Gestational Diabetes Testing
During pregnancy a placental hormone makes it a bit more difficult for blood sugar to get into a mom's cells. The benefit is that it makes it easier for the blood sugar to get to the baby. This is very normal and a healthy adaptation to pregnancy. However, in some women this will develop to an unhealthy level. This is called Gestational Diabetes. If the diabetes started before pregnancy but was first detected during pregnancy, it is not technically gestational diabetes but we won't know that until after pregnancy.
Women at the highest risk are those who are:
Most women with gestational diabetes will give birth to healthy babies, particularly if they make the changes to keep the blood sugar levels normal. Blood sugar levels that are only slightly elevated are not likely to have a serious impact on birth plans. In the baby, the most obvious and fairly common effect is very large babies. Very high levels of blood sugar can cause immature lung development, prematurity and unexplained stillbirth in the last weeks of pregnancy. It can also make it very difficult for a baby to stabilize after birth.
Recent research has shown another very interesting connection between high maternal blood sugar levels and an increased risk of childhood obesity and diabetes for the baby. It appears that keeping blood sugar levels normal in the mom during pregnancy can actually reduce this risk in the baby as it grows to adulthood.
For the mom, high levels of blood sugar can cause excessive weight gain, more urinary tract infections and yeast infections, and an overall feeling of illness. Women with gestational diabetes are more likely to develop high blood pressure or preeclampsia during pregnancy as well.
Gestational diabetes also predicts very well which women will likely develop type 2 diabetes later in life. The lifestyle changes that are needed to control gestational diabetes are also the same things that will help prevent type 2 diabetes later. In particular, reaching an ideal weight after birth greatly reduces a woman's chance of developing diabetes as she gets older.
Diet and exercise are generally very effective at keeping blood sugar levels within a normal range. In fact they are more effective at both treatment and prevention than medications. Pregnancy is a unique time of change and can be a great chance to make habits of healthy lifestyle choices. These changes can benefit both you and your children for the rest of your lives.
To screen for this, we use a drink containing 50 grams of glucose (similar to a large glass of juice or about 1 cup of brown rice) and then draw blood for a blood sugar test one hour later. This lets us know how your body handles a large amount of sugar. Some women are concerned about how their body will react because they rarely eat a concentrated sugar. A healthy body will never let blood sugar levels get abnormally high no matter how much is taken in. With diabetes, even this relatively small amount will not be able to get into the cells quickly enough resulting in a positive test.
Many women do not like to do this test because of the low blood sugar symptoms that they feel as their body processes the sugars. To avoid this, you can make sure to eat several servings of good quality carbohydrates the evening before the test (e.g. whole grain breads, pasta, beans and brown rice). Then, the day of the test, eat a fairly low carbohydrate/high protein meal before the test (eggs/cottage cheese/whole grain toast rather than cereal with low-fat milk or refined grain pancakes) and eat low carbohydrate snacks if you get hungry before the test (e.g. nuts, seeds or cheese).
If gestational diabetes is diagnosed, postpartum testing should be considered as well to determine if the diabetes existed before pregnancy.
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