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WHAT IS GESTATIONAL DIABETES AND ITS LINK TO PRE-DIABETES?


Insulin Resistance and obesity-associated Gestational Diabetes are conditions that develop in the third trimester of pregnancy and affect 4-5% of all pregnant women in the U.S. - around 135,000 cases each year. With Gestational Diabetes, the pancreas produces insulin but it doesn't lower the mother's blood sugar levels.

Pre-diabetes Gestational DiabetesThe symptoms are only detectable by laboratory testing. Pregnant women get a urine dip stick test with each pre-natal visit. This test may show glucose in the urine, which will prompt a health care provider to carry out further examinations for the presence of Gestational Diabetes, also known as Gestational Diabetes Mellitus (GDM).

To determine if a woman has this condition, she should be tested between 24 and 28 weeks if she is at average risk i.e. has no history of prior Gestational Diabetes and is of regular weight.

Women at higher risk should be tested earlier. A patient is considered high risk if she is obese, has glycosuria (glucose in the urine) or has a personal or family history of Gestational Diabetes.

Laboratory diagnosis of the condition includes a fasting blood glucose measurement of greater than 126 milligrams per deciliter (mg/dl) or a random blood glucose of 200 mg/dl. An Oral Glucose Tolerance Test should also be carried out. If the glucose level exceeds what is considered normal, this could result in a diagnosis of Gestational Diabetes.

Pregnancy and Obesity

Pre-diabetes Gestational DiabetesWomen who are overweight before they become pregnant are most at risk from this disorder. The best way to avoid it is to lose weight before becoming pregnant via a low insulin, low Glycemic Index (GI) diet and regular exercise. Gestational Diabetes usually disappears after pregnancy, but it can lead to the development of Pre- and Type 2 Diabetes years later.

As a baby grows, it is supported by the placenta. Hormones from the placenta help the baby develop but these hormones can also block the action of insulin in the mother's body. This problem is called Insulin Resistance, which makes it hard for the mother's body to use insulin in the normal way and requires her to need up to three times as much insulin as when she was not pregnant.

The process starts when the body is not able to make and use all the insulin it needs for pregnancy. Without enough insulin, glucose cannot leave the blood through the cell wall properly and be converted to energy. Glucose builds up in the blood to high levels, which is called hyperglycemia.

Gestational Diabetes affects the mother in late pregnancy, after the baby's body has been formed and it is busy growing. Because of its late development, the disorder does not cause the kinds of birth defects sometimes seen in babies whose mothers had other forms of Diabetes before pregnancy.

Gestational Diabetes' Effect on Babies

Pre-diabetes Gestational DiabetesHowever, untreated or poorly-controlled Gestational Diabetes can hurt the baby. Although insulin does not cross the placenta, glucose and other nutrients do. So extra blood glucose gives the baby high blood glucose levels. This causes the baby's pancreas to make extra insulin to get rid of the blood glucose. Since the baby is getting more energy than it needs to grow and develop, the extra energy is stored as fat.

This can lead to macrosomia, or a "fat" baby. Babies with macrosomia face health problems of their own, including damage to their shoulders during birth. Because of the extra insulin made by the baby's pancreas, newborns may have very low blood glucose levels at birth and are also at higher risk for breathing problems.

Babies with excess insulin become children who are at risk for obesity and, later, adults who are at risk for Pre- and Type 2 Diabetes. Pre-Diabetes is a reversible condition that occurs when a person's blood glucose levels are higher than normal but not in the range of Type 2 Diabetes.

The latter condition can only be managed for the rest of a Diabetic's life in the vast majority of cases. Type 2 Diabetes, itself, is a severely increased risk factor for blindness, heart and kidney disease and the need for amputation.

The best way of preventing Gestational Diabetes is to have a more active lifestyle and not be overweight before pregnancy. But if it does develop, early treatment is required because the disorder can hurt both mother and baby. The treatment aims to reduce and maintain normal blood glucose levels to those of pregnant women. It includes special meal plans and scheduled physical activity, though pregnancy is not a good time for rigorous exercise.

It may also include daily blood glucose testing and insulin injections. You will need help from your doctor and other members of your health care team, so that your treatment for Gestational Diabetes can be modified as needed.

Treatment for Gestational Diabetes helps lower the risk of a cesarean section birth that very large babies may require. While the disorder usually goes away after pregnancy, your chances are 2 in 3 that it will return in future pregnancies. In a few women, however, pregnancy uncovers Type 1 or reversible Pre-Diabetes. If left unchecked, Pre-Diabetes can lead to the Type 2 variety. It is sometimes difficult to diagnose whether these women have Gestational Diabetes or have just started showing their Diabetes symptoms during pregnancy.

Gestational and Type 2 Diabetes - A Link?

As mentioned, many women who have Gestational Diabetes go on to develop Type 2 Diabetes years later. The link may involve Insulin Resistance. This hormonal condition causes an imbalance in glucose and insulin levels, impairing the process whereby glucose is converted into energy.

Once Gestational Diabetes has disappeared after giving birth, some basic changes in lifestyle can help prevent the later onset of Insulin Resistance. If neglected, this latter condition may lead to Pre-Diabetes and a severely increased risk of Type 2 Diabetes. These lifestyle changes are:

  • Losing weight - if you're 20% over your ideal body weight, you're at risk. Losing even a few pounds can help you avoid developing Type 2 Diabetes.

  • Gestational Diabetes PREDMaking healthy food choices – follow simple daily guidelines, like eating a variety of foods including fresh fruits and vegetables, avoiding refined carbohydrates (e.g. sugar, bread, bagels, pasta, cookies, crackers, chips, soda and candy), minimizing intake of complex carbs (e.g. brown rice, whole wheat pasta and whole wheat bread) and keeping a close eye on your portion size and the Glycemic Index (GI) rating of food in your diet.

  • Healthy eating habits can help prevent Type 2 Diabetes and a host of other Insulin-Resistance-related health problems like the cluster of cardiovascular diseases called Metabolic Syndrome (Syndrome X) and Polycystic Ovarian Syndrome (PCOS), a hormonal imbalance which is a leading form of female infertility. All Insulin Resistance-related conditions are increased risk factors for Cardiovascular Disease, which can lead to a heart attack or stroke in both sexes.

  • Exercising - regular exercise allows your body to use glucose without extra insulin. This helps combat Insulin Resistance, a root cause of Pre-Diabetes that can lead to Type 2 Diabetes if neglected. But always check with your doctor before starting an exercise regime. Pregnancy is not a good time to either start or pursue strenuous exercise. The ideal aim should be to lose weight and reach a healthy level through regular exercise before becoming pregnant.

Click here to read about "Diagnosing Pre- and Type 2 Diabetes"

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"Simply losing 5-7% of your body fat (typically 10-15 pounds) and increasing your physical activity by taking a brisk walk 4-5 times a week can reduce your risk of developing Type II Diabetes by almost 60%."
Diabetes Prevention Program study 2001, study funded by the National Institute of Child Health and Human Development, et al.
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Our results support the view that improving insulin resistance may be crucial in the prevention of both type 2 diabetes and premature cardiovascular disease in this at-risk subpopulation of Hispanic youth."
Cruz ML, Weigensberg MJ, Huang TT, Ball G, Shaibi GQ, Goran MI.,J Clin Endocrinol Metab. 2004 Jan;89(1):108-13.
Article by Dr. Sheri Colberg, Phd, FACSM
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