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| Credit: diabetic.org |
Gestational
diabetes is diabetes that occurs during pregnancy. Diabetes is a common
condition where there is too much glucose in the blood. Women usually recover
from gestational diabetes after their baby is born, when their blood glucose
levels return to normal.
Our body makes insulin to help keep our blood glucose at the right level. Blood
glucose becomes higher when we can’t make enough insulin or when it does not
work as well as it should
Development of
gestational diabetes
During
pregnancy, hormones are made by the placenta to help the baby develop and grow.
These hormones, however, stop the mother’s insulin from working properly. This
is called insulin resistance. As the pregnancy develops and the baby grows
bigger, the mother’s body has to make more insulin to keep her blood glucose at
normal levels. Later in pregnancy the amount of insulin needed to keep
blood glucose levels normal is two to three times higher than usual. If the
body is unable to produce enough insulin to keep blood glucose levels in the
normal range, gestational diabetes develops.
Women
at risk of gestational diabetes
Between
three and eight per cent of pregnant women develop gestational diabetes. It is
usually detected around weeks 24 to 28 of pregnancy, although it can develop
earlier. Being diagnosed with gestational diabetes can be both unexpected and
upsetting.
Certain women are at increased risk of developing gestational diabetes. This
includes women who:
·
are
over 30 years of age
·
have
a family history of type 2 diabetes
·
are
overweight or obese
·
are
of Aboriginal and Torres Strait Islander descent
·
are
of particular cultural groups, such as Indian, Chinese, Vietnamese, Middle
Eastern, Polynesian and Melanesian
·
have
previously had gestational diabetes
·
take
some antipsychotic or steroid medications
·
have
previously had a baby whose birth weight was greater than 4,500 grams (4.5 kg)
·
have
had a previous complicated pregnancy.
·
have
had polycystic ovarian syndrome.
Some women
who develop gestational diabetes have no known risk factors.
Symptoms
of gestational diabetes
Gestational
diabetes usually has no obvious symptoms. If symptoms do occur, they can
include:
·
unusual
thirst
·
excessive
urination
·
tiredness
·
thrush
(yeast infections).
Diagnosis
of gestational diabetes
Most women
are diagnosed using a pathology test, which requires a blood sample to be taken
before and after a glucose drink. These tests are usually performed between 24
and 28 weeks into the pregnancy, or earlier if you are at high risk.
To diagnose gestational diabetes a pregnancy oral glucose tolerance test
(POGTT) is recommended.
This involves taking a blood test after fasting overnight. Next you have a
drink containing 75 grams of glucose and blood is taken to be tested one and
two hours afterwards.
Diagnosis of gestational diabetes is made if the
fasting blood glucose is raised or the two-hour blood glucose is raised (or
both).The new diagnostic guidelines for gestational diabetes state a raised
blood glucose level at one hour after the glucose drink also indicates
gestational diabetes.
Some health centres may be still using the Glucose Challenge Test (GCT). A
sweet glucose drink is given and the blood glucose measured one hour after the
drink. If this is above normal, an oral glucose tolerance test is required.
This test is no longer considered part of diagnostic testing as it is not
specific or sensitive enough for diagnosing GDM.
Treatment
for gestational diabetes
If you are
diagnosed with gestational diabetes it is important that you are supported and
know what to do to manage it. Health professionals such as your doctor, a dietitian,
a diabetes nurse educator or sometimes a diabetes specialist will help you
understand what to do and will support you. Family also can be a great support
and it is important that they also understand about gestational diabetes and
how it is managed.
It is important that blood glucose is kept as close to normal as possible,
especially during pregnancy. High blood glucose levels can affect the baby
before birth, later as a child and even as an adult.
During pregnancy, glucose crosses the placenta from mother to baby to provide
energy for the growing baby. If your blood glucose levels are higher than
normal, extra glucose will cross the placenta to the baby. To deal with this
extra glucose, the baby then makes more insulin which makes the baby grow larger
more quickly. If your blood glucose levels remain high, the baby may become
larger than normal. This can lead to problems during and after birth.
Keeping blood glucose in the recommended range can prevent problems during
birth and also helps reduce the baby’s risk of being overweight in childhood
and developing type 2 diabetes later in life.
