What Causes Gestational Diabetes?

Gestational diabetes is the result of some hormonal changes that occur in all women during pregnancy. Increased levels of certain hormones made in the placenta (the organ that connects the baby by the umbilical cord to the uterus and transfers nutrients from the mother to the baby) interfere with the ability of insulin to manage glucose. This condition is called insulin resistance. As the placenta grows larger during pregnancy, it produces more hormones and increases this insulin resistance.

Usually the mother's pancreas is able to produce more insulin (about three times the normal amount) to overcome the insulin resistance. If, however, the pancreas cannot produce enough insulin to overcome the effect of the increased hormones during pregnancy, sugar levels will rise, resulting in gestational diabetes.

Am I at Risk for Gestational Diabetes?

These factors increase your risk of developing diabetes during pregnancy:

1.Being overweight prior to becoming pregnant (if you are 20% or more over your ideal body weight)
2.Family history of diabetes (if your parents or siblings have diabetes)
3.Being over age 25
4.Previously giving birth to a baby over 9 pounds
5.Previously giving birth to a stillborn baby
6.Having gestational diabetes with a previous pregnancy
7.Having too much amniotic fluid (a condition called polyhydramnios)
8.Keep in mind that half of women who develop gestational diabetes have no known risk factors.

How Is Gestational Diabetes Diagnosed?

Gestational diabetes is generally diagnosed between the 24th and 28th week of pregnancy when insulin resistance usually begins. If you have had gestational diabetes before, or if your doctor is concerned about your risk of developing gestational diabetes, a test may be performed before the 13th week of pregnancy.

To screen for gestational diabetes, you will take a test called the oral glucose tolerance test. This test involves quickly drinking a sweetened liquid, which contains 50g of glucose. The body absorbs this glucose rapidly, causing blood sugar levels to rise within 30-60 minutes. A blood sample will be taken from a vein in your arm about 30 minutes after drinking the solution. The blood test measures how the glucose solution was metabolized (processed by the body).

If your test results are not normal, you will have a similar type of diabetes test that requires you to fast (not eat anything) before the test. If this second test yields abnormal results, you have gestational diabetes.

How Is Gestational Diabetes Managed?

Gestational diabetes is managed by:

1.Monitoring your blood sugar levels
2.Following specific dietary guidelines as instructed by your doctor
3.Exercising
4.Monitoring your weight gain
5.Taking insulin, to lower blood sugar

How Do I Monitor My Blood Sugar?

Testing your blood sugar at certain times of the day will help determine if your exercise and eating patterns are keeping your blood sugar levels in control, or if you need extra insulin to protect your developing baby. Your doctor will tell you when and how often to test your blood sugar.

Testing your blood sugar involves pricking your finger with a lancet device (a small, sharp needle), putting a drop of blood on a test strip, using a blood glucose meter to display your results, recording the results in a log book, and then disposing the lancet and strips properly (in a used sharps container or a hard plastic container, such as a laundry detergent bottle). Bring your blood sugar readings with you to your doctor appointments so he or she can evaluate how well your sugar levels are controlled and determine if changes need to be made to your treatment plan.

Your doctor will show you how to use a glucose meter. He or she can also tell you where to get a meter. You may be able to borrow it from your hospital, as many hospitals have loaner meter programs for women with gestational diabetes.

The goal of monitoring is to keep your blood sugar as close to normal as possible. The ranges include:

How Will My Diet Change?

Here are some goals for healthy eating during pregnancy if you have gestational diabetes:

1.Eat three small meals and two or three snacks at regular times every day. Do not skip meals or snacks.
2.Eat less carbohydrate at breakfast than at other meals because this is when insulin resistance is the greatest.
3.Try to eat a consistent amount of carbohydrate during each meal and snack.
4.If you have morning sickness, eat 1-2 servings of crackers, cereal or pretzels before getting out of bed. Eat small, frequent meals throughout the day and avoid fatty, fried and greasy foods. If you take insulin and have morning sickness, make sure you know how to treat low blood sugar.
5.Choose foods high in fiber such as whole-grain breads, cereals, pasta, rice, fruits, and vegetables.
6.Eat foods with less sugar and fat.
7.Drink at least 8 cups (or 64 ounces) of liquids per day.
8.Make sure you are getting enough vitamins and minerals in your daily diet. Ask your doctor about taking a prenatal vitamin and mineral supplement to meet the nutritional needs of your pregnancy.

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