Gestational Diabetes

Definition:
Gestational diabetes (or gestational diabetes mellitus, GDM) is a condition in which women without previously diagnosed diabetes exhibit high blood glucose levels during pregnancy (especially during their third trimester). Gestational diabetes is caused when insulin receptors do not function properly. This is likely due to pregnancy-related factors such as the presence of human placental lactogen that interferes with susceptible insulin receptors. This in turn causes inappropriately elevated blood sugar levels.

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Gestational diabetes generally has few symptoms and it is most commonly diagnosed by screening during pregnancy. Diagnostic tests detect inappropriately high levels of glucose in blood samples. Gestational diabetes affects 3-10% of pregnancies, depending on the population studied.

As with diabetes mellitus in pregnancy in general, babies born to mothers with untreated gestational diabetes are typically at increased risk of problems such as being large for gestational age (which may lead to delivery complications), low blood sugar, and jaundice. If untreated, it can also cause seizures or stillbirth. Gestational diabetes is a treatable condition and women who have adequate control of glucose levels can effectively decrease these risks. The food plan is often the first recommended target for strategic management of GDM.

Clasifications:
There are two subtypes of gestational diabetes:
Type A1: abnormal oral glucose tolerance test (OGTT), but normal blood glucose levels during fasting and two hours after meals; diet modification is sufficient to control glucose levels

Type A2: abnormal OGTT compounded by abnormal glucose levels during fasting and/or after meals; additional therapy with insulin or other medications is required

Approximately 7% of all pregnancies are complicated by GDM, resulting in more than 200,000 cases annually. The prevalence may range from 1 to 14% of all pregnancies, depending on the population studied and the diagnostic tests employed.

Symptoms:
Because gestational diabetes does not cause much symptoms, the patient need to be tested for the condition. This is usually done between the 24th and 28th weeks of pregnancy. It is surprised if your test shows a high blood sugar level and is important for the patient to be tested for gestational diabetes, because high blood sugar can cause problems for both the pregnent woman and the baby.Sometimes, a pregnant woman has been living with diabetes without knowing it. If she has the  symptoms of diabetes  and that may include:

*Increased thirst.
*Increased urination.
*Increased hunger.
*Blurred vision.

Pregnancy causes most women to urinate more often and to feel more hungry, so having these symptoms doesn’t always mean that a woman has diabetes.Doctor should be consulted wheather  these symptoms are for diabetes  and then he can suggest for the test of diabetes.

*Infections:
Since diabetes interferes with the body’s ability to fight infections, the pregnant woman may experience frequent infections in areas such as the bladder, vagina and skin. White blood cells defend the body against bacteria, but these cells aren’t able to function normally when a person has a high blood sugar. A woman with gestational diabetes may also complain of a yeast infection in the vagina or on the skin. Yeast cells are normally present in the vaginal area in small amounts. The vaginal secretions and urine contain more glucose when a woman has gestational diabetes. The yeast cells use the glucose as food, which causes the cells to multiply. With the body’s immune system compromised by the high level of glucose in the blood, this increase in yeast cells turns into a yeast infection.

*High Blood Sugar:
Since a woman may not have any noticeable symptoms of gestational diabetes and symptoms can mimic regular pregnancy symptoms, screening for this condition is part of prenatal care for at-risk women between weeks 24 and 28 of pregnancy. The doctor will initially order a blood test called a glucose challenge test. If the glucose challenge test indicates a high blood sugar level, the doctor may order a glucose tolerance test to confirm the diagnosis of gestational diabetes. Both tests involve drinking a sweet glucose solution and having your blood drawn after a prescribed amount of time.

Causes:
Almost all women have some degree of impaired glucose intolerance as a result of hormonal changes that occur during pregnancy. That means that their blood sugar may be higher than normal, but not high enough to have diabetes. During the later part of pregnancy (the third trimester), these hormonal changes place pregnant woman at risk for gestational diabetes.

During pregnancy, increased levels of certain hormones made in the placenta (the organ that connects the baby by the umbilical cord to the uterus) help shift nutrients from the mother to the developing fetus. Other hormones are produced by the placenta to help prevent the mother from developing low blood sugar.

They work by resisting the actions of insulin.
Over the course of the pregnancy, these hormones lead to progressive impaired glucose intolerance (higher blood sugar levels). To try to decrease blood sugar levels, the body makes more insulin to get glucose into cells to be used for energy.
Usually, the mother’s pancreas is able to produce more insulin (about three times the normal amount) to overcome the effect of the pregnancy hormones on blood sugar levels. If, however, the pancreas cannot produce enough insulin, blood sugar levels will rise, resulting in gestational diabetes.

Risk factors:
Any woman can develop gestational diabetes, but some women are at greater risk. Risk factors for gestational diabetes include:

*Age greater than 25. Women older than age 25 are more likely to develop gestational diabetes.
*Family or personal health history. the risk of developing gestational diabetes increases if the woman has 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.the woman is also more likely to develop gestational diabetes if she had it during a previous pregnancy, if the woman delivered a baby who weighed more than 9 pounds (4.1 kilograms), or if she had an unexplained stillbirth.
*Excess weight. You’re more likely to develop gestational diabetes if you’re significantly overweight with a body mass index (BMI) of 30 or higher.
*Race factor. For reasons that aren’t clear, women who are black, Hispanic, American Indian or Asian are more likely to develop gestational diabetes.

