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Gestational Diabetes – What you need to know.

mackey_blogthumb2by Kim Christopher Mackey, MD, OBGYN

Pregnancy makes all women diabetic, just a Little. Why? A specific hormone, human placental lactogen (HPL), keeps sugar circulating at higher levels during pregnancy because babies use this sugar for energy. In some pregnancies the placenta makes too much HPL, and sugar levels in mom become too high as well. When mom’s blood sugar levels are high, babies get too much food, thus allowing them to grow too much. And babies who grow too big can get stuck during labor. In addition, babies who are exposed to high sugar levels during pregnancy can have dangerously low sugar levels after birth.

How do we know you have it?

Diabetes during pregnancy has no reliable or predictable symptoms, so we test everyone. The test consists of drinking a specific amount of sugar and having a blood test one hour later. If the single blood test is elevated, we do a follow up test to confirm whether or not it is gestational diabetes (diabetes of pregnancy). The follow up test consists of four blood draws in a three hour period.

A positive diagnosis is not the end of the world.

Complications from diabetes of pregnancy can be avoided by keeping sugar levels in the normal range. Dietary changes are almost always enough intervention for most women diagnosed with gestational diabetes. However, when diet is not enough, we use medicines, either pills or injections of insulin. Patients monitor their sugar levels (and their control of them through diet or medication) by measuring sugar levels before breakfast and after meals.

When it comes time to deliver…

It is recommended that most women with diabetes of pregnancy are induced and delivered by their due date. Other than that, pregnancy management, labor, and delivery are essentially normal for women who control their sugar levels with diet only. Pregnancies requiring medication are usually delivered at 39 weeks.

How will this affect my baby?

We use ultrasound to monitor the baby’s size. Babies who are estimated to be greater than ten pounds at the due date are considered for cesarean section without labor. The extra growth from diabetes can make the shoulders and body bigger than the head, leading to a dangerous situation at delivery.

All babies born to moms with diabetes during pregnancy can have dangerously low sugar levels immediately after birth. We measure sugar levels in these infants often, during the first day(s) of life, to detect and treat low sugars should they occur.

Will it go away after delivery?

After delivery, diabetes of pregnancy goes away…usually. There are a few situations in which it stays or comes back, and we have tests to diagnose that. It may simply be that mom didn’t know she’s diabetic before pregnancy. In such cases, diabetes will stick around. Alternatively, it may be that mom became diabetic during pregnancy. Finally, the diabetes of pregnancy may go away after pregnancy only to have diabetes come back years later. Women with diabetes of pregnancy should be tested for diabetes six weeks after delivery and at regular intervals for the next 30 years.

Kim Christopher Mackey, MD, OBGYN
Director of Women’s Health
Direct (608) 342-0986

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