St. Joseph’s/Candler OB/GYN Dr. Tiffany Loftus explains this increasingly common pregnancy condition

The diagnosis of gestational diabetes (diabetes that develops during pregnancy) can be both unexpected and alarming. However, pregnant women with gestational diabetes can still have healthy babies with help from their physician and by taking steps to manage blood sugar levels.

Gestational diabetes is a type of diabetes diagnosed in a pregnant person who did not have the condition prior to pregnancy, explains Dr. Tiffany Loftus, St. Joseph’s/Candler OB/GYN. It is typically diagnosed around 24-28 weeks into the pregnancy. Early screening may be indicated if patients have risk factors going into the pregnancy.

The prevalence of gestational diabetes has been on the rise, Dr. Loftus says. About six to nine percent of pregnant women will develop gestational diabetes, which does have risk factors for both mom and baby that should be taken seriously.

What causes gestational diabetes?

During pregnancy, the placenta produces a variety of placental hormones, including human placental lactogen, that can affect a person’s blood sugar levels, Dr. Loftus explains. These hormones impair the body’s response of insulin, leading to insulin resistance, which subsequently leads to elevated glucose in the bloodstream.

As the placenta grows, it makes more placental hormones and the risk for insulin resistance becomes greater. Normally, the pancreas is able to make more insulin to overcome the insulin resistance, but if it cannot make enough to overcome the effects of the placenta’s hormones, a pregnant person can develop gestational diabetes.

Who’s most at risk of developing gestational diabetes? 

Any woman is at risk of developing gestational diabetes, that’s why all pregnant people are screened for the condition in every pregnancy. However, there are some factors that can put you at higher risk including:

• Overweight or obesity prior to pregnancy
• A family history of diabetes, especially a first-degree relative
• Gestational diabetes in previous pregnancies
• Poor diet and sedentary lifestyle
• Other metabolic conditions such as high blood pressure or high cholesterol

“Appropriate nutrition and exercise are very important throughout pregnancy,” Dr. Loftus says. “The daily recommendation of getting at least 30 minutes of exercise five days a week still pertains to pregnant people. Maintaining healthy nutrition is important not only for preventing potential complications of gestational diabetes, but also other complications of pregnancy such as preeclampsia.”

Related Article: The known and unknown of preeclampsia in pregnant women

What are the signs of gestational diabetes?

Unfortunately, gestational diabetes does not present with any specific signs or symptoms. Your provider may discover after the diagnosis that the baby is large for the gestational age or that there is more fluid around the baby.

“Ideally, we would diagnosis it prior to any of those things occurring to prevent complications,” Dr. Loftus says. “That’s why it’s so important to screen every pregnant person.”

So how do you screen for gestational diabetes?

Most pregnant people with no risk factors will be screened between 24 and 28 weeks gestation. However, if you have risk factors associated with gestational diabetes, it is recommended you are tested between 14 and 18 weeks gestation. It starts with a screening test:

• A one-hour glucose tolerance test: The patient drinks a syrupy, 50-gram glucose load beverage, and one hour later, the doctor checks blood sugar levels, Dr. Loftus explains. If the levels are elevated, it is considered an abnormal result.

When that happens, then there’s a follow-up confirmatory test:

• A three-hour glucose confirmatory test: The patient, who needs to be fasting for this test, drinks a 100-gram glucose load, and then the doctor measures glucose levels fasting, one hour, two hours and three hours later. If two values are elevated, then gestational diabetes is diagnosed, says Dr. Loftus.

How do you treat gestational diabetes?

Following a diagnosis, your physician will determine if you are classified as A1 diabetic or A2 diabetic. A1 diabetics are people who are diet-controlled and don’t need any form of medication, Dr. Loftus says. They will monitor their blood sugar, and as long as it stays within an appropriate threshold, they do not need to start medication.

A2 diabetics, on the other hand, will need to start a medication, as well as lifestyle modifications, to help control their blood sugar levels.

What are the complications of gestational diabetes?

People who have gestational diabetes are at higher risk of developing other complications throughout their pregnancy such as gestational hypertension (high blood pressure diagnosed in pregnancy) and preeclampsia.

Related Article: Tips for a healthy pregnancy and successful delivery

Additionally, uncontrolled gestational diabetes can increase the risk of delivery complications, such as a shoulder dystocia (shoulder of the baby gets stuck during birth) and increased risk of cesarean deliveries. If a patient has to have a cesarean delivery, poorly controlled sugars can impact wound healing and increase the risk of infection.

There’s also potential complications for baby such as the baby growing too large. There also can be issues with the development of the heart, especially if blood sugars are significantly elevated early in pregnancy, Dr. Loftus says. Some babies after birth may experience fetal hypoglycemia, meaning their blood sugars are low, which could require extended care and treatment.

“Ideally, you want to be as healthy as possible before getting pregnant to try to combat conditions such as gestational diabetes developing in pregnancy,” Dr. Loftus says. “I encourage women if they have any questions about nutrition and appropriate weight gain during pregnancy to talk to their OB/GYN so those topics can be further discussed.”

 

Looking for an OB/GYN in Savannah to address your concerns and care? Request an appointment with a St. Joseph’s/Candler provider today.