Anne Peters, MD, FACP, CDE (Professor and Director of Clinical Diabetes Programs, USC Keck School of Medicine) gives expert video advice on: How is gestational diabetes treated?; Can gestational diabetes be prevented? and more...
What is "gestational diabetes"?
<a href="http://www.videojug.com/interview/gestational-diabetes">Gestational Diabetes</a> is diabetes that happens during pregnancy. Gestational diabetes generally happens during the last third of pregnancy. The reason why it happens is that the placenta that grows around the baby makes hormones that make the mum insulin-resistant. If you think about it, it's a good thing, because what the mum's trying to do is give sugar to the baby because the baby needs to grow and develop. So, what the placenta does is to make sure mum makes plenty of sugar. In someone who's not at risk for gestational diabetes, someone who doesn't get it, their own pancreas makes enough insulin to keep the blood sugar levels normal. However, you could be somebody who's prone to get gestational diabetes, and the risk factors are very similar to those of somebody with type 2 diabetes (if you have a family history, if you're overweight); all of those risk factors make a woman less likely to be able to make enough insulin during her pregnancy. When that happens the blood sugar levels go up because of the insulin resistance caused by the placenta. A woman with gestational diabetes is treated just like anybody with diabetes; through diet and exercise. However, there's not a lot of diet and exercise you can often do in a pregnancy, so what happens is they end up going on insulin briefly until the end of their pregnancy to make sure their sugar levels are normal.
What are the risk factors for developing gestational diabetes?
Not everybody is at the same risk for getting gestational diabetes. If you're in a high risk group, you're much more likely to get it, and if you're a high risk group member, then after the baby is delivered you're at risk for getting diabetes subsequently. Just like everything in diabetes, it's lifestyle. So, if you had gestational diabetes, you had the baby and you're able to lose the baby weight, maybe a few extra pounds if you need to, and exercise, you'll markedly reduce your risk not only of getting diabetes in the future but of getting diabetes with a subsequent pregnancy. Gestational diabetes is really type 2 diabetes brought on in higher-risk people by a pregnancy that causes insulin resistance. Almost everybody that gets gestational diabetes has some risk, but sometimes it happens in women that don't seem to have any risk factors. That's one of the reasons we screen almost everybody with a glucose test during pregnancy, because we don't want to risk missing it. So, even though we think it's more likely, we know it's more likely in women with risk factors, some women without risk factors can also get gestational diabetes.
How is gestational diabetes treated?
Gestational diabetes is treated just like ordinary Type 2 diabetes, in the sense that the first thing we do is lifestyle change. We have people see a nutritionist, we have them work with the dietician on what they can do to eat differently, perhaps reduce the carbohydrates, change the composition of their diet, and increase their physical activity. But if that doesn't work, then we go on to using insulin, which is generally a short period of time, just during the last part of the pregnancy, and then once the woman delivers the baby they no longer need to be on insulin.
Can gestational diabetes be prevented?
In some cases gestational diabetes can be prevented in women who are overweight and sedentary. Those women need to be encouraged to lose weight and to increase their activity prior to conception and then to avoid excessive weight gain throughout the pregnancy. There are some women, though, who just seem to get gestational diabetes, and we really can't prevent it which is why we need to screen women for gestational diabetes at 25 weeks into their pregnancy.
Does gestational diabetes always go away after the pregnancy?
Gestational diabetes usually goes away after the pregnancy, but can come back subsequently over the next months to years, particularly if a woman isn't able to keep their weight in a normal range or exercise. The one caveat to that, though, is that there are women who seem like they have gestational diabetes who are actually getting adult onset Type 1 diabetes. They have antibodies to their beta cells. So there is an occasional woman whose gestational diabetes -- which actually has been sort of misdiagnosed, because it's not gestational diabetes at all -- it's really diabetes that's developing and just happened to be picked up during pregnancy. And those women end up either on insulin or oral medications, depending on the kind of diabetes they have. So I see women whose diabetes doesn't go away after pregnancy, but those are the exceptions, not the rule.
If I have gestational diabetes, will my baby be affected?
Babies born to mothers who have gestational diabetes tend to be too big, and if you control the blood sugar levels that doesn't generally happen. But the problem with babies that are too big is that they tend to get stuck when they come out, so they end up having problems with their shoulders, rates of ceasarean sections are higher, and so there's some issues related to the size of the baby. So we want to control the blood sugar levels to keep the baby a normal size so that birth is easier. After delivery, babies of mom's who have had gestational diabetes can have low blood sugar levels and high bilirubin levels, but all of that tends to be monitored in the hospital for a day or two and then the babies are fine. I think another important point though is that babies who are big at birth and babies who are too little at birth are at increased risk themselves for getting diabetes in the future. So we think that there might be hyperstimulation of the pancreas during pregnancy, we're not quite sure. But I think it's a good idea to treat the gestational diabetes and then if that 's done the baby's going to be just fine and there should be no long term problems with the baby.