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  DIABETES MELLITUS

 

WHY WORRY ABOUT GESTATIONAL DIABETES?

Untreated gestational diabetes can lead to problems for both mother and child. You are 28 weeks pregnant. Your health care provider has just told you that you have gestational diabetes mellitus. Should you be concerned?

The short answer: yes. Good care means a lot for your health and your baby's health. 

What Is Gestational Diabetes?

 Pregnant women who have never had diabetes before but who have high blood sugar levels during pregnancy are said to have gestational diabetes. Gestational diabetes affects about 8 to 10 percent of all pregnant women in Singapore.

 We don't know what causes gestational diabetes, but we have some clues. Your placenta supports your baby as he or she grows. Hormones from the placenta help your baby develop. But these hormones also block the normal action of your insulin in your body during pregnancy. This creates a problem called insulin resistance. Insulin resistance makes it hard for the mother's body to use insulin. You may need up to three times as much insulin as when you were not pregnant.

 The American Diabetes Association says that pregnant women who are 25 years or older, were overweight before they became pregnant, have a family history, are Hispanic, African, Native, Asian American, or a Pacific Islander should be screened for gestational diabetes between the 24th and 28th weeks--around the 6th month--of pregnancy. By then, your placenta has begun to make the hormones that lead to insulin resistance.

 How Gestational Diabetes Can Affect Your Baby

 Gestational diabetes does not cause the kinds of birth defects sometimes seen in babies whose mothers had diabetes before pregnancy. However, untreated or poorly controlled gestational diabetes can hurt your baby. Babies can develop macrosomia ie extra-big, and face health problems of their own, including damage to their shoulders during birth. Because of the extra insulin made by the baby's pancreas, newborns may have very low blood sugar levels at birth and may also have a higher risk for experiencing breathing problems. Babies with excess insulin become children who are at risk for obesity and adults who are at risk for type 2 diabetes.

Treating Gestational Diabetes

Because this condition can hurt you and your baby, you need  to start treatment quickly. Treatment is geared toward keeping blood sugar levels equal to those of pregnant women who don't have gestational diabetes. Treatment includes special meal plans and scheduled physical activity. It may also include daily blood sugar testing and insulin injections. You will need help from your endocrinologist, nurse educator, dietitian, and other members of your health care team so that your treatment can be changed as needed. Oral diabetes pills cannot be used during pregnancy.

For you as the mother-to-be, treatment for gestational diabetes helps lower the risk of a cesarean section birth that very large babies may require. Sticking with your treatment will give you a healthy pregnancy and birth and help your baby avoid future health problems. 

Looking Ahead

Gestational diabetes usually goes away after pregnancy. But once you've had gestational diabetes, your chances are 2 in 3 that it will return in future pregnancies. Additionally, in a few women, pregnancy uncovers type 1 or type 2 diabetes. It is hard to tell whether these women have gestational diabetes or have just started showing their diabetes during pregnancy. These women will need to continue diabetes treatment after pregnancy. 

Your blood sugar level should be checked with an oral glucose tolerance test six weeks after your baby is born. If your blood sugar level is normal, it should be rechecked at least every three years.

Latest news about gestational diabetes  

Many women who have gestational diabetes go on to develop type 2 diabetes years later. There seems to be a link between the tendency to have gestational diabetes and type 2 diabetes as both conditions involve insulin resistance. Certain basic lifestyle changes may help prevent diabetes after gestational diabetes. Exercise regularly, avoid becoming overweight and eat a healthy diet. 

Women with gestational diabetes are at greater risk of developing type 2 diabetes, with almost 20% of women developing the condition within 9 years of pregnancy, found a large, population-based study of 659,000 women published in the Canadian Medical Association Journal in 2008.

The study, conducted by a group of researchers from the University of Toronto, Mount Sinai Hospital and the Institute for Clinical and Evaluative Sciences, looked at 21,823 women diagnosed with gestational diabetes and examined follow up records up to 9 years. They found the rate of diabetes increased rapidly in the first 9 months after delivery, peaking at 9 years.

"In this large, population-based study, we found that diabetes developed within 9 years after the index pregnancy in 18.9% of women with previous gestational diabetes; this rate was much higher than the rate among women without gestational diabetes (2%)," state Dr. Denice Feig and coauthors.

As well, they note that the rate of gestational diabetes in Ontario, the study province, seems to be increasing and is linked to older mothers. Living in low-income neighbourhoods and in urban areas were also risk factors for gestational diabetes. Higher urban statistics "may reflect the large numbers of South and East Asian and black populations living in urban areas, who have a higher risk of type 2 diabetes," postulate Dr. Feig and colleagues.

"The main strength of our study lies in the fact that it was a large population-based study involving more than 21,000 women with gestational diabetes, with up to 9 years of follow-up," state the researchers. "Unlike other studies, it covered a large, well-defined geographic region with a population of 13 million, which allowed us to make a more robust assessment of the risk of type 2 diabetes after gestational diabetes than has been possible in previous studies."


 

Copyright of Lee Chung Horn Diabetes & Endocrinology 2009