At Lansing OB/GYN, we screen all pregnant women for gestational diabetes. This test is scheduled some time between the 26th and 28th week of pregnancy.

The diabetes of pregnancy is called gestational diabetes and exists in 2.5-4% of all pregnancies. Gestational diabetes is an inability to metabolize carbohydrates normally. This inability results in elevated blood sugar levels. Carbohydrate intolerance manifests itself in varying degrees of severity and is usually diagnosed in the second or third trimester.

During pregnancy, rising levels of placental hormones cause a resistance to insulin actions. Usually, the body will compensate by producing increased amounts of insulin. However, age, obesity, family history, and pancreatic reserve are factors which may make a woman susceptible to gestational diabetes.

Testing involves a visit to the laboratory. One hour after drinking a sweet drink at the laboratory, a blood sample will be drawn and analyzed.

The test is abnormal or positive if the glucose level is 135 mg./dl. or higher. Any reading below 135 mg./dl. is considered within normal limits, and the mother is at very low risk for developing gestational diabetes.

A positive screen, 135 mg/dl or higher, requires further evaluation with a three-hour glucose tolerance test. The preparation for this test is more involved. A three-day, high carbohydrate preparation diet is required for the most accurate results. Then, after an overnight fast, a blood sample is drawn. The mother drinks a solution containing glucose and, after each hour for three consecutive hours, a blood sample is drawn. A diagnosis of gestational diabetes is made if at least two of the blood glucose levels are elevated over the norm.

If you are diagnosed with Gestational Diabetes

Mothers with gestational diabetes need to understand the following points:

- What is gestational diabetes and what are the potential risks to me and my baby?

- What are my individual dietary needs?

- What does a balanced exercise program consist of?

- Self-monitoring of blood glucose.

- How to record fetal movement.

- The use of insulin treatment if needed.

Treatment for gestational diabetes includes dietary counseling and blood glucose monitoring. The goal is to maintain a glucose level of between 60-120 mg/dl A referral to the Diabetes Center is made for nutritional counseling. The diet is well-balanced, carefully controlling carbohydrate, fat and protein eaten in three meals and two or three snacks daily. Approximately 5 percent of women with gestational diabetes cannot adequately control their glucose levels by dietary management alone and need insulin therapy.

If gestational diabetes is treated appropriately, there is little difference between the outcome of a pregnancy complicated with gestational diabetes and one where blood sugar levels have been normal. However, untreated gestational diabetes has significant consequences. Fetal and neonatal death rates of up to 20% have been reported by researchers. Complications may include large birth weight babies, post-delivery low blood sugar for babies and blood chemical imbalance. Children of gestational diabetic mothers may be at greater risk for obesity and development of glucose intolerance later in life.

Sometimes gestational diabetes does not show up until later, somewhere around the 32nd week of pregnancy. If after an elevated gestational diabetes screen, the three-hour glucose tolerance test has only one elevated blood sugar level, care options will be individualized.

An important component of the plan of care is exercise. Walking after a meal can work to decrease blood sugar levels. Other good forms of exercising are swimming, prenatal exercise classes, and stationary biking.

Gestational diabetes is not of itself an indication for early delivery or cesarean section. The timing and route of delivery will be individualized, and the plan carefully worked out between the mother and her doctor.

Note: This information applies only to Sparrow Medical Group Lansing OB/GYN.