In January, the American Diabetes Association (ADA) enacted stricter guidelines for diagnosing gestational diabetes. Although the new guidelines are predicted to greatly increase the number of women treated for the disease, doctors hope the changes will reduce the number of early births and diabetes-related complications in mothers and babies.
The ADA lowered the normal range for blood sugar levels in pregnant women to under 92 after a fasting test, under 180 after a one-hour glucose tolerance test, and under 153 after a two-hour glucose tolerance test. Previously, these levels had been considered normal. Also, a woman now has only to receive one high-level test result, instead of two, to be diagnosed with gestational diabetes.
Rose Wade, program coordinator for East Jefferson General Hospital Diabetes Management Center, explains the reasoning behind the change: "Even at these levels, women were having babies that were too large, which can complicate pregnancy, birth and sometimes compromise the health of the mother and baby. Expanding the guidelines to include more women will hopefully mean more mothers can successfully manage the effects of the disease."
Because of added sugar in the blood, gestational diabetes causes the baby to gain weight too quickly, potentially leading to a variety of problems including early delivery or cesarean, jaundice, respiratory issues, obesity and an increased likelihood of developing type 2 diabetes later in life. Gestational diabetes also puts mothers at risk for type 2 diabetes.
Normally, the pancreas produces enough insulin to remove sugar from the blood. However, according to Wade, "pregnancy hormones work in direct opposition to this, causing the liver to release more sugar into the bloodstream and making the body more insulin resistant. As pregnancy progresses and the body prepares for birth, the hormones get stronger, further increasing the amount of sugar being released."
The test, which is usually given during the sixth month of pregnancy, can indicate to what degree the mother will need to change her diet, if at all, and whether she will need to take insulin for the remainder of her pregnancy. Gestational diabetes can occur in any woman during pregnancy, but women who are overweight, have given birth to a baby weighing more than nine pounds, have had gestational diabetes in the past, are over age 25 or have a family history of diabetes have a higher risk. Fortunately, gestational diabetes generally resolves itself after childbirth, when pregnancy hormones disappear. Although there is no way to prevent the disease, Wade recommends women planning to become pregnant try reaching their ideal body weight (or close to it) first. However, losing weight during pregnancy is not advisable.
Gestational diabetes can usually be managed without adverse effects. Diet changes and exercise are the first line of defense. "We always send patients to a nutritionist who can set them up with a meal plan," Wade says. "They are typically advised to cut out sweets, limit carbohydrates and eat six small meals a day instead of three big ones."
If blood sugar levels are too high, patients may have to take insulin throughout pregnancy. Although the idea of daily insulin injections may be unsettling, refusing them can be dangerous. Patients should test blood sugar levels regularly. "They should test blood sugar before breakfast, and two hours after the beginning of breakfast, lunch and dinner," Wade says.
One high reading is not necessarily cause for alarm. In that event, Wade advises women to consider what they ate that day. If they find they've strayed too far from their meal plan, going back to the recommended diet should help bring blood sugar levels back down. Adding light exercise, like a 20-minute walk after a meal, can also help.
All patients with gestational diabetes are advised to stay in close contact with their physicians. "All of the blood sugar levels should be slightly better than the normal limits for a non-diabetic," Wade says. "Because there is a baby involved, physicians want the gestational mom to be better than normal."