WOMEN'S HEALTH
December 14, 2009

Diabetes In Pregnancy

Preventing or controlling high blood sugar during pregnancy makes a big difference in the health of mother and baby.

Gestational diabetes is diabetes, or high blood sugar, that begins during pregnancy. It is diagnosed by a series of blood tests and treated with diet and, if necessary, medication. Although the blood sugar often returns to normal after the delivery, many women, particularly seriously overweight or obese women, develop diabetes within 5−10 years after their pregnancy.

A woman who has gestational diabetes is at risk of complications during her pregnancy including elevated blood pressure and a more serious condition called preeclampsia. When a woman has preeclampsia, in addition to having high blood pressure, she has protein in her urine. Her baby is at risk because the placenta may not provide adequate blood flow for optimal growth and the baby may have to be delivered early to protect both the mother and the infant. The baby of a mother with gestational diabetes is also at risk of complications including: low blood sugar, and elevated bilirubin in the first few days of life, as well as large size which makes delivery difficult and raises the likelihood of a birth injury. There is also an increased risk of fetal death, although fortunately, this is rare. The baby also is at risk for developing diabetes and obesity later in life.

Many women are not aware that their blood sugar is elevated and may confuse symptoms of high sugar with symptoms of pregnancy.

Usually, pregnant women have blood tests for gestational diabetes between the 24 and 28 week of their pregnancy. The goal is to identify women with gestational diabetes and decrease the complications by controlling their blood sugar with diet and/or medication. Controlling blood sugar has been shown to decrease many of the potential complications of gestational diabetes. But how closely must blood sugar be controlled? Does a mild elevation pose enough risk to warrant intervention? A study published in the October 1st issue of the New England Journal of Medicine investigated whether treating mild changes in blood sugar made a difference in the health and well being of mother and baby.

The investigators targeted women with mild gestational diabetes. One group received nutritional counseling, diet therapy, and insulin, if necessary. Their blood sugar was treated even if it were only slightly high. The women in the control group received standard prenatal care and were only treated for high blood sugar if it reached the current accepted level for intervention. Babies and mothers were carefully monitored and appropriate treatment was instituted if any abnormalities developed during the study.

The researchers found that the group that was treated for mild gestational diabetes had fewer excessively large babies. That meant that there were fewer cesarean sections and fewer delivery complications such as injury to the nerves to the arms and hands. Their infants were less likely to require treatment for low blood sugar and high bilirubin in the first few days of life. The women in the study group had a lower occurrence of preeclampsia, which meant that their infants received appropriate blood flow from the placenta for normal development. It also meant that there were fewer preterm deliveries because of preeclampsia related risks to the babies' and mothers' health.

The researchers concluded that monitoring pregnant women and treating mild gestational diabetes reduced the risks of certain significant maternal and fetal conditions. Pregnant women should be sure to get regular prenatal care and to obtain all tests ordered by their doctors. They may want to ask their doctors specifically about blood sugar tests. Many women are not aware that their blood sugar is elevated and may confuse symptoms of high sugar with symptoms of pregnancy. High sugar can cause blurred vision, fatigue, recurrent infections increased thirst and increased urination, nausea and vomiting, and poor weight gain or even weight loss, despite increased appetite and food intake.

Although they are "eating for two," pregnant women must follow the advice of their doctors or nutritionist's regarding appropriate foods and safe weight gain.

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