Gestational Diabetes Facts
Category : Gestational Diabetes Facts
Pregnant women who have never had diabetes before but who have high blood glucose (sugar) levels during pregnancy are said to have gestational diabetes. According to a 2014 analysis by the Centers for Disease Control and Prevention, the prevalence of gestational diabetes is as high as 9.2%.
We don’t know what causes gestational diabetes, but we have some clues. The placenta supports the baby as it grows. Hormones from the placenta help the baby develop. But these hormones also block the action of the mother’s insulin in her body. This problem is called insulin resistance. Insulin resistance makes it hard for the mother’s body to use insulin. She may need up to three times as much insulin.
Gestational diabetes starts when your body is not able to make and use all the insulin it needs for pregnancy. Without enough insulin, glucose cannot leave the blood and be changed to energy. Glucose builds up in the blood to high levels. This is called hyperglycemia.
It usually appears late in the second trimester and resolves after childbirth. Most women are screened for it between 26 and 28 weeks of pregnancy. Women with gestational diabetes are either unable to produce enough insulin or unable to use insulin effectively.
Managing the condition involves regular exercise and healthy eating. Some women also require medication, such as insulin injections. Women with gestational diabetes have an increased risk of developing type 2 diabetes and/or cardiovascular disease later in life – 17 per cent of women with gestational diabetes develop type 2 diabetes within 10 years and 50 per cent develop it within 30 years.
Risk factors for gestational diabetes
1.Age greater than 25. Women older than age 25 are more likely to develop gestational diabetes.
2.Family or personal health history. Your risk of developing gestational diabetes increases if you have prediabetes — slightly elevated blood sugar that may be a precursor to type 2 diabetes — or if a close family member, such as a parent or sibling, has type 2 diabetes. You’re also more likely to develop gestational diabetes if you had it during a previous pregnancy, if you delivered a baby who weighed more than 9 pounds (4.1 kilograms), or if you had an unexplained stillbirth.
4.Nonwhite race. For reasons that aren’t clear, women who are black, Hispanic, American Indian or Asian are more likely to develop gestational diabetes.
How Will Gestational Diabetes Affect My Baby?
Because your baby may be larger than normal, he or she is at higher risk for some complications. Remember, these are just possible complications. Your baby might have none of them. They include:
1.Injuries during delivery because of the baby’s size
The greatest impact of gestational diabetes on delivery is related to fetal size. When gestational diabetes is undiagnosed or poorly managed during pregnancy the fetus responds to the high maternal glucose levels by secreting insulin.
These high levels of fetal insulin result in excessive fetal growth. At term these infant may weigh in the range of 9 to 12 pounds.
These macrosomic infants are more likely to become wedged in the birth canal, to cause laterations of the maternal perineal tissue, to sustain birth injuries and to necessitate a cesaream delivery.
How Will Gestational Diabetes Affect Me?
Gestational diabetes increases the chances of certain pregnancy complications. Your doctor or midwife will want to watch your health and your baby’s health closely for the rest of your pregnancy.
Possible risks include:
1.Higher chance of needing a C-section
Gestational diabetes can sometimes affect whether you are able to deliver your baby vaginally or by cesearean delivery.
Your healthcare provider, once you have been diagnosed with gestational diabetes, will follow you closely, and monitor your baby. In monitoring you and your baby closely, your healthcare provider will monitor the baby’s growth.
Babies born to mothers with gestational diabetes are often large for their gestational age — meaning that they are bigger than most babies at the same time in their mother’s pregnancy. Large babies, sometimes referred to as macrosomic infants, are at risk for not fitting through the mother’s boney pelvis.
This may lead to a failure to dilate in labor, or an ability to dilate in labor to 10 centimeters, but an innability to push the baby out safely.
As your healthcare provider measures your baby’s growth in the last weeks of your pregnancy, he/she will be able to determine the safest route of delivery for you and your baby.
Treatment for gestational diabetes during pregnancy
1.Eating balanced meals.
After you find out that you have gestational diabetes, you will meet with a registered dietitian to create a healthy eating plan. You will learn how to limit the amount of carbohydrate you eat as a way to control your blood sugar.
You may also be asked to write down everything you eat and to keep track of your weight. You will learn more about the range of weight gain that is good for you and your baby. Going on a diet during pregnancy is NOT recommended.
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2.Getting regular exercise.
Try to do at least 2½ hours a week of moderate exercise. One way to do this is to be active 30 minutes a day, at least 5 days a week. It’s fine to be active in blocks of 10 minutes or more throughout your day and week. Regular, moderate exercise during pregnancy helps your body use insulin better and helps control your blood sugar level.
If you have never exercised regularly or were not exercising before you became pregnant, talk with your doctor before you start exercising. Low-impact activities, such as walking or swimming, are especially good for pregnant women. You may also want to try special exercise classes for pregnant women.
3.Checking blood sugar levels. An important part of treating gestational diabetes is checking your blood sugar level at home. Every day, you will do a home blood sugar test one or more times. It may be overwhelming to test your blood sugar so often. But knowing that your level is within a target range can help put your mind at ease. Talk to your doctor about how often to test your blood sugar.
