What is Gestational Diabetes?
GDM develops due to hormones associated with pregnancy that make your body more resistant to the effects of insulin. Risk factors for GDM include advanced maternal age (older than 35 years old), obesity, GDM in prior pregnancy, and African American/Latina moms.
Screening for GDM involves ingesting a set amount of glucose and monitoring your body’s response via blood sugar testing. The most common approach is a one-hour glucose challenge test using a standardized glucose drink, followed by a confirmatory three-hour test if abnormal.
There have been some concerns raised by moms regarding the ingredients in the drink, most notably brominated oils and artificial colors. While there are alternatives to the drink reported in the literature, many practitioners are hesitant to use them as ensuring the exact amount of glucose needed to accurately test is very difficult.
Given this, the best approach if you choose to not drink the glucose drink is to either ask your practitioner for the dye-free glucose drink or to follow your blood sugars at home for 10-14 days in lieu of glucose testing. The American College of Obstetricians and Gynecologists (ACOG) recommends all moms be screened for GDM. If left untreated, the disease can have very serious consequences for mom and baby. Complications include the risk for large babies, elevated amniotic fluid volume, stillbirth, and labor complications including higher cesarean rate, shoulder dystocia, and fetal birth injury.
Moms with GDM need to track their blood glucose levels four times a day – fasting (immediately upon waking before eating or drinking anything) and after each meal (either one or two hours). Many women can manage GDM with diet (reducing sugar and carb intake) and exercise. However, some moms require medications to treat their diabetes. Oral medications can be used, but many moms need insulin to control their blood sugars. It is important to report your blood sugars to your provider and adjust your medications and diet as they suggest.
If you can control your GDM with diet and exercise, you don’t need additional ultrasounds or fetal monitoring. You can proceed with your pregnancy as normal and there is no indication for early delivery.
If you require medications to control your GDM, it is recommended the growth of the baby is monitored with monthly growth ultrasounds due to risk for large babies. You will also need fetal testing via a non-stress test (NST) weekly starting at 32 weeks and increased to twice weekly at 36 weeks due to increased risk for stillbirth. Also due to the risk for stillbirth, delivery is recommended at 39 weeks gestation.
GDM usually resolves after delivery. However, nearly half of all women with GDM will go on to develop Type II Diabetes within 10 years of pregnancy. It is important to follow up with your provider for continued diabetes screening at your postpartum and well-women visits.
Although the diagnosis of GDM can be a scary one, motivated moms who make good choices and work closely with their practitioners can have very successful pregnancies. MercyOne Perinatal Center sees patients for all aspects of diabetic management in pregnancy including preconception counseling (for moms with diabetes before pregnancy), diabetic education and blood sugar management during pregnancy, as well as ultrasounds and fetal testing. Ask your provider about a referral to MercyOne Perinatal Center for management of your GDM.
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The post is part of a series of sponsored posts by MercyOne Des Moines Medical Center