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Gestational Diabetes Risk Factors
Youâre more likely to get gestational diabetes if you:
- Were overweight before you got pregnant
- Are African-American, Asian, Hispanic, Alaska Native, Pacific Islander, or Native American
- Have blood sugar levels that are higher than they should be but not high enough to be diabetes
- Have a family member with diabetes
- Have had gestational diabetes before
- Have polycystic ovary syndrome or another health condition linked to problems with insulin
Mothers’ High Normal Blood Sugar Levels Place Infants At Risk For Birth Problems
Pregnant women with blood sugar levels in the higher range of normal but not high enough to be considered diabetes are more likely than women with lower blood sugar levels to give birth to babies at risk for many of the same problems seen in babies born to women with diabetes during pregnancy, according to a study funded in large part by the National Institutes of Health.
These problems included a greater likelihood for Caesarean delivery and an abnormally large body size at birth. Infants born to women with higher blood sugar levels were also at risk for shoulder dystocia, a condition occurring during birth, in which an infants shoulder becomes lodged inside the mother’s body, effectively halting the birth process.
The study authors declined to make recommendations for acceptable blood sugar levels for pregnant women. The researchers were unable to identify a precise level where an elevation in blood sugar increased the risk for any of the outcomes observed in the study. Rather, the chances for the outcomes were observed to increase gradually, corresponding with increases in the womens blood sugar levels.
Additional NIH funding was provided by the National Institute of Diabetes and Digestive and Kidney Diseases, and the National Center for Research Resources.
The seven-year study involved more than 23,000 pregnant women at 15 centers in 9 countries.
Information on nutrition during pregnancy is available at
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Significance Of Decreasing Insulin Requirements
In contrast, results from other studies found no association with decreasing insulin requirements and birthweight, and neonatal weight distribution . However, 1 study observed a trend for greater LGA neonates in women with decreasing insulin requirements . Caution is required when interpreting the findings as researchers used differing calculation methods to indicate fall in insulin requirements or perhaps due to heterogeneity in the population of women with type 2 diabetes included in the studies. The use of advanced sonographic and fetal doppler assessment in the surveillance of the fetus at risk, as in other high-risk pregnancies, may allow further stratification of risk in this population, but the optimal indicator of feto-placental compromise, particularly in women with diabetes, remains unclear.
In summary, the impact of decreasing insulin requirements is still not certain. While fetal monitoring in this situation can provide reassurance of current fetal well-being, it should not be viewed as a substitute for a well thought out plan for timing of delivery that takes into consideration other risks for perinatal mortality, such as gestational age, maternal glycemic control , prepregnancy retinopathy , maternal age, obesity and smoking history.
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What Causes Diabetes During Pregnancy
Some women have diabetes before they get pregnant. This is called pregestational diabetes. Other women may get a type of diabetes that only happens in pregnancy. This is called gestational diabetes. Pregnancy can change how a woman’s body uses glucose. This can make diabetes worse, or lead to gestational diabetes.
During pregnancy, an organ called the placenta gives a growing baby nutrients and oxygen. The placenta also makes hormones. In late pregnancy, the hormones estrogen, cortisol, and human placental lactogen can block insulin. When insulin is blocked, its called insulin resistance. Glucose can’t go into the bodys cells. The glucose stays in the blood and makes the blood sugar levels go up.
Key Points About Diabetes During Pregnancy
Diabetes is a condition in which the body cant produce enough insulin, or it cant use it normally.
There are 3 types of diabetes: Type 1, tType 2, and gestational diabetes.
Nearly all pregnant women without diabetes are screened for gestational diabetes between 24 and 28 weeks of pregnancy.
Treatment for diabetes focuses on keeping blood sugar levels in the normal range.
Women with gestational diabetes are more likely to develop Type 2 diabetes in later life. Follow-up testing is important.
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How Do Women Feel About The Diagnosis
Many women are very surprised by the because they wouldn’t have thought that they were at risk. Others blame themselves and think that they must have done something wrong. Many are worried at first because they don’t know what the diagnosis means for their baby and the rest of their pregnancy, and what steps need to be taken. There is a great need for information, particularly simple, easy-to-follow advice about how to treat gestational diabetes.
Many women would like to have emotional support in coping with gestational diabetes both from their doctors and their family. Some also see the as an opportunity to change their lifestyle.
Who’s At Risk Of Gestational Diabetes
Any woman can develop gestational diabetes during pregnancy, but you’re at an increased risk if:
- your body mass index is above 30 use the BMI healthy weight calculator to work out your BMI
- you previously had a baby who weighed 4.5kg or more at birth
- you had gestational diabetes in a previous pregnancy
- 1 of your parents or siblings has diabetes
- you are of south Asian, Black, African-Caribbean or Middle Eastern origin
If any of these apply to you, you should be offered screening for gestational diabetes during your pregnancy.