Complications:
Most women who have gestational diabetes deliver healthy babies. However, gestational diabetes that’s not carefully managed can lead to uncontrolled blood

sugar levels and cause problems for patient and the baby, including an increased likelihood of needing a C-section to deliver.

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Complications that may affect the baby are:
1.Excessive birth weight. Extra glucose in your bloodstream crosses the placenta, which triggers your baby’s pancreas to make extra insulin. This can cause the baby to grow too large (macrosomia). Very large babies — those that weigh 9 pounds or more — are more likely to become wedged in the birth canal, sustain birth injuries or require a C-section birth.

2.Early (preterm) birth and respiratory distress syndrome. A mother’s high blood sugar may increase her risk of early labor and delivering her baby before its due date. Or her doctor may recommend early delivery because the baby is large.

3.Babies born early may experience respiratory distress syndrome — a condition that makes breathing difficult. Babies with this syndrome may need help breathing until their lungs mature and become stronger. Babies of mothers with gestational diabetes may experience respiratory distress syndrome even if they’re not born early.

4.Low blood sugar (hypoglycemia). Sometimes babies of mothers with gestational diabetes develop low blood sugar (hypoglycemia) shortly after birth because their own insulin production is high. Severe episodes of hypoglycemia may provoke seizures in the baby. Prompt feedings and sometimes an intravenous glucose solution can return the baby’s blood sugar level to normal.

5.Type 2 diabetes later in life. Babies of mothers who have gestational diabetes have a higher risk of developing obesity and type 2 diabetes later in life.
Untreated gestational diabetes can result in a baby’s death either before or shortly after birth.

Complications that may affect the patient are:
1.High blood pressure and preeclampsia. Gestational diabetes raises your risk of high blood pressure, as well as, preeclampsia — a serious complication of pregnancy that causes high blood pressure and other symptoms that can threaten the lives of both mother and baby.

2.Future diabetes. If the pregnent woman has gestational diabetes, she is more likely to get it again during a future pregnancy and also more likely to develop type 2 diabetes as she gets older. However, making healthy lifestyle choices such as eating healthy foods and exercising can help reduce the risk of future type 2 diabetes.Of those women with a history of gestational diabetes who reach their ideal body weight after delivery, fewer than 1 in 4 eventually develops type 2 diabetes.

Diagnosis:
Gestational diabetes usually starts halfway through the pregnancy. All pregnant women should receive an oral glucose tolerance test between the 24th and 28th week of pregnancy to screen for the condition. Women who have risk factors for gestational diabetes may have this test earlier in the pregnancy.

Once the pregnent woman is diagnosed with gestational diabetes, she can see how well she is doing by testing the glucose level at home. The most common way involves pricking her finger and putting a drop of the blood on a machine that will give her the glucose reading.

Treatment:
The goals of treatment are to keep blood sugar (glucose) levels within normal limits during the pregnancy, and to make sure that the growing baby is healthy.

Watching the baby:
1.The health care provider should closely check both the patient  and the baby throughout the pregnancy. Fetal monitoring will check the size and health of the fetus.

2.A nonstress test is a very simple, painless test for the patient and the baby.

3.A machine that hears and displays the baby’s heartbeat (electronic fetal monitor) is placed on the abdomen.
The health care provider can compare the pattern of the baby’s heartbeat to movements and find out whether the baby  is doing well.

Diet and exercise:
The best way to improve the pregnent woman’s diet is by eating a variety of healthy foods.She should learn how to read food labels, and check them when making food decisions.The doctor or dietitian  should advice the diet chart and that should be strictly followed  during pregnancy.

In general, when the pregnent woman has gestational diabetes the diet should:
*Be moderate in fat and protein.

#Provide  carbohydrates through foods that include fruits, vegetables, and complex carbohydrates (such as bread, cereal, pasta, and rice)
Be low in foods that contain a lot of sugar, such as soft drinks, fruit juices, and pastries.

#If managing the diet does not control blood sugar (glucose) levels, she may be prescribed diabetes medicine by mouth or insulin therapy.
Most women who develop gestational diabetes will not need diabetes medicines or insulin, but some will.

Prevention:
Theoretically, smoking cessation may decrease the risk of gestational diabetes among smokers.Physical exercise has not been found to have a significant effect of primary prevention of gestational diabetes in randomized controlled trials. It may be effective as tertiary prevention for women who have already developed the condition.
Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.

Resources:
http://en.wikipedia.org/wiki/Gestational_diabetes
http://www.webmd.com/diabetes/guide/gestational-diabetes-symptoms
http://www.ehow.com/list_6080912_signs-symptoms-gestational-diabetes.html
http://www.webmd.com/diabetes/guide/gestational_diabetes
http://www.mayoclinic.org/diseases-conditions/gestational-diabetes/basics/risk-factors/CON-20014854
http://www.nytimes.com/health/guides/disease/gestational-diabetes/overview.html

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