Show Gestational Diabetes InformationGestational diabetes is when high blood sugar levels arise during pregnancy, then typically disappear after pregnancy. Gestational diabetes, which affects about 7 percent of all pregnant women, usually appears around the 24th week of pregnancy, when the placenta begins producing large quantities of hormones that cause insulin resistance. Diabetes Management Program, Newton-Wellesley Hospital Who is at Risk?You may be at greater risk for gestational diabetes if you:
Potential Concerns for the Mother and BabyIf you have gestational diabetes, your baby can have an increased risk of:
In addition, you can have an increased risk of:
The development of ketones, substances that the body produces when it breaks down fat for energy, also can affect your baby. Ketones cross the placenta and enter the baby’s bloodstream, which may happen when your diet is low in carbohydrates or if your body cannot use glucose properly. You will need to check your urine every morning during pregnancy for the presence of ketones. TreatmentDo not skip meals or decrease calories. East three meals and three snacks a day, as outlined by your dietitian. If you have moderate or large amounts of ketones for two mornings in a row, call your diabetes nurse educator or dietician — you probably need more calories. Blood Glucose TestingBelow are guidelines to follow when testing your blood sugar levels:
Check your blood sugar when fasting and one hour after every meal. Call your doctor or diabetes nurse educator if your blood sugar is above 100 in the morning or above 130 one hour after meals for two days in a row. An endocrinologist may need to evaluate you to see if you need insulin. Follow-Up
Your Regular ScheduleTo continuously ensure you are successfully managing your gestational diabetes:
Once you are diagnosed as having gestational diabetes, you and your health care providers will want to know more about your day-to-day blood sugar levels. What is self blood glucose monitoring? Self blood glucose monitoring is done by using a special device to obtain a drop of your blood and test it for your blood sugar level. Your doctor or other health care provider will explain the procedure to you. Make sure that you are shown how to do the testing before attempting it on your own. Some items you may use to monitor your blood sugar levels are: Lancet–a disposable, sharp needle-like sticker for pricking the finger to obtain a drop of blood. Your health care provider can advise you where to obtain the self-monitoring equipment in your area. You may want to inquire if any places rent or loan glucose meters, since it is likely you won't be needing it after your baby is born. How
often and when should I test? How should I record my test results? You should record any test result immediately because it's easy to forget what the reading was during the course of a busy day. You should always have this diary with you when you visit your doctor or other health care provider or when you contact them by phone. These results are very important in making decisions about your health care. Are there any other tests I should know about? How do I test for ketones? When do I test for ketones? Is it ever necessary to take insulin? There is no absolute blood sugar level that necessitates beginning insulin injections. However, many physicians begin insulin if the fasting sugar exceeds 105 mg/dl or if the level 2 hours after a meal exceeds 120 mg/dl on two separate occasions. Blood sugar levels measured by you at home will help your doctor know when it is necessary to begin insulin. The ability to perform self blood glucose monitoring has made it possible to begin insulin therapy at the earliest sign of high sugar levels, thereby preventing the fetus from being exposed to high levels of glucose from the mother's blood. Will my baby be healthy? Ultrasound. Fetal movement records. Fetal monitoring. Non-stress test. Stress test(oxytocin challenge test). Amniocentesis. Amniocentesis can be performed in an obstetrician's office or on an outpatient basis in a hospital. For genetic testing, amniocentesis is usually performed around the 16th week when the placenta and fetus can be located easily with ultrasound and a needle can be inserted safely into the amniotic sac. The overall complication rate for amniocentesis is less than 1 percent. The risk is even lower during the third trimester when the amniotic sac is larger and easily identifiable. Does gestational diabetes affect labor and delivery? Gestational diabetes, by itself, is not an indication to perform a cesarean delivery, but sometimes there are other reasons your doctor may elect to do a cesarean. For example, the baby may be too large (macrosomic) to deliver vaginally, or the baby may be in distress and unable to withstand vaginal delivery. You should discuss the various possibilities for delivery with your obstetrician so there are no surprises. Careful control of blood sugar levels remains important even during labor. If a mother's blood sugar level becomes elevated during labor, the baby's blood sugar level will also become elevated. High blood sugars in the mother produce high insulin levels in the baby. Immediately after delivery high insulin levels in the baby can drive its blood sugar level very low since it will no longer have the high sugar concentration from its mother's blood. Women whose gestational diabetes does not require that they take insulin during their pregnancy, will not need to take insulin during their labor or delivery. On the other hand, a woman who does require insulin during pregnancy may be given insulin by injection on the morning labor begins, or in some instances, it may be given intravenously throughout labor. For most women with gestational diabetes there is no need for insulin after the baby is born and blood sugar level returns to normal immediately. The reason for this sudden return to normal lies in the fact that when the placenta is removed the hormones it was producing (which caused the insulin resistance) are also removed. Thus, the mother's insulin is permitted to work normally without resistance. Your doctor may want to check your blood sugar level the next morning, but it will most likely be normal. Should
I expect my baby to have any problems? Another problem that may develop in the infant of a mother with gestational diabetes is jaundice. Jaundice occurs when extra red blood cells in the baby's circulation are destroyed, releasing a substance called bilirubin. Bilirubin is a pigment that causes a yellow discoloration
of the skin (jaundice). A minor degree of jaundice is common in many newborns. However, the presence of large amounts of bilirubin in the baby's system can be harmful and requires placing the baby under special lights which help get rid of the pigment. In extreme cases, blood transfusions may be necessary. Pregnancy is a kind of “stress test” that often predicts future diabetic problems. In one large study more than onehalf of all women who had gestational diabetes developed overt Type II diabetes within 15 years of pregnancy. Because of the risk of developing Type II diabetes in the future, you should have your blood sugar level checked when you see your doctor for your routine checkups. There is a good chance you will be able to reduce the risk of developing diabetes later in life by maintaining an ideal body weight and exercising regularly. What is the normal fasting blood sugar level for a pregnant woman?The Joslin-Beth Israel Deaconess Pregnancy Program recommends the following goals and medical assessments before pregnancy: Fasting and pre-meal blood glucose: 80-110 mg/dl. Blood glucose one hour after meal: 100-155 mg/dl.
Why is my fasting glucose high in the morning gestational diabetes?High blood sugar in the morning may be caused by the Somogyi effect, a condition also called "rebound hyperglycemia." It also may be caused by dawn phenomenon, which is the end result of a combination of natural body changes.
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