Sugared up

What gestational diabetes means for mom-to-be and baby

Most women cruise through their pregnancy with no problems – well, except for some nausea, heartburn, insomnia, food cravings and an occasional sense of tiredness. A small percentage of women, though, are diagnosed with gestational diabetes, or high blood sugars first uncovered during pregnancy.

But while the number of women diagnosed with gestational diabetes is small (current estimates are about 4% of all pregnant women, or 135,000 cases each year in the US), untreated gestational diabetes can cause some big problems for both mom and baby.

Risk factors

Gestational diabetes has few, if any, symptoms and some nausea, increased urination and thirst and fatigue are similar to pregnancy symptoms and might be ignored. If you have any of these risk factors, it’s extra important that you’re screened:  African, Hispanic or Native American ancestry; family history of diabetes; maternal age greater than 25;  Obesity; previous unexplained miscarriage or stillbirth; previous delivery of a baby over 9 lbs. and recurrent infections.

Risky business

Left untreated, gestational diabetes increases the risk of preeclampsia, which is high blood pressure and protein in the urine that develops after the 20th week of pregnancy. Gestational diabetes also increases the risk of preterm labor and because the excess glucose (sugar) crosses the placenta, your baby may be affected as well.

Babies of diabetic mothers may develop macrosomia, a technical term that means ‘too big baby.’ Because the baby is big, it’s more likely to be delivered by C-section or with the assistance of forceps. It’s also more likely to become stuck during a vaginal delivery, which can cause shoulder injury and, in extreme cases, death due to a lack of oxygen.

Gestational diabetes is a “very manageable condition,” according to Aradhna Pal, MS, RD, a certified diabetes educator (CDE) with Middletown Medical in Middletown. “If the blood sugars are controlled, the mother has as a good chance of having a healthy pregnancy and delivery.” 

Managing blood sugars

While a diagnosis of gestational diabetes can be overwhelming, Pal says that most women diagnosed with gestational diabetes learn to manage the disease without much difficulty. “Pregnancy puts women in a state where they’re concerned about their babies,” says Pal. “They really want to control their diabetes and are very motivated.”

If you have been diagnosed, the first step to getting it under control is learning to check your blood sugar. You may be intimidated at the thought of pricking your finger, but old pros insist it’s not so bad. “The pain really is instant,” says Cheryl Alkon, a diabetic and author of the soon-to-be-published book, Balancing Pregnancy with Preexisting Diabetes: Healthy Mom, Healthy Baby (Demos Health, Jan.2010). “It’s the anticipation of the potential pain that can cause more worry than the actual pain itself.”

Eat right

Pal encourages the women she works with to monitor their blood sugars for a few days before changing their diet. That way, they can see firsthand how certain foods cause a spike in blood sugar. Once they understand the relationship between intake and blood sugar, Pal works with them to design a healthier eating plan. “Diet is the first line of treatment in gestational diabetes,” Pal says. That doesn’t mean, however, that all your favorite foods will now be off-limits. “There is no taboo food,” Pal says.

Instead, she encourages women to choose complex carbs – whole grains such as brown rice – over simple and processed carbs, like white bread. Women should also include a small amount of protein at every meal, which can be easy as sprinkling nuts on your morning oatmeal.

Walk a little

Exercise is the next line of defense. Ideally, moms with gestational diabetes should begin a simple exercise program – walking is good – while tweaking their diet. For most women, that’s all it takes: studies show that 85% of women with gestational diabetes can control it with diet and exercise alone The remaining 15% will need some kind of drug therapy, either insulin or an oral medication. Your doctor will help you decide what treatment is right for you.

Extra TLC

If you’ve been diagnosed with gestational diabetes, you and your baby may need a little extra care for the duration of your pregnancy. Your healthcare provider wants to keep a close eye on your baby’s growth and may order weekly or biweekly non-stress tests starting around 32 weeks, just to make sure all is well with baby.

A non-stress test is a simple, painless procedure done during pregnancy to evaluate your baby’s condition. A practitioner or technician monitor’s the baby’s heartbeat while it is resting and then while it is moving. Just as your heart beats faster when you’re active, your baby’s heart rate should go up while he’s moving or kicking.

The vast majority of women with gestational diabetes have an uncomplicated vaginal delivery sometime between 37 and 42 weeks. Your healthcare provider will probably want to check the baby’s blood sugar shortly after delivery – some infants develop hypoglycemia, or low blood sugar after leaving their high-sugar home, but most babies do just fine. 

Tell your baby’s doctor that you had gestational diabetes since babies of gestational diabetics are more likely to develop diabetes in adolescence and adulthood. You’re at an increased risk too, so make sure your healthcare provider checks your blood sugar at the post-partum check-up and  as part of an annual physical. Maintaining a healthy weight, eating well and exercising can decrease your risk of gestational diabetes.

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Jennifer L.W. Fink is a freelance writer and mother of four boys.