Management
of gestational diabetes
Advice to help manage gestational diabetes (which will
help to keep blood glucose levels close to normal) may include:
·
healthy diet – make sure you are eating a
nutritious diet that helps you maintain a healthy weight. Choose varied and
enjoyable food, including foods rich in calcium (milk and cheese), iron (red
meat, chicken and fish) and folic acid (dark green leafy vegetables). Include
some carbohydrates at each meal such as grains, cereals, fruits, pasta and
rice. Reduce your saturated fat intake by limiting the amount of processed and
takeaway foods that you eat. Avoid foods and drinks containing a lot of added
sugar. Discuss with a dietitian how much carbohydrate you should eat and the
best way to spread it out throughout the day to help control your blood glucose
levels. A dietitian can also help you with any other questions about how to
make sure you are eating the best diet for you and your baby
·
physical activity – such as walking, helps to
keep you fit, prepares you for the birth of your baby and will help to control
your blood glucose levels. Check with your doctor before starting a new or
particularly strenuous exercise regimen
·
monitoring your blood glucose levels – is
essential. It gives a guide as to whether the changes you have made to your
lifestyle are effective or whether further treatment is required. A diabetes
nurse educator can teach you how and when to measure your blood glucose levels.
They will discuss the recommended blood glucose levels to aim for. Your doctor
or diabetes educator can help you link in with the National Diabetes Services
Scheme (NDSS) for cheaper blood glucose strips. Regular contact with your
diabetes educator or doctor is recommended
·
insulin injections – may be needed to help
keep your blood glucose level in the normal range. Many diabetes tablets are
not safe to take during pregnancy so insulin injections may be necessary.
Insulin is safe to take during pregnancy and does not cross the placenta from
the mother to the baby
·
education – it is very important that you get
information and support from your diabetes educator or doctor on how insulin
works, how to give insulin and how to store it. Insulin sometimes causes blood
glucose levels to go too low (hypoglycaemia), therefore it is very important
that you learn the signs and symptoms of this and how to prevent and treat it
(as well as safe blood glucose levels for driving).
After
your baby is born
If you have been having insulin injections to help manage
gestational diabetes, you can usually stop these injections once your baby is
born. This is because your blood glucose levels usually return to normal quite
quickly after the baby’s birth.
Your blood glucose levels will be measured for a few days after your baby is
born to make sure that they are within the normal range. Testing times are
usually before breakfast and two hours after meals. An Oral Glucose Tolerance
test (OGTT) is done six to eight weeks after the baby is born to make sure that
diabetes has gone away.
Following the birth of your baby, it is important that your baby’s blood
glucose levels are measured to make sure that their blood glucose is not too
low. If it is, this can be treated by feeding your baby breast milk or formula.
Breastfeeding is encouraged as this is best for you and your baby.
A baby whose mother had gestational diabetes will not be born with diabetes,
but, they may be at risk of developing type 2 diabetes later in life.
Future pregnancies and gestational
diabetes
If you have
had gestational diabetes you are more likely to have it again in future
pregnancies. For that reason an OGTT will be performed early in any future
pregnancy to look for gestational diabetes. If this test is normal, then
another OGTT will be done again later in the pregnancy (between 22 and 28
weeks) to make sure blood glucose levels are still normal.
Reducing your risk of type 2 diabetes
Women who
have gestational diabetes have a high chance (almost one in two) of developing
type 2 diabetes within 10 to 20 years. Type 2 diabetes can be prevented, so it
is important to take steps to reduce your risk.
You should:
·
maintain
a healthy eating plan
·
maintain
a healthy weight for your height
·
do
regular physical activity
·
have
a follow-up blood test (OGTT) every year to check your blood glucose levels.
Where
to get help
·
Your
doctor
·
Obstetrician
·
Diabetes
specialist or endocrinologist
·
Diabetes
educator – ask at the hospital where you are booked to have your baby, or
alternatively, you may see a diabetes educator privately
·
Diabetes
Info Line Tel. 1300 136 588
·
Dietitians
Association of Australia Tel. (02) 6163 5200
Things
to remember
·
Gestational
diabetes is diabetes that occurs during pregnancy.
·
When
the pregnancy is over, the diabetes usually disappears.
·
Women
who develop gestational diabetes have an increased risk of developing type 2
diabetes.
·
A
healthy lifestyle is important for both mother and baby to reduce their risk of
diabetes in the future.
·
If
you have had gestational diabetes before, in future pregnancies, a test will be
performed early in the pregnancy to make check that your blood glucose levels
are in the normal range .
