keep your diet low in
fat
- Have bedtime snacks that include both protein and
complex carbohydrate
Related information
Diet for
diabetes
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page
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| 2) |
Frequent self-monitoring of blood
glucose (SMBG) |
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The only way
to tell if you are succeeding in controlling your blood glucose
is to monitor your levels, and to do it frequently. This is called
self-monitoring of blood glucose, or SMBG. Pregnant women are advised to monitor at least four times
a day, and sometimes as often as 10 times a day. It
requires a drop of your blood (from a fingerstick) and a home glucose monitor. Since
your need for this will be temporary, inquire about renting the equipment from
your local pharmacy or diabetes supplier.
Your doctor and diabetes specialist will teach you about
this important aspect of your self-management.
Related information
Glucose testing |
Monitoring devices
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| 3) |
Administering insulin injections and knowing how to
adjust the doses depending on the results of SMBG |
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If you are unable to control your glucose levels with diet and
exercise, you may need to take insulin. Pregnant women cannot take oral
anti-diabetes medications, since the safety of those medications during pregnancy has not been established. You
should use only human insulin, since the use of insulin analogs has not
been adequately tested in pregnant women.
Your body's need
for insulin is going to steadily increase throughout your pregnancy. Your
insulin dose may have to be adjusted upward periodically; it may also have to be
recalculated as you and your baby get
bigger. Your doctor will be watching this area carefully
and will want to see your SMBG results for
guidance.
In order to maintain tight control, you will need to know
how to adjust your dosage depending on the results of your frequent
monitoring. Again, your healthcare provider or pharmacist can help you
master this
process.
Related information
Insulin |
Insulin delivery device |
Latest development
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| 4) |
Controlling/treating
hypoglycemia |
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When people with diabetes undertake
a program to achieve tight control of their blood glucose levels,
they increase the risk of severe hypoglycemia, or low blood glucose. There is
no evidence that hypoglycemia is a risk to the developing baby, but it can be a
problem for you. Therefore, be sure to keep ready sources of carbohydrates
with you at all times. It would also be a good idea for you, your
family, and perhaps a close co-worker to learn how to administer glucagon injections
in case of a hypoglycemic crisis.
Related information
Hypoglycemia |
Emergency products
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| 5) |
Adding or maintaining an appropriate
level of physical activity |
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A moderate exercise program will help maintain control of blood
glucose levels while also making you feel better. It will help get you in shape
for delivery, too. If you've already been exercising, you can probably continue it,
although you should avoid sports or exercises where you might fall. Bicycling,
jogging, and cross-country skiing are good exercises to continue during your
pregnancy.
If you aren't exercising regularly, now is
a good time to start, but check with your doctor about your
planned activity and start slowly. Vigorous walking is an excellent way to start. Even if
you are having some problems during your pregnancy, light exercise such as leisurely
walking is still a good idea.
You'll need to
plan your periods of activity along with your food intake and insulin injections. If you're on insulin, you'll
need to take a few precautions:
- Be aware of the risk of hypoglycemia, and take a
high-sugar snack along with you.
- It may be necessary to eat small snacks between meals.
- If you exercise right after a meal, have a snack after
the exercise.
- If you exercise two hours or more after a meal, eat the
snack before the exercise.
- One serving of fruit will maintain blood sugar for most
short-term activities (about 30 minutes).
- One serving of fruit plus a serving of starch will be
enough for activities that last longer (an hour or more).
- Don't reduce your insulin intake before exercising.
- Don't inject insulin into a part of the body that will
be exercised; for example, if you'll be walking, avoid injecting into
your leg.
Related information
Diabetes and
exercise |
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How
much weight to gain?
Your doctor has already
given you guidelines for gaining weight during your pregnancy. Caloric input and
nutrition are especially important for you and your
baby.
The "optimal"
weight gain depends on your weight when you became pregnant. If your weight was
in a good range for your body size, then a weight gain of 24 to 27 pounds is
recommended. If you are 20 or more pounds above your desirable level, you should
gain 24 pounds.
If you gain too
much weight, the extra fat requires the body to produce more insulin to try to
keep blood sugar levels normal. But if your body is incapable of producing more
insulin, then your blood glucose levels will rise above acceptable
levels.
Related information
Impact on baby |
Labor and delivery |
Glucose control during labor and
delivery
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