There are several types of ‘Diabetes in Pregnancy’. Diabetes can sometimes present for the first time during a pregnancy and this type which is usually picked up by a routine test about half way through the pregnancy is called “gestational diabetes”. A diabetes diagnosis during pregnancy may go away after delivery. On a different note, a woman could already have diabetes before pregnancy, either type 1 or type 2, and needs to plan carefully for her pregnancy with this pre-existing condition (stay tuned for this discussion in part 2 in my next blog!).
Gestational diabetes affects about 5% of pregnancies and is detected by a routine test that all women should get at about 24-28 weeks of pregnancy. If the doctor or mid-wife suspects that there may be diabetes, they will check earlier. The screening test is a non-fasting sugar drink followed by a blood test, 1 hour later. If this is elevated she will usually have another test that is also a sugary drink and has a fasting blood test and then another blood test, 1 and 2 hours after the drink. If her results are elevated, then she is usually referred to a diabetes education team for a gestational diabetic meal plan and blood sugar testing routine. If the woman is not able to control her blood sugars by her diet then she will begin on insulin. Insulin is a safe, easy and effective method for controlling blood sugars in pregnancy. Woman develop diabetes in pregnancy because pregnancy is a state where there is more demand for insulin due to the increasing resistance to insulin as the pregnancy progresses as a result of the hormones in pregnancy.
Risk Factors for Getting Gestational Diabetes
These are similar to risk factors for developing diabetes in the non-pregnant state, such as having a relative with diabetes, belonging to an ethnic group where diabetes is more common such as Native Canadians, Latinos, Indo-Canadians, being over weight or obese, being older, having had a previous gestational pregnancy or giving birth to a large baby (greater than 9 pounds).
Complications of Having Gestational Diabetes
If gestational diabetes goes undetected or untreated, the higher sugars in the mother’s blood can affect the baby. This could result in a larger baby that causes difficulties at the time of birth and a higher C-section or forceps rate. The baby has more chance of spending time in the intensive care unit due to trouble breathing or low blood sugars. However, gestational diabetes can be fairly easily treated with a combination of a diabetic meal plan and sometimes insulin and these complications can be avoided. Birth defects are not a concern as the higher blood sugars do not generally happen until after 20 weeks of pregnancy and this is after the baby has developed their organs.
Follow Up After Delivery
If a woman has had gestational diabetes, she should be screened for diabetes before her next pregnancy to be sure she has not developed diabetes prior to this pregnancy. It is therefore very important that women who have had gestational diabetes follow up after the baby is born to see if the diabetes has gone away. Usually, this involves a 2-hour sugar drink test, 6 weeks to 6 months after delivery. She needs to continue to be checked regularly (every 1-3 years) to see if she has developed diabetes for her own health and certainly before another pregnancy to protect her next child from high sugars if she has developed diabetes prior to that pregnancy. If a woman has had diabetes in pregnancy, it will help her to reduce the risk of developing diabetes to attain her ideal weight prior to the next pregnancy.
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