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Diabetes During Pregnancy: What is Gestational Diabetes?

Pregnancy is an exciting and life-changing time. While your body is adjusting to keeping your baby healthy, you're adjusting to eventually bringing your baby into the world.
Sometimes, your body's adjustments aren't perfect, and your body doesn't have enough insulin to provide energy for both you and your baby - a sign of gestational diabetes.
Normally, a hormone called insulin takes the glucose (sugar) from what you eat and converts it to energy. If you have diabetes, your body doesn't make enough insulin or it doesn't use it properly.
Gestational diabetes is a type of diabetes that begins during pregnancy and is often temporary. It occurs when your body doesn’t make enough insulin to use sugar for energy during your pregnancy. All women are tested for it - usually between 24 and 28 weeks of pregnancy.
It's normal for a diagnosis of gestational diabetes to leave you feeling overwhelmed and even frightened. However, you're not alone - nearly 10% of pregnant women get it. And most importantly, you can still have a completely healthy pregnancy and baby.
Most of the time, gestational diabetes can be managed by eating healthy and exercising regularly. However, some women need to take insulin.
If you've been diagnosed with gestational diabetes, you probably have some questions. But remember, you have the support you need for you and your baby. Here's what you need to know about your diagnosis to make sure you both stay healthy.
Gestational Diabetes: What Causes It?
Nobody knows for sure why a woman develops gestational diabetes. It doesn't mean you had diabetes before you got pregnant, and it doesn't necessarily mean you’ll have it after you give birth.
When you're pregnant, your placenta (the organ that provides nutrition and oxygen to your baby) supports your growing baby. It produces hormones such as chorionic gonadotropin (hCG), estrogen, and progesterone. Sometimes, these hormones block your insulin from getting to your body, causing a problem called insulin resistance. When your body has trouble using insulin, you may need up to three times as much insulin to make up for it.
Not having enough insulin makes it hard for your body to use glucose (sugar) for energy, so the glucose remains in the blood. This buildup of glucose is called hyperglycemia, or high blood sugar.
Though the exact cause is unknown, there are a few factors that may play a role in developing gestational diabetes, including if you:
  • Are overweight - or if you have gained too much weight during pregnancy
  • Have a family history of diabetes
  • Had gestational diabetes during a previous pregnancy
  • Are more than 25 years old
  • Have given birth to a baby who was more than 9 pounds
  • Are African American, Hispanic or Latino American, American Indian, Alaska Native, Native Hawaiian, or Pacific 
How Do I Know If I Have Gestational Diabetes?
You might have a hunch about gestational diabetes if you experience the common signs and symptoms, such as:
  • Extreme thirst
  • Frequent urination
  • Fatique
  • Nausea
  • Vaginal, bladder, and skin infections
  • Blurry vision
However, it's not quite as straightforward as noticing symptoms.
Since not all women have symptoms, and some symptoms are the same as the effects of pregnancy in general, don't jump to conclusions. Gestational diabetes is one of those things that can't be diagnosed just by looking at someone, which is why all women are tested for it during pregnancy.
An oral glucose tolerance test is given usually between the 24th and 28th weeks of pregnancy. If you think you’re experiencing symptoms, or have risk factors for gestational diabetes, your provider may have you tested earlier.
The test is simple. It measures your blood glucose level when you have nothing to eat for at least 8 hours. You will drink a sweet - but not necessarily tasty - liquid. It may make you feel a little nauseous, but this will go away. After 1 hour, 2 hours and 3 hours a blood sample will be taken and tested, the blood glucose levels will determine if you have gestational diabetes.

How Can Gestational Diabetes Affect My Baby - or Me?
The key to gestational diabetes is to act quickly. Without treatment, your blood sugar levels can become too high, which can be dangerous for you and your baby.
Risks for your baby include:
  • Premature birth (before 37 weeks of pregnancy completed)
  • Large birth weight, which can cause problems during delivery
  • Low blood sugar right after being born
  • Breathing problems
  • Miscarriage
  • Becoming overweight as they get older

Risks for you include:
  • Preeclampsia (when you have high blood pressure and too much protein in your urine), which can be life-threatening
  • A need to have a cesarean section (C-section)
  • Other health problems, such as diabetic retinopathy (eye problems), heart disease, kidney disease, and nerve damage
Treating Gestational Diabetes
With the right plan, gestational diabetes is completely manageable. By working with your physician, you can have a healthy pregnancy and a healthy baby.
The goal of treatment is simple: to keep your blood sugar levels normal. Though each woman is different, your recommended target blood sugar levels will likely be:
  • Before meals, at bedtime, or overnight: 60-94 mg/dL (milligrams per deciliter)
  • 1 hour after eating: 140 mg/dL or less
  • 2 hours after eating: 120 mg/dL or less
Many women can keep their blood sugar levels in a healthy range with a well-planned diet and regular exercise. However, some women may require insulin shots.
Eating Healthy
What you eat - and when and how much - all impact your blood sugar levels. If your blood sugar gets too high, your body may produce a chemical called ketones, which can be a sign that you and your baby are not getting enough energy from your diet.
By creating a food plan with your physician, you can make sure both you and your baby stay healthy. Your physician may recommend that you test your urine or blood each day to make sure there are no ketones. If there are, you may need to change the type or amount of food you eat.

Exercising Regularly
Physical activity is always important, but it's extra important when you have gestational diabetes. Moderate exercise - such as brisk walking or water aerobics - will help you lower your blood sugar so you don't need as much insulin.
Of course, exercise has other benefits, too - relieving stress, strengthening your heart and bones, improving strength, and keeping your joints flexible. Just make sure you talk to your physician about what exercises are safe when you're pregnant.
If Needed - Taking Insulin

If diet and exercise aren't enough, you may need insulin. Your physician will show you how to give yourself insulin injections, which are completely safe for the baby and only feel like a tiny prick in your skin. Some women may be prescribed pills such as metformin and glyburide instead. Talk to your physician about which treatment is best for you and your baby.
Monitoring and More Monitoring
The most effective way to avoid gestational diabetes both during and after your pregnancy is by monitoring both your and your baby's health. During your pregnancy, make sure you go to your check-ups so your physician can keep an eye on your baby's growth and development.
If you do have gestational diabetes, you should get tested for diabetes within a year of giving birth. For most women with gestational diabetes, their blood sugar levels return to normal soon after delivery. If your blood sugar levels are high, there is a possibility that you may have type 2 diabetes and require treatment. If they're back to normal, you will still need to get tested every 3 years.
Staying active, eating nutritiously, and maintaining a healthy weight has always been important. Now more than ever, make your health a priority — for you and your baby.
Still have questions about gestational diabetes? The Gestational Diabetes Management Program at Chester County Hospital can help you manage your diabetes during pregnancy.
You can also call 610-738-2300 to find a primary care physician near you.

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Chester County Hospital's Health e-Living Blog offers a regular serving of useful health and lifestyle information for the residents of Chester County, PA and the surrounding region.

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