All For Diabetes

What is gestational diabetes mellitus?

Gestational diabetes mellitus or gestational diabetes is a type of diabetes that only pregnant women get. If a woman gets diabetes when she is pregnant, but never had it before, then she has gestational diabetes.

Normally, your stomach and intestines digest the carbohydrate in your food into a sugar called glucose. Glucose is your body’s main source of energy. After digestion, the glucose moves into your blood to give your body energy.

Diabetes Mellitus in Pregnancy

Carbohydrate metabolism in normal pregnancy as measured by glucose changes very little. Pregnant women have a slightly lower blood glucose level then when they are not pregnant but you certainly don’t get a deterioration of glucose tolerance in normal women when they go through pregnancy. The insulin levels are way elevated in pregnancy compared to non-pregnancy and as you go from trimester to trimester they become higher and higher. Indeed when you move into that third trimester, the levels of insulin are three times higher than they were when she wasn’t pregnant, yet we just saw that her glucose doesn’t change very much at all. What this says to us is that in pregnancy there is a development of insulin resistance, and her pancreas has to put out three times as much insulin to get the same job done. It does that, and if she is normal she maintains normal blood glucose because she produces tremendous amounts of insulin in order to accomplish this with the insulin resistance of pregnancy. Insulin resistance in pregnancy. The placenta produces growth hormones that are identical in structure and sequence to the pituitary growth hormone. The difference is we don’t know of any regulators for the placental growth hormone. We know that glucose and free fatty acids regulate the pituitary growth hormone, but the placental growth hormone just keeps coming out. We don’t know of any feedback mechanisms that allow more or less coming out. The pregnant woman is producing tremendous amounts of growth hormone from her placenta and that growth hormone then is creating insulin resistance and for her to remain normal, she has to have a pancreas that puts out two to three times as much insulin.

Gestational Diabetes Diagnosis

Women who are considered at risk for gestational diabetes are given a screening test called a 50 gram glucose challenge between the 24th and 28th weeks of pregnancy (those with two or more risk factors may be tested earlier). The glucose challenge is performed by giving 50 grams of a glucose drink and then drawing a blood sample one hour later and measuring the level of blood glucose present. A blood sugar level of less than 140 mg/dl at one hour is considered normal. Women with a blood sugar level greater than 140 mg/dl may have gestational diabetes, and require a follow up test called a 3-houroral glucose tolerance test (OGTT).

Gestational Diabetes Treatment

Women with gestational diabetes must make dietary adjustments to control their blood glucose levels; in some cases insulin injections may be required to keep blood sugars in a safe range. Treatment for gestational diabetes may include:

Gestational Diabetes Complications

Complications

Women who are able to effectively manage their gestational diabetes and keep blood glucose levels in a safe range dramatically reduce the risk of complications for both themselves and their baby.

The potential complications of uncontrolled gestational diabetes include:

Gestational Diabetes

Gestational diabetes, or diabetes that occurs in pregnancy and resolves at birth, occurs in approximately three to eight pregnancies of every 100 in America. Risk factors for developing gestational diabetes include:
# A family history of diabetes
# Being overweight
# Having prediabetes
# Having given birth previously to a child weighing 9 pounds or more

Gestational Diabetes: Causes And Risk Factors

The hormones produced by the placenta in pregnancy—including estrogen, cortisol, and human placental lactogen (HPL)—are what trigger the insulin resistance in women predisposed to the condition. As pregnancy progresses and the placenta grows larger, hormone production also increases and so does the level of insulin resistance. This process usually starts between 20 and 24 weeks of pregnancy. At birth, when the placenta is delivered, the hormone production stops and so does the GDM.

Gestational Diabetes Mellitus - DEFINITION, DETECTION, AND DIAGNOSIS

Definition
Gestational diabetes mellitus (GDM) is defined as any degree of glucose intolerance with onset or first recognition during pregnancy. The definition applies whether insulin or only diet modification is used for treatment and whether or not the condition persists after pregnancy. It does not exclude the possibility that unrecognized glucose intolerance may have antedated or begun concomitantly with the pregnancy.

Approximately 7% of all pregnancies are complicated by GDM, resulting in more than 200,000 cases annually. The prevalence may range from 1 to 14% of all pregnancies, depending on the population studied and the diagnostic tests employed.

Gestational Diabetes Obstetric and Perinatal considerations

The presence of fasting hyperglycemia (>105 mg/dl or >5.8 mmol/l) may be associated with an increase in the risk of intrauterine fetal death during the last 4–8 weeks of gestation. Although uncomplicated GDM with less severe fasting hyperglycemia has not been associated with increased perinatal mortality, GDM of any severity increases the risk of fetal macrosomia. Neonatal hypoglycemia, jaundice, polycythemia, and hypocalcemia may complicate GDM as well. GDM is associated with an increased frequency of maternal hypertensive disorders and the need for cesarean delivery. The latter complication may result from fetal growth disorders and/or alterations in obstetric management due to the knowledge that the mother has GDM.

Gestational Diabetes Long-term therapeutic considerations

Reclassification of maternal glycemic status should be performed at least 6 weeks after delivery and according to the guidelines of the “Report of the Expert Committee on the Diagnosis and Classification of Diabetes Mellitus”.