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Gestational Diabetes

(Diabetes, Gestational; GDM; Gestational Onset Diabetes Mellitus [GODM]; Glucose Intolerance During Pregnancy)

Definition

Diabetes occurs when there is a higher level of glucose in the blood than is normal. Glucose comes from the breakdown of the food you eat. It travels through your body in the blood. A hormone called insulin then helps glucose move from your blood to your cells. Once glucose is in your cells, it can be used for energy. A problem making or using insulin means glucose cannot move into your cells. Instead, the glucose builds up in your blood. The build-up is called hyperglycemia.
Gestational diabetes is a type of diabetes that first occurs during pregnancy. The extra glucose can affect the mother and the baby.
Large Baby Due to Gestational Diabetes
IMAGE
Copyright © Nucleus Medical Media, Inc.

Causes

The exact cause is unknown.

Risk Factors

Gestational diabetes is more common in women who are 25 years and older. It is also more common in women of Hispanic, African-American, Native-American, Asian-American, Indigenous Australian, or a Pacific Islander descent.
Factors that may increase the risk of gestational diabetes include:
  • Obesity or being overweight—This can affect the body's ability to use insulin.
  • Gestational diabetes in a previous pregnancy
  • Multiple pregnancy—carrying two or more babies
  • Family history of diabetes
  • Previous delivery of a large baby
  • Sleep-disordered breathing—abnormal breathing during sleep ranging from snoring to sleep apnea
  • History of polycystic ovary syndrome
  • Previous stillbirth or too much fluid surrounding a baby during pregnancy
Also, hormones that help the baby's growth may interfere with insulin.

Symptoms

This condition may not cause any symptoms. If symptoms do occur, they may include:

Diagnosis

As part of prenatal screening, you will be tested for gestational diabetes. If you don't have a history of diabetes, the test will be done at 24-28 weeks of gestation. You will be given a drink that has a special glucose solution in it. The level of glucose in your blood will be measured. Other tests may be used that require fasting (not eating or drinking anything). If you are high risk for gestational diabetes or have symptoms, you will be tested earlier in the pregnancy.

Treatment

The goal of treatment is to return blood glucose levels to normal. Treatment may include:

Diet

A dietitian can help you develop a healthy meal plan. Guidelines include:
  • Eat a balanced diet . Do not skip meals.
  • Eat plenty of fruits, vegetables , and high fiber foods .
  • Limit the amount of fat you eat.
  • Avoid foods high in sugar such as soda, candy, and cookies.
  • Manage your portion sizes at each meal.
  • Plan a bedtime snack each night. It should include protein and complex carbohydrates such as legumes, potatoes, corn, or rice.
  • Keep a record of your food intake. Share this information with your doctor.
Do not gain more weight during pregnancy than your doctor advises. Excess weight can increase complications in your pregnancy. It will also make it more difficult to control your diabetes.

Exercise

Physical activity can make it easier for your body to use glucose. There are some precautions you may need to take or certain exercises you may need to avoid. Ask your doctor about an exercise plan.

Blood Sugar Testing

A blood glucose monitor will help you check your glucose levels throughout the day. Knowing your glucose level will help you plan your meals, activities, and medication. Keep a record of your results. Discuss them with your doctor at your visits.

Medication

You may need to give yourself insulin injections to control diabetes. For some pregnant women, oral medication is recommended.
After delivery, glucose levels usually return to normal. Your glucose levels will be checked to make sure that you no longer have diabetes.

Prevention

The following may help prevent gestational diabetes:
  • Do not gain more weight than recommended during pregnancy.
  • Eat a healthy diet.
  • Exercise regularly. Talk to your doctor before starting an exercise program.
  • Talk to your doctor about whether you should take probiotics to reduce your risk of gestational diabetes.

RESOURCES

The American College of Obstetricians and Gynecologists http://www.acog.org

American Diabetes Association http://www.diabetes.org

CANADIAN RESOURCES

Canadian Diabetes Association http://www.diabetes.ca

Women's Health Matters http://www.womenshealthmatters.ca

References

Gestational diabetes. ACOG practice bulletin No. 30. Obstet Gynecol. 2001;98:525-538.

Gestational diabetes mellitus (GDM). EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated August 19, 2014. Accessed September 29, 2014.

Hillier TA, Pedula KL, Vesco KK, et al. Excess gestational weight gain: modifying fetal macrosomia risk associated with maternal glucose. Obstet Gynecol. 2008;112:1007-1014.

How to treat gestational diabetes. American Diabetes Association website. Available at: http://www.diabetes.org/diabetes-basics/gestational/how-to-treat-gestational.html. Updated April 29, 2014. Accessed September 29, 2014.

2/5/2009 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Cheng YW, Chung JH, Kurbisch-Block I, Inturrisi M, Shafer S, Caughey AB. Gestational weight gain and gestational diabetes mellitus: perinatal outcomes. Obstet Gynecol. 2008;112:1015-1022.

4/1/2011 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Dhulkotia JS, Ola B, Fraser R, Farrell T. Oral hypoglycemic agents vs insulin in management of gestational diabetes: a systematic review and metaanalysis. Am J Obstet Gynecol. 2010;203(5):457.e1-9.

3/17/2014 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Luoto R, Laitinen K, et al. Impact of material probiotic-supplemented dietary counselling on pregnancy outcome and prenatal and postnatal growth: a double-blind, placebo-controlled study. Br J Nutr. 2010. Jun;103(12):1792-1799.

6/9/2014 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Qin JZ, Pang LH, et al. Obstetric complications in women with polycystic ovary syndrome: a systematic review and meta-analysis. Reprod Biol Endocrinol. 2013;11:56

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