What is Gestational Diabetes?

    Diabetes is a common condition in which the body’s cells are unable to effectively obtain glucose from the bloodstream. Glucose is required to provide the body with energy for day-to-day activities. The hormone insulin moves glucose from the blood into the body’s cells, where it can be used for energy. When the movement of glucose into the cells is delayed, blood glucose levels rise, causing diabetes to develop.


    Gestational diabetes is a form of diabetes that occurs during pregnancy and usually goes away after the baby is born. Over 10% of pregnant women will develop gestational diabetes and this usually occurs around the 24th to 28th week of pregnancy.


    In pregnancy, the placenta produces essential hormones that help the baby grow and develop. These hormones also partly stop insulin working which is called insulin resistance. Usually pregnant women naturally increase their insulin levels to overcome this block. If the body is unable to produce the extra insulin or becomes more resistant, gestational diabetes develops.


    Diagnosis of GDM is based on a fasting 75-g oral glucose tolerance test (OGTT) at 24–28 weeks of gestation in pregnant women not previously known to have diabetes. This test can be performed earlier if there are significant risk factors present or there is a clinical indication.


    Once a diagnosis of GDM is made, careful planning for the ongoing management of your pregnancy is important.


    How does GDM affect the baby?

    As the mother’s excess glucose crosses the placenta into the baby’s bloodstream, untreated or uncontrolled GDM may result in complications for your baby such as:

    •   Being born very large and with extra fat, thus may make delivery difficult and more dangerous for the baby

    •   Low blood glucose levels after birth

    •   Breathing problems

    •   Requiring admission to a special care nursery

    •   Problems maintaining body temperature

    •   An increased risk of developing diabetes or obesity later in life.


    How to Treat Gestational Diabetes?

    The management and treatment of GDM is a team effort, involving the woman and her partner, her obstetrician, endocrinologist, diabetes educator, dietitian and midwife.


    Special attention is paid to home blood glucose monitoring, diet and physical activity. Sometimes insulin injections may be needed. Your treating doctor will discuss with you which treatment option is more suitable for you.

    •   Start treatment quickly because gestational diabetes can hurt you and your baby.

    •   Special meal plans and scheduled physical activity

    •   Daily blood glucose testing

    •   Insulin injections if needed


    Home blood glucose monitoring

    Self-monitoring blood glucose (SMBG) is a valuable tool in helping manage GDM. These simple finger prick blood tests will give you an indication on what your blood glucose levels are.


    Your diabetes nurse will teach you how to perform home blood glucose monitoring. You will require:

    •   A blood glucose meter

    •   Lancet device – for pricking finger

    •   Testing strips

    •   Diary to record blood glucose levels.


    Blood glucose meters, lancet device and testing strips may be purchased at your local or online pharmacy.


    Target of Glucose Control

    The blood glucose checks you do at home are a key part of taking good care of yourself and your baby before, during and after pregnancy


    Both American Diabetes Association and Chinese Diabetes Society recommend glucose targets for women with GDM are as follows:

    Pregnancy Glucose Goals


    Status:

    Blood glucose:

    Fasting or premeal

    <95 mg/dL (5.3   mmol/L) and either

    One-hour postprandial

    <140   mg/dL (7.8 mmol/L) or

    Two-hour postprandial

    <120 mg/dL (6.7   mmol/L)

    Food and Exercise

    During pregnancy, you may need to change your meal plan to avoid problems with low and high blood glucose levels. For most women, the focus of a good meal plan during pregnancy is improving the quality of foods you eat rather than merely increasing the amount of food eaten. A good meal plan is designed to help you avoid high and low blood glucose levels while providing the nutrients your baby need to grow.


    Exercise is a key part of diabetes treatment. Discuss your exercise plans with your diabetes team and ask for guidance. Just as you need to get your blood glucose under control before getting pregnant, it's best to get fit before you get pregnant.


    In general, it's not a good idea to start a new strenuous exercise program during pregnancy. Good exercise choices for pregnant women include walking, low-impact aerobics, swimming, or water aerobics. Regular physical activity is not only safe for pregnant women, it benefits health by offsetting some of the problems of pregnancy, such as varicose veins, leg cramps, fatigue and constipation. Exercise after meals may help the muscles use the glucose in the bloodstream, and help keep your blood glucose levels in your target range.


    Medication (if needed)

    For women with gestational diabetes, meal planning and exercise often work to keep blood glucose levels in control; however, if blood glucose levels are still high, your doctor will probably start you on insulin.


    Insulin is the traditional first choice for blood glucose control during pregnancy, because it is the most effective for fine-tuning blood glucose and it doesn’t cross the placenta. Therefore, it is safe for the baby. Insulin can be injected with a syringe, an insulin pen, or through an insulin pump. All three methods are safe for pregnant women.


    Weight Goals During Pregnancy

    If you start pregnancy weighing too much, you should not try to lose weight. Instead, work with your dietitian or doctor to curb how much weight you gain during pregnancy.


    Your dietitian will keep track of your weight gain. If you start pregnancy at a normal weight, expect to add between 25 to 35 pounds (11.5-16.0kg). Women who start pregnancy too thin need to gain more. If you are obese at the start of your pregnancy, work with your dietitian to limit your weight gain to about 15–25 pounds. You can determine your healthy weight by finding your BMI level by using our BMI calculator.

    Pregnancy Weight Goals


    If your   pre-pregnancy weight is…

    Then gain…

    Underweight

    28~40pounds or   12.5~18.0kg

    Normal

    25~35   pounds or 11.5~16.0kg

    Overweight

    15~25 pounds or   7.0~11.5kg

    Obese

    11~20   pounds or 5.0~9.0kg


    After delivery

    GDM usually goes away after the baby is born. To make sure, your doctor or midwife will order a special glucose test, the oral glucose tolerance test (OGTT), which is performed 6–8 weeks after delivery. This test will show whether your blood glucose levels are back to normal.


    Breastfeeding is good for women with GDM and may also help you lose the weight you gained during pregnancy.

     

    Refer from the website of American Diabetes Association at http://www.diabetes.org/diabetes-basics/gestational/

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