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Gestational Diabetes

Gestational diabetes (GDM) is a type of diabetes that is diagnosed during pregnancy and usually goes away after the baby is delivered. When you hear that you have gestational diabetes, you may feel quite anxious and overwhelmed. You probably have many plans for your pregnancy and your new baby. Learning you have diabetes may cause you to worry about your baby's health but please be aware that most babies born to mothers with gestational diabetes are perfectly healthy.

Gestational diabetes typically occurs after the baby's organs have already developed and the baby is in the process of growing, therefore the risks to the baby are not the same as when the mother has type 1 or type 2 diabetes. Still, it is natural to be concerned for both yourself and your baby.

How Will Gestational Diabetes Affect my Baby?

Gestational diabetes is not associated with increased risk of congenital malformations in the baby. However it is associated with large babies. The developing baby receives glucose and other nutrients from your blood stream. If your blood glucose levels are high, this excess glucose will be passed on to the baby through the placenta. Although the baby can produce more insulin as needed, he or she may gain extra weight in fat. This is known as "macrosomia". The birth weight of such babies is often 9 pounds (4kg) or greater. These babies can have more difficulties during delivery because of their large size. Labour may be slowed down or the baby may be too large for a vaginal delivery, therefore a caesarean section is more likely. There is also an increase in birth injuries when the baby is large.

Excess insulin produced by the baby can also lead to hypoglycemia (low blood glucose) within the first 24 hours after birth. This situation will quickly correct itself once the baby receives breast milk, supplemental sugar water or formula.

Your baby will not be born with diabetes.

How Will Gestational Diabetes Affect Me?

Typically women with gestational diabetes feel well. However, gestational diabetes (GDM) can be associated with high blood pressure. Your doctor will regularly monitor your blood pressure, check your weight and have your urine tested for protein.

Once your baby is born, your blood glucose will most likely return to normal but there is an increased risk that you could develop type 2 diabetes later in life. It is important to have your fasting blood glucose checked about 6 weeks after delivery and annually thereafter. You may reduce the risk of developing diabetes later in life through healthy eating, regular exercise and maintaining a healthy weight.

Adjusting your Schedule

Pregnancy already entails a lot of change to your life and routine. The suggested recommendations for the treatment of gestational diabetes could mean more changes and adjustments. The support of family and friends can be helpful, but they may also be worried and unsure of how to respond. If you aren't getting the support you need, talk to your diabetes health care team. They may be able to arrange counselling or help you find a support group for women in a similar situation.

Your medical visits will increase during this time. Besides your obstetrician or family doctor, a diabetes specialist or endocrinologist may also be part of the medical team. Routinely, the following tests are done: Blood pressure; urine test for protein; blood glucose. Ultrasound pictures of the baby will be taken regularly. Medical appointments are usually weekly or every two weeks and do take time. It may be a good idea to ask your doctor to provide a letter for your employer if medical visits conflict with work. All this activity is to ensure that you stay well during your pregnancy and have a healthy baby.

Insulin

Insulin may be necessary if blood glucose cannot be maintained at a healthy level through meal planning and increased activity. Pills for diabetes are not recommended during pregnancy. Insulin is given by injection 1 - 4 times daily depending on blood glucose results. Insulin is discontinued after delivery. If you require insulin, you will be taught how to use it.

Managing your Pregnancy with GDM

Here are some suggestions for managing your pregnancy when you have gestational diabetes:

Eat healthy meals

It is recommended that you avoid concentrated sweets and sugars such as all fruit juices. There are helpful recommendations in Canada's Food Guide to Healthy Eating. It is important to eat enough food to promote a healthy, gradual weight gain. Foods containing carbohydrates such as starchy foods, fruit, some vegetables, milk and yogurt all contain natural sugars and will increase blood glucose. However, these foods should not be avoided as they are a necessary part of healthy eating habits and are important for normal growth of your developing baby. Servings of these foods should be spread out over the day into three meals and three snacks. A bedtime snack should include some carbohydrate.

If you have a sweet tooth and like to use sugar substitutes, be aware that these should be used in moderation as they may satisfy your hunger but cause you to eat less-nutritious foods. For example, diet soft drinks have no nutritional value and are no substitute for a glass of milk. However, evidence suggests that aspartame (Nutrasweet), sucralose (Splenda) and acesulfame potassium (Sunnett) are safe to use during pregnancy. A registered dietitian can provide you with specific and personalized suggestions for healthy eating during your pregnancy.

Be Active

If you have been active up to this point in your pregnancy, continued regular and moderate activity can help blood glucose control. If you have not been active, try going for a walk after a meal as this helps lower blood glucose levels naturally and is something many women can fit into their day. Other activities should be discussed with your doctor. For more information about exercise during pregnancy visit our Pregnancy Health Centre.

Have your blood glucose tested regularly

Self-monitoring or laboratory testing of your blood glucose can provide you and your health care team with information about how best to manage your GDM. It also indicates whether other treatment is necessary, as some women need to take added insulin during pregnancy. If your doctor decides that frequent blood glucose monitoring is necessary, you will be taught how to do this. The frequency of self-monitoring is determined on an individual basis. Typically, if you need to take insulin, you will be taught to test your blood for glucose 2-4 times a day: before breakfast and then 2 hours after meals.

Learn to manage stress

Keep up your previous interests and hobbies, if possible. Learn relaxation techniques or join yoga classes for mothers-to-be. You may also find childbirth education classes provide you with reassurance and support at this time. Women often deal with stress through over-eating, especially on high fat or sweet foods. Many women also become less active when under stress. This can increase your blood glucose level. Being able to talk about your fears and frustrations with your friends, family or health care team can go a long way towards helping you resolve some of your concerns.

 

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