CWC Article - Exercise In Pregnancy

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Gestational Diabetes

By: Bradley G. Goldberg, M.D.

Gestational diabetes affects 4% of all pregnancies or over 100,000 women in the U.S. every year. It is newly diagnosed during the pregnancy, therefore differentiating it from pre-existing diabetes, which also complicates some pregnancies.

Similar to pre-existing diabetes, gestational diabetes creates a state of “hyperglycemia” or too much circulating blood sugar. Not only is this not healthy for the pregnant woman, it can also lead to problems for the developing baby.

This includes the possibility of an excessively large baby (macrosomia). When the baby is very large this can increase the chance of problems during labor, such as prolonged labor, shoulder dystocia, or even Cesarean Section. Women with this are also at risk for urinary tract infections and hypertension. When gestational diabetes is severe, it may be a cause of miscarriage as well.

Due to these potential risks most OB/GYN physicians screen their pregnant patients for gestational diabetes. The test ideally is performed between the 24th and 28th week of the pregnancy. Some doctors do not perform this testing on all patients, instead testing only those women considered “high-risk” such as patients who are obese, over 30 years old, those with high blood pressure, certain ethnic groups, those patients with high amounts of glucose in their urine, and those with previous history of gestational diabetes.

Testing involves drinking a sugar drink (50 grams of ‘glucola’) followed one hour later by a blood test to measure the amount of sugar in the bloodstream. If the result is greater than 135-140 mg/dl of glucose, further testing is performed. It is not necessary to fast for this initial test.

Of the women who have an abnormal one-hour test, only 15% will actually be diagnosed with gestational diabetes. So don’t worry yet, at this point the odds are still in your favor that you will be not have gestational diabetes.

The diagnostic test for women with an abnormal one-hour test is the three-hour “glucose tolerance test”. This three-hour test does require fasting, and unfortunately also requires four blood draws after a 100-gram ‘glucola’ drink.

If two or more of the four values are high, then the woman is diagnosed with gestational diabetes and an ADA (American Diabetic Association) diet is started. In addition a regimen of “accu-checks” or finger-sticks is started so the woman can monitor her blood sugar at home. If the blood sugar remains mostly normal while on the diet, then no other treatment is needed. So it is very important to follow the ADA diet. If the diet alone does not control the blood sugar then Insulin may be needed, which could mean several injections per day, fortunately this is only needed in 10% of cases.

If blood sugar is poorly controlled then it may be necessary to deliver the baby 1 ½ to 2 weeks early. Usually the diabetes resolves shortly after the baby is delivered. However, women who have gestational diabetes, especially those who required Insulin, are at high risk for developing traditional diabetes later in life. Therefore periodic monitoring for these patients is prudent.