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.
 The 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
 Women 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
 However, 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.
 Making
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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