Gestational Diabetes

Gestational diabetes is diabetes that is diagnosed in pregnancy. It is treated with a low carbohydrate diet and exercise. Sometimes Insulin shots or oral medication will be needed. As long as the diet is followed and the blood sugars are kept under control, the baby will be fine.

Gestational diabetes usually starts at the end of the second trimester. Pregnant women will be screened for gestational diabetes at 26-28 weeks. The test should be done fasting (in the morning before eating). A blood sample will be taken, you will then be given a sweet liquid to drink, and another blood sample will be taken one hour later. This tests how your body processes a known amount of sugar. If the test results are high you may be asked to do another similar test involving twice as much sweet stuff and blood tests every hour for three hours. This second test confirms the diagnosis.

If you had diabetes before you got pregnant, this is considered preexisting diabetes. If you did not know you had diabetes and only got diagnosed when you where pregnant, this is considered gestational diabetes, but it is really a different disease then true gestational diabetes that is only present in pregnancy. The way to tell the difference is to test for diabetes 6-8 weeks after the baby is delivered. If the diabetes is still present, it was preexisting diabetes. Because there is no way to tell the difference during pregnancy, it is recommended that all gestational diabetics get tested for diabetes after delivery.

Gestational diabetes can be very dangerous for the baby if it is not controlled. If blood sugars get way too high, this can cause a stillbirth. A stillbirth is when the baby dies inside the mother prior to delivery. Even if this does not occur, consistently high blood sugars can cause the baby to get too big. This can cause injury to both the mother and the baby at birth. One of the scariest things is a condition called shoulder dystocia. The head should be the biggest part of the baby. Once the head delivers the rest of the baby should come out easily. With poorly controlled diabetes the shoulders can grow bigger then the head. This can cause the baby to get stuck after the head delivers. This is a shoulder dystocia. This can cause serious injury to the mom and baby. The baby can suffer broken bones, permanent nerve injury, brain injury, or even death. This is one of the reasons it is so important to keep the blood sugars under control.

The initial treatment for gestational diabetes is a low carbohydrate diet. Carbohydrates come in several forms. There are the obvious sweet things: candy, cake, ice cream, sodas, juices, etc. These need to be completely removed from the diet of someone with gestational diabetes. Other carbohydrate containing food may not be so obvious. All the starchy foods are carbohydrates. These include: bread, cereal, tortillas, rice, corn, potato, chips, crackers, etc. These need to be limited. When a piece of bread is eaten, it is turned into sugar by the digestive process. Complex carbohydrates like whole wheat products get digested more slowly then simple carbohydrates, so the sugar gets to the bloodstream more slowly. This is easier for the body to handle, but it is still sugar.

The gestational diabetic diet is mostly meats and vegetables and other protein sources like beans and nuts. A small amount of fruit (not juice) can be consumed. Carbohydrates should be limited to a small amount of complex carbohydrates. Sugar substitutes such as NutraSweet and Splenda are safe. So if you do not like water, then diet soda or Crystal Light are all right to drink.

Exercise is also important. Walking or other exercise after meals and especially at night can really help to keep the blood sugars under control. Eating the last meal earlier in the evening can be a big help as the fasting blood sugar (first blood sugar in the morning) can be the most difficult to control.

Your doctor will likely ask you to check your blood sugar at home. You will be given a machine to do this. The blood sugars are usually checked in the morning before you eat (fasting) and after each meal. Your doctor will watch these numbers to help you achieve your blood sugar goals. If the goal blood sugars cannot be reached with diet and exercise Insulin or oral medication may be added. Don’t worry, insulin will not give your baby diabetes. It is being used to protect the baby.

Gestational diabetes can be very scary for patients. It will require major lifestyle changes for most people. On the bright side, it is something that can be safely managed. The sacrifice is worth having a healthy baby.