Gestational diabetes in seen in pregnant women who have never had diabetes before but have high glucose levels during the pregnancy.

During pregnancy, the placenta supports and helps the baby to grow by producing certain hormones. These hormones are also responsible for insulin resistance in the mother and this resistance is a normal occurrence in pregnancy. In this case if the pancreas is able to produce enough insulin to compensate for the insulin resistance, the women does not get diabetes. However, in a small minority of the women the pancreas is unable to do so and the leads to a rise in the glucose levels and is termed as Gestational Diabetes Mellitus (GDM). If left untreated, it can cause harm to both, mother and the baby.

Usually GDM resolves within hours of the delivery of the baby.

Diabetes And Pregnancy

Image PlaceholderIdeally, a woman with diabetes who is planning pregnancy should consult her healthcare provider well before she becomes pregnant. This provides an opportunity to make sure blood glucose levels are in optimal control, adjust medications if needed, evaluate and treat any medical complications related to diabetes (such as diabetes-related eye disease, thyroid disease), and start folic acid supplementation (at least 400 mcg per day is recommended, starting at least one month before conception). It is also an opportunity to discuss how pregnancy may affect diabetes and vice versa. Care during pregnancy is a team effort involving an obstetrician and an endocrinologist or primary care provider who oversees insulin management and medical care. Some family practitioners perform all of these functions.
Today, most women with diabetes can have a safe pregnancy and delivery, similar to that of women without diabetes. This improvement is largely due to good blood glucose (sugar) control, which requires adherence to diet, frequent daily blood glucose monitoring, and frequent insulin adjustment. Women whose blood sugar levels are under control are less likely to have problems during pregnancy. Women with high blood sugar levels are more likely to have problems during pregnancy.
Are you a diabetic thinking about getting pregnant- BREATHE!! NO NEED TO WORRY

Image Placeholder Talk with your doctor before you start trying. He or she can:
  • Help you get your blood sugar levels under control.
  • Make changes to your medicines, if they need to be changed – This is especially important since some medicines used to treat diabetes are not safe to take during pregnancy.
  • Treat any medical problems you have – Some people with diabetes also have other problems, such as obesity, high blood pressure, or kidney disease. Your doctor or nurse can talk to you about how to treat these problems and how they might affect your pregnancy.
High blood sugar levels can cause problems throughout pregnancy and after the baby is born:
  • Early on, high blood sugar levels can increase the chance that a woman has a miscarriage. A miscarriage is when a pregnancy ends on its own before the woman has been pregnant for 20 weeks.
  • High blood sugar levels early on can also increase the chance that a baby will be born with a birth defect, such as a spine or heart problem.
  • High blood sugar levels can increase the chance that a baby gets too big than expected, making it a difficult delivery.
  • High blood sugar levels at the end of pregnancy can sometimes cause the baby to have problems right after birth. This can include blood sugar levels that are too low, or other issues.
Different doctors will take care of you during pregnancy. One doctor will take care of your pregnancy. This doctor might also be able to take care of your diabetes. If not, you will see your diabetes doctor during pregnancy. He or she will:
  • Tell you what your blood sugar levels should be and how often to check them – Many women need to check their blood sugar levels every day before and after meals.
  • Help you make changes to your diet and medicines so that your blood sugar levels stay under control.
Your diabetes medicines might need to be changed because:
  • Women who take insulin might need more insulin during pregnancy.
  • Some diabetes pills are not safe to take during pregnancy. Women who take these pills need to start using insulin or take a different pill during pregnancy. Your doctor will tell you which medicine is right for you.
  • Women who don’t already take medicine for their diabetes might need to start taking a diabetes medicine during pregnancy.
  • A nutritionist can help to plan a diet that provides the optimal number of calories, carbohydrates, and snacks/meals throughout the day for pregnant women with diabetes. The optimal number of calories depends upon the woman's prepregnancy weight and activity level.
  • Exercise is an excellent way to control weight and blood glucose levels. Most women who exercised before pregnancy can continue to do so during pregnancy at the same or a slightly reduced pace. Moderate intensity exercise, such as brisk walking, is recommended. Women who did not exercise previously may begin to exercise during pregnancy after consulting with their healthcare provider. Exercise intensity, type, and duration may need to be modified as the pregnancy progresses or if complications develop.
Sometimes, pregnancy worsens the eye and kidney problems that people with diabetes can get. Pregnancy can also make high blood pressure worse. Your doctor will check you for these problems by:
  • Doing blood and urine tests to check your kidneys.
  • Doing eye exams.
  • Checking your blood pressure at each visit.
Ultrasound
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Ultrasound may be recommended for several reasons during pregnancy.
  • To determine the due date.
  • To screen for birth defects.
  • To monitor amniotic fluid levels.
  • To monitor the baby's growth.
Fetal Testing
Close monitoring of the fetus is recommended during the third trimester, usually starting at 32 to 34 weeks of pregnancy. This usually includes weekly to twice-weekly nonstress testing. This is done by monitoring the baby's heart rate with a small device that is placed on the mother's abdomen. The device uses sound waves (ultrasound) to measure the baby's heart rate over time, usually for 20 to 30 minutes.

Normally, the baby's baseline heart rate should be between 110 and 160 beats per minute and should increase above its baseline by at least 15 beats per minute for 15 seconds when the baby moves.

The test is considered reassuring (called “reactive”) if two or more fetal heart rate increases are seen within a 20-minute period. Further testing may be needed if these increases are not seen after monitoring for 40 minutes.

A woman and her obstetrician may decide to schedule the date of her delivery (either an induction of labor or cesarean delivery), especially if there are risk factors for an adverse maternal or fetal outcome, such as increased blood glucose levels, nephropathy, worsening retinopathy, high blood pressure or preeclampsia, or if the baby is smaller or larger than normal.

Waiting for labor to start on its own is reasonable if blood glucose levels are well-controlled and the mother and baby are doing well. However, extending pregnancy beyond 40 to 41 weeks of gestation is generally not recommended; some practitioners routinely induce labor between 39 and 40 weeks in all women with type 1 or 2 diabetes.
Infant Care
The infant of the diabetic mother is at risk for several problems in the newborn period, such as low blood glucose levels, jaundice, breathing problems, excessive red blood cells (polycythemia), low calcium level, and heart problems. These problems are more common when the mother's blood glucose levels have been high throughout the pregnancy. Most of these problems resolve within a few hours or days after delivery. Infants of diabetic mothers are often evaluated in a special care nursery to monitor for these potential problems.

Infants of mothers with diabetes are at higher risk of having difficulties with breathing, especially if the baby is born earlier than 39 weeks. This is because the lungs appear to develop more slowly in infants of women with diabetes. The risk of breathing problems is highest when maternal blood glucose levels have been high near the time of delivery.
After Delivery Care
Postpartum (after delivery) care of a woman with diabetes is similar to that of women without diabetes. However, it is important to pay close attention to blood glucose levels because insulin requirements can fall rapidly in the first few days after delivery; some women require little or no insulin.
Breastfeeding
In all women (with and without diabetes), breastfeeding is strongly encouraged because it benefits both the infant and the mother. Insulin requirements may be lower while breastfeeding, and frequent blood glucose monitoring is important to prevent severe hypoglycemia.

If your blood sugar levels have been under control, chances are good that your baby will be healthy. But your baby’s doctor will keep a close eye on your baby, because babies whose mothers have diabetes can have problems, including low blood sugar or breathing problems. Most of these problems go away on their own within 1 to 2 days.

Your Doctor is the best source of information for questions and concerns related to your medical problem.