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Who Is At Risk For Diabetes During Pregnancy
The risk factors for diabetes in pregnancy depend on the type of diabetes:
Type 1 diabetes often occurs in children or young adults, but it can start at any age.
Overweight women are more likely to have Type 2 diabetes.
Overweight women are more likely to have gestational diabetes. Its also more common in women who have had gestational diabetes before. And its more common in women who have a family member with Type 2 diabetes. Women with twins or other multiples are also more likely to have it.
How Does Food Affect My Blood Sugar
When you eat, your body breaks food down into carbohydrates, proteins, fats, vitamins, and minerals.
You need all of these parts for a healthy diet, but carbohydrates are really important when it comes to your blood glucose level. However, not all carbs change into blood sugar at the same rate.
Examples of foods that fit into each carb category include:
- Starches, or complex carbohydrates: Starchy vegetables, dried beans, and grains
- Sugars: Fruits, baked goods, beverages, and processed food items like cereals
- Fiber: Whole wheat products, chickpeas, lentils, berries, pears, and Brussels sprouts
The glycemic index is a carb ranking system that uses a scale ranging from zero to 100. You can use the GI to find out how different foods affect your blood sugar levels.
High GI foods are quickly processed and can cause a rapid spike in blood sugar levels. Low index foods are more slowly processed which leads to smaller blood glucose level changes.
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Eating Well With Gestational Diabetes
An important part of managing gestational diabetes relates to diet. Following a healthy eating plan will assist in:
- Managing blood glucose levels within the target range advised by your doctor
- Providing adequate nutrition for you and your growing baby
- Achieving appropriate weight changes during your pregnancy.
It is advisable to see an Accredited Practising Dietitian to work out a meal plan that is appropriate for mum and the growing baby.
Possible Complications For The Baby
Unlike type 1 diabetes, gestational diabetes generally occurs too late to cause birth defects. Birth defects usually originate sometime during the first trimester of pregnancy. The insulin resistance from the contra-insulin hormones produced by the placenta does not usually occur until approximately the 24th week. Women with gestational diabetes mellitus generally have normal blood sugar levels during the critical first trimester.
The complications of GDM are usually manageable and preventable. The key to prevention is careful control of blood sugar levels just as soon as the diagnosis of diabetes is made.
Infants of mothers with gestational diabetes are vulnerable to several chemical imbalances, such as low serum calcium and low serum magnesium levels, but, in general, there are two major problems of gestational diabetes: macrosomia and hypoglycemia:
Blood glucose is monitored very closely during labor. Insulin may be given to keep the mothers blood sugar in a normal range to prevent the babys blood sugar from dropping excessively after delivery.
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If I Have Gestational Diabetes How Will It Be Treated
Treating gestational diabetes comes down to one key factor: controlling your blood sugar. The goal is to manage your blood glucose level so that it doesnt go too high and stay high. This is accomplished by eating wisely, remaining physically active, and if needed taking medication to help keep your blood sugar levels in your target range.
The importance of treating gestational diabetes gained attention following the Hyperglycemia and Adverse Pregnancy Outcomes trial, which demonstrated a direct link between continuous treatment of the maternal glucose levels and reducing negative outcomes.²
What Are The Risk Factors For Gestational Diabetes
The American College of Obstetricians and Gynecologists recommends that people who are pregnant receive a screening for gestational diabetes between 24 and 28 weeks into pregnancy. And your doctor will also likely talk to you about risk factors during your early checkups.
If you have multiple risk factors or if theres a lot of glucose in your urine during those early prenatal visits, youll probably do the screening sooner.
For people who have risk factors for gestational diabetes, we usually recommend that they get screening earlier in pregnancy usually in the first trimester, says maternal-fetal medicine specialist Jeff Chapa, MD.
Youre more likely to have gestational diabetes if you:
- Are older than age 35.
- Have a family history of Type 2 diabetes.
- Had a previous baby that weighed more than 9 pounds.
- Had gestational diabetes during an earlier pregnancy.
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Should I Use A Continuous Glucose Monitor
While a fingerstick blood sugar test gives you a static glimpse of your glucose level at that precise moment in time, a CGM is a more constant flow of information that provides a more complete picture and pattern of how youre doing.
This device monitors glucose levels under the skin, providing real-time results every 1 to 5 minutes. You insert a CGM on your body and wear it for 7 to 14 days, with the diabetes data being streamed to a separate handheld receiver or your smartphone app.
Importantly, you can see in real-time the effects of food and exercise on your glucose levels, and catch cases of hyperglycemia and hypoglycemia as they happen, avoiding the potentially dangerous consequences. Its also a potentially life-saving tool for people with diabetes who experience hypoglycemia unawareness, alerting them to impending low blood sugars when their own bodies fail to recognize the warning signs.
Research has shown, time and time again, the benefits of CGM in helping people improve their diabetes outcomes. This
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