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Diabetes is a condition where sufficient amounts of insulin are either not produced or the body is unable to use the insulin that is produced. Insulin is the hormone that allows glucose to enter the cells of the body to provide fuel. When glucose cannot enter the cells, it builds up in the blood and the body's cells literally starve to death.
Diabetes in pregnancy can have serious consequences for the mother and the growing fetus. The severity of problems often depends on the degree of the mother's diabetic disease, especially if she has vascular (blood vessel) complications and poor blood glucose control. Diabetes that occurs in pregnancy is described as:
Gestational diabetes is a condition in which the glucose level is elevated and other diabetic symptoms appear during pregnancy in a woman who has not previously been diagnosed with diabetes. In most cases, all diabetic symptoms disappear following delivery. However, women with gestational diabetes have an increased risk of developing diabetes later in life, especially if they were overweight before the pregnancy.
Unlike other types of diabetes, gestational diabetes is not caused by a lack of insulin, but by blocking effects of other hormones on the insulin that is produced, a condition referred to as insulin resistance.
Although the cause of gestational diabetes is not known, there are some theories as to why the condition occurs.
The placenta supplies a growing fetus with nutrients and water, as well as produces a variety of hormones to maintain the pregnancy. Some of these hormones (estrogen, cortisol, and human placental lactogen) can have a blocking effect on insulin, which usually begins about 20 to 24 weeks into the pregnancy.
As the placenta grows, more of these hormones are produced, and insulin resistance becomes greater. Normally, the pancreas is able to make additional insulin to overcome insulin resistance, but when the production of insulin is not enough to overcome the effect of the placental hormones, gestational diabetes results.
Although any woman may develop gestational diabetes during pregnancy, some of the factors that may increase risk are:
Although increased glucose in the urine is often included in the list of risk factors, it is not believed to be a reliable indicator for gestational diabetes.
A glucose screening test is usually performed between 24 and 28 weeks of pregnancy, which involves drinking a glucose drink followed by measurement of glucose levels after a one-hour interval.
If this test shows an increased blood sugar level, another test will be performed after a few days of following a special diet. The second test also involves drinking a glucose drink, and results are measured several times over the next two or three hours.
If results of the second test are in the abnormal range, gestational diabetes is diagnosed.
Specific treatment gestational diabetes will be determined by your physician based on:
Treatment for gestational diabetes focuses on keeping blood glucose levels in the normal range. Treatment may include:
Unlike other types of diabetes, gestational diabetes generally does not cause birth defects. Birth defects usually originate sometime during the first trimester of pregnancy. They are more likely in women with pregestational diabetes, who may have changes in blood glucose during that time. Women with gestational diabetes generally have normal blood sugar levels during the critical first trimester.
The complications of gestational diabetes are usually manageable and preventable. The key to prevention is careful control of blood sugar levels just as soon as the diagnosis of gestational diabetes is made.
Infants of mothers with gestational diabetes are vulnerable to several chemical imbalances, such as low serum calcium and low serum magnesium levels, but, in general, the major problems of gestational diabetes include: