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Diabetes mellitus is a serious medical disorder characterized by varying or persistently high blood sugar levels resulting from the defective secretion of the hormone insulin. It is a lifetime condition and has many possible complications.

Many people don’t know that diabetes can also develop during pregnancy. This is called gestational diabetes, which affects 2 to 3 percent of pregnant women. If it is not properly controlled, it can lead to problems for the mother or the baby.

What exactly is diabetes?

Diabetes is a disorder of metabolism, which means a disorder in the process in which our bodies use digested food for growth and energy. Most of the food we eat is broken down into glucose, the form of sugar which is present in our blood. This means that glucose is the main fuel for the body. It is used by cells for growth and energy but it can't enter the cells without the presence of insulin - a hormone produced by the pancreas, a large gland behind the stomach. This is a well coordinated process. When we eat, the pancreas automatically produces the right amount of insulin to move glucose from blood into our cells.

When someone has diabetes however, the pancreas either produces little or no insulin, or the cells do not respond appropriately to the insulin that is produced. The results are clear - glucose builds up in the blood, overflows into the urine, and is passed out of the body. 

Incidence of the condition

It is estimated that about 20.8 million people in the United States or 7 percent of the population, have diabetes. Of those, 14.6 million have been diagnosed, and 6.2 million have not yet been diagnosed. In 2005, about 1.5 million people aged 20 or older were diagnosed with diabetes.
About 1 in 200 women of childbearing age has diabetes before pregnancy and another 2 to 5 percent develop diabetes during pregnancy.

Gestational diabetes and possible causes


Gestational diabetes mellitus is a specific type of diabetes that arises during pregnancy, usually during the second or third trimester. During the pregnancy the body needs more insulin but which mechanism leads to developing diabetes is still not completely clear. During pregnancy, female placenta produces several hormones such as estrogen, cortisol and human placental lactogen, that prevent insulin from doing its job. These hormones are vital to preserving your pregnancy. In some women, this type of diabetes occurs because the body cannot produce enough insulin to meet the extra needs of pregnancy. Anyway, if diabetes was diagnosed in the first trimester, the condition most likely existed before the pregnancy.

Diabetes and risks for the baby


Increased possibility for birth defects

It is proven that women with poorly controlled preexisting diabetes in the early weeks of pregnancy, are 3 to 4 times more likely to have a baby with a serious birth defect, such as:

  • a heart defect
  • neural tube defect,
  • other birth defects of the brain or spinal cord


They also are at the increased risk of miscarriage and stillbirth.

The exact month in pregnancy in which a women has developed this condition is of great importance. Women with gestational diabetes, which generally develops later in pregnancy, usually do not have an increased risk of having a baby with a birth defect.

Hypoglycemia

Sometimes babies of mothers with gestational diabetes develop low blood sugar (hypoglycemia) shortly after the birth.

Macrosomia – very large baby

It is proven that women with poorly controlled diabetes are at the increased risk of having a very large baby. This condition is called macrosomia. It is proven that these babies grow that much because of the extra sugar in mother’s blood crosses the placenta and goes to the fetus. The fetus then produces extra insulin, which helps it process the sugar and store it as fat. This excess fat tends to accumulate around the shoulders and trunk, sometimes making these babies difficult to deliver vaginally and putting them at risk for injuries during the delivery.

Death of the baby

There is also a slightly higher chance of stillbirth or death of the newborn, but if diabetes is detected and the glucose levels are well managed, death is rare.

Other problems

Research has proven that babies of women with poorly controlled diabetes are at the increased risk of breathing difficulties, low blood sugar levels and jaundice. Babies of women with poorly controlled diabetes also may be at increased risk of developing obesity and diabetes as young adults.

Gestational diabetes and risks for the mother

Gestational diabetes is not an immediate threat to the woman's health. This means that most women whose blood sugar levels stay within the safe range deliver their babies without complications, although in some women it can result in high blood pressure.

The problem is that women who get gestational diabetes are more likely to develop gestational diabetes in future pregnancies, and are at a higher risk of developing type II diabetes later in life. That’s why an early diagnosis and treatment are crucial.

Risk factors for developing gestational diabetes



Although there are no rules, it is proven that some risk factors could contribute to developing the gestational diabetes. Some of those are:

Age
It is proven that women older than 25 are more likely to develop gestational diabetes, although it can actually happen at any age.

Family or personal history
Several researches done in the past have proven that chance of developing gestational diabetes increases if a close family member, such as a parent or sibling, has type 2 diabetes.
 
Weight
It is reasonable that being overweight before pregnancy makes it more likely that you'll develop gestational diabetes. However, gaining weight during your pregnancy doesn't cause gestational diabetes.

Race
Some statistical data are indicating that woman is at increased risk if she is African American, Hispanic or American Indian.

Previous complicated pregnancy

Diagnosis of gestational diabetes

To screen for gestational diabetes, most doctors recommend a glucose tolerance test. The woman is given a solution of glucose to drink, and then the blood samples are taken and analyzed at different intervals to see how the body deals with the glucose over time. The experts do not agree on whether a pregnant women who is younger than 25 and has no other risk factors for gestational diabetes needs to have this test done. Another very useful test is a simple urine test. Unfortunately it isn't a reliable indicator of gestational diabetes because the amount of sugar in your urine can vary throughout the day as a result of what a woman was eating.

Treatment of diabetes in pregnancy - Controlling body sugar


Diet

A pregnant woman who has been diagnosed with diabetes should follow a diet designed especially for her.  The number of calories a pregnant woman with diabetes should eat depends upon many factors, including weight, stage of pregnancy and baby’s rate of growth. However, there are some rules that should be followed. A pregnant woman with diabetes who is of average weight should consume about 2,000 to 2,200 calories a day.

This should help her gain the recommended 25 to 35 pounds during pregnancy.

The dietitian will most likely recommend a diet that includes:

  • 10 to 20 percent of calories from protein (meat, poultry, fish, legumes);
  • about 30 percent from fats (with less than 10 percent from saturated fats);
  • avoiding the sweets.


Home glucose testing kits are also available. These usually involve taking a tiny blood sample with a pinprick device. The blood is put onto a strip and inserted into a glucose measuring device, which gives the blood glucose level.

Regular exercise

Exercise can help control diabetes by prompting the body to use insulin more efficiently and is recommended for most women with gestational diabetes and some women with preexisting diabetes. Not only that but regular exercise can help prevent some of the discomforts of pregnancy, such as:

  • back pain,
  • muscle cramps,
  • swelling,
  • constipation
  • difficulty sleeping

It can also help prepare you for labor and delivery. Woman shouldn’t practice some hard exercises. She should aim for moderate aerobic exercise on most days. For best results, aerobic activity should be combined with stretching and strength-training exercises. Exercising at the same time every day, varying your fitness routine and working out with other pregnant women can help a woman stay motivated.

Medications

Sometimes diet and exercise may not be enough. In that case, a pregnant woman should take daily medication to help lower her blood sugar to safe levels. The most commonly used substance is of course the insulin! Until recently, insulin was the only option for women with gestational diabetes because it doesn't cross the placental barrier. But there is a new anti-diabetes drug, Glyburide, which may also be safe and effective in controlling blood sugar in gestational diabetes.

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