Diagnosis:
Diabetes
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What moms-to-be should know about high blood-sugar levels during pregnancy
By Erika Rasmusson Janes
In the weeks before I had a gestational diabetes screening, I gave in to my pregnancy ice-cream cravings—a lot. I figured that if I had the condition, then I’d need to cut ice cream out of my diet. It wasn’t the healthiest decision; luckily, I wasn’t diagnosed with gestational diabetes. But an estimated 4 percent of pregnant women are, and many experts believe the number should be higher. “We’re finding that the blood- sugar levels associated with pregnancy complications are not as high as previously thought,” says Elisa Ross, M.D., an ob-gyn at the Cleveland Clinic.
In fact, an international panel of experts recently proposed new recommendations that would change the method of testing and the criteria for diagnosing gestational diabetes—and could increase the number of women with the diagnosis to about 18 percent. Although these standards haven’t been adopted by the American College of Obstetricians and Gynecologists, experts agree about the condition’s potentially harmful effect on pregnancy, and the importance of diagnosing and treating it.
Insulin Issues
Let’s be clear: Eating sugary foods doesn’t cause gestational diabetes. It’s a condition of poor pancreatic function, says Carol Major, M.D., clinical professor of obstetrics and gynecology at the University of California, Irvine, School of Medicine. “When you’re pregnant, your placenta makes hormones that help support pregnancy, but they work against your body’s own insulin, which pulls glucose from the blood into your cells. As a result, your pancreas has to work harder to make more insulin. If it can’t keep up, your blood sugar rises and you develop gestational diabetes,” she says.
Not that you’d notice. Unlike type 1 diabetes, which can cause excessive weight loss and the frequent need to pee, you probably won’t experience any symptoms. And any you might notice are hard to distinguish from side effects of pregnancy.
Left uncontrolled, the condition can have serious consequences for mom and baby. Because glucose crosses the placenta, your baby can grow too big, leading to a difficult delivery, nerve damage during birth, and an increased risk of childhood obesity and diabetes. Your baby could also be born with breathing problems, jaundice, or low blood sugar. For moms, gestational
diabetes can mean an increased risk of pregnancy complications like preeclampsia and the need for a C-section. Having gestational diabetes also increases the risk of developing type 2 diabetes by 50 percent over a lifetime.
Relative Risks
If you’re over 25, Hispanic, African-American, Native American, Asian, overweight, or obese, the odds that you could develop the disorder increase. Another risk factor: putting on too many pounds too soon. A recent study found that gaining 7 pounds or more in the first trimester might increase your chances of developing gestational diabetes. Don’t fall into any of these categories? You can still develop it. “That’s why every mom-to-be should be screened,” says Steven Gabbe, M.D., professor of obstetrics and gynecology at The Ohio State University College of Medicine, in Columbus.
Testing, 1, 2, 3
Sometime between your 24th and 28th week of pregnancy, you’ll down a sweet drink and then have blood drawn. If your glucose level is elevated, you’ll be scheduled for a 3-hour diagnostic test; your blood will be measured four times. If two of those measurements are elevated, you’ll be diagnosed with gestational diabetes. (The proposed new guidelines would cut the 1-hour screening and subject everyone to a 2-hour test—and just one abnormal measurement would warrant a diagnosis.)
The Treatment
If you have gestational diabetes, your doctor will probably tell you to exercise and eat a healthy diet (more fresh veggies and high-fiber foods, fewer sweets and processed foods), and measure your blood sugar four or five times a day. If your glucose is elevated after a week on a diabetic diet, you’ll likely start insulin injections or a pill that lowers blood glucose. Even if you’re not given a diagnosis of gestational diabetes,
Dr. Gabbe recommends asking your ob- gyn if your levels put you close to the cutoff; if so, you may want to increase your exercise and stick to a healthy diet. No one wants to be told she’s borderline or has gestational diabetes, but knowing it—and following a treatment plan—will improve your health and your baby’s, both now and in the future.