4.Monitoring fetal growth and well-being.
Your doctor may want you to monitor fetal movements called kick counts and let him or her know if you think your baby is moving less than usual. You may also have fetal ultrasounds to see how well your baby is growing. You may have a nonstress test to check how well your baby’s heart responds to movement.
5.Getting regular medical checkups. Having gestational diabetes means regular visits to your doctor. At these visits, your doctor will check your blood pressure and test a sample of your urine. You will also discuss your blood sugar levels, what you have been eating, how much you have been exercising, and how much weight you have gained.
6.Taking diabetes medicine and insulin shots. The first way to treat gestational diabetes is by changing the way you eat and exercising regularly. If your blood sugar levels are too high, you may need diabetes medicine or insulin shots.
7.During labor and delivery, you and your baby are monitored closely. (a)Checking your blood sugar level regularly. If your level gets too high, you may be given small amounts of insulin through a vein (intravenously, or IV). If your level drops too low, you may be given IV fluid that contains glucose.
(b)Checking your baby’s heart rate and how well your baby’s heart responds to movement. Fetal heart monitoring helps your doctor know how your baby is doing during labor. If the baby is large or does not seem to be doing well, you may need to have a C-section to deliver your baby.
8.After delivery, you and your baby still need to be monitored closely.
(a)For the first few hours, your blood sugar level may be tested every hour. Usually blood sugar levels quickly return to normal.
(b)Your baby’s blood sugar level will also be watched. If your blood sugar levels were high during pregnancy, your baby’s body will make extra insulin for several hours after birth. This extra insulin may cause your baby’s blood sugar to drop too low (hypoglycemia). If your baby’s blood sugar level drops too low, he or she may need extra sugar, such as a sugar water drink or glucose given intravenously.
(c)Your baby’s blood may also be checked for low calcium, high bilirubin, and extra red blood cells.
Most of the time, the blood sugar levels of women who have gestational diabetes return to normal in a few hours or days after delivery.
Most doctors will recommend that you breast-feed, if possible, for the health benefits for you and your baby. For example, breast-feeding can help keep your child at a healthy weight, which may reduce his or her chances of developing diabetes. It provides antibodies to strengthen your baby’s immune system. And it lowers your baby’s risk for many types of infections. Also, it may lower your chances of developing diabetes later in life.
Preventing gestational diabetes
There are no guarantees when it comes to preventing gestational diabetes — but the more healthy habits you can adopt before pregnancy, the better. If you’ve had gestational diabetes, these healthy choices may also reduce your risk of having it in future pregnancies or developing type 2 diabetes down the road.
1.Eat healthy foods. Choose foods high in fiber and low in fat and calories. Focus on fruits, vegetables and whole grains. Strive for variety to help you achieve your goals without compromising taste or nutrition. Watch portion sizes.
Exercising before and during pregnancy can help protect you from developing gestational diabetes. Aim for 30 minutes of moderate activity on most days of the week. Take a brisk daily walk. Ride your bike. Swim laps.
If you can’t fit a single 30-minute workout into your day, several shorter sessions can do just as much good. Park in the distant lot when you run errands. Get off the bus one stop before you reach your destination. Every step you take increases your chances of staying healthy.
3.Lose excess pounds before pregnancy.
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Doctors don’t recommend weight loss during pregnancy. But if you’re planning to get pregnant, losing extra weight beforehand may help you have a healthier pregnancy.
Focus on permanent changes to your eating habits. Motivate yourself by remembering the long-term benefits of losing weight, such as a healthier heart, more energy and improved self-esteem.
Pregnancy is a situation in which insulin resistance is a normal feature.
This is because it is beneficial for the nutrients absorbed from a pregnant woman’s meals to be channeled first to the growing fetus.
The development of maternal insulin resistance in the second half of pregnancy assures that this will occur.
At least part of the reason for the development of maternal insulin resistance is that the placenta produces substances that lead to insulin resistance and as the placenta grows, the insulin resistance increases.
This is called physiologic (i.e., normal) insulin resistance.
Indeed, a healthy pregnant woman may be more insulin resistant than the average patient with type 2 diabetes!
However, the vast majority (>95%) of otherwise healthy pregnant women do not get diabetes in this situation because the pancreas is able to make enough insulin to overcome the insulin resistance and keep the glucose levels normal.
A small minority of women cannot do so and their glucose levels rise.
These women tend to be the same women who are destined to get type 2 diabetes later in life.
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The risk of developing type 2 diabetes is much higher in a woman who has had diabetes detected in pregnancy ( gestational diabetes mellitus or GDM).
Most GDM goes away very rapidly, often within hours, after the baby is delivered and can reappear in later life as type 2 diabetes.
If untreated, GDM can cause harm to both mother and baby, especially at or soon after delivery.
Fortunately, outcomes of GDM are generally excellent in most developed countries.
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For more information on diabetes and pregnancy in Ireland refer to Diabetes Ireland Website.
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