High-risk pregnancies are on the rise in the US, as are conditions that arise during pregnancy, such as gestational diabetes. Gestational diabetes is a form of high blood sugar unique to pregnancy caused by hormones being released from the placenta that inhibit the production of insulin. It can adversely affect the health of the mother and the child.
In this episode of San Diego Health, host Susan Taylor and guest Roman Starikov, MD, an OB-GYN who specializes in maternal and fetal medicine at Scripps Clinic, discuss the signs of gestational diabetes, who’s at risk, and how it’s treated. Dr. Starikov also outlines the perinatology program at Scripps, which focuses on patients with a higher risk for complications during pregnancy and birth.
Doctors can screen for gestational diabetes and offer treatment options ranging from lifestyle changes to medication.
Gestational diabetes is a condition that is unique to pregnancy. It is a specific condition that a woman gets diagnosed with only while she is pregnant and not diagnosed outside of pregnancy.
The symptoms of gestational diabetes are usually not present, not typical symptoms of excessive source, excessive urination, or excessive eating that you see in people who are having diabetes symptoms outside of pregnancy. Usually people do not have any symptoms.
Gestational of diabetes is diagnosed with a one-hour sugar tolerance test. Basically, you drink a solution and they check your sugar one hour later. This is a screening test. If this test is abnormal, the doctor usually orders a three-hour sugar test, where you drink a solution and they check for different values: before you drink, one hour after, two hours after and three hours after.
Gestational diabetes is caused by pregnancy itself. There are hormones that are released from the placenta that can make a woman resistant to glucose, meaning she cannot produce enough insulin to lower her sugar in her blood.
Gestational diabetes can affect an unborn child in many different ways. Most studies show that having high blood sugar during pregnancy accelerates growth of the child, and usually the child gains much more weight than it potentially should be gaining without gestational diabetes. This can result in a bigger baby and injuries during childbirth and delivery.
Women who are at risk for gestational diabetes are women who have a strong family history of gestational diabetes; mothers who are overweight or have medical conditions, such as diabetes; women who previously had a very large baby.
There is a genetic component of gestational diabetes, which can be a window to a woman’s future because a lot of these women are at an increased risk for having type two diabetes or diabetes outside of pregnancy. So yes, it is strongly linked to family history and to developing type two diabetes later in a woman’s life.
There are many factors that contribute to the rise of gestational diabetes. Certainly obesity in the population is a significant factor. Poor nutrition, eating foods that are high in carbohydrates or high in sugar put you at an increased risk.
Also, a lot of pregnancies are now among women who are older. These are women who have delayed their child bearing until older age and age is a risk factor.
Management of diabetes during pregnancy can be quite simple for a majority of women.
Management involves simple dietary modifications, such as decreasing amount of sugar intake. We don’t want pregnant women to be eating cookies, cakes, anything that has high number or high glycemic index. If that doesn’t work, you may need to have pills. Some women may need to take insulin.
The program involves certified diabetes educators who are nurses, nutritionists. It involves endocrinologists and perinatologists or high-risk obstetricians and gynecologists. They talk about the patient as a group. We review each patient as a group and we decide what’s the most appropriate management and offer it to the patient to get the best outcome from pregnancy.
Usually we’ll follow them closely. They have many more appointments. Some of them include antenatal testing, which is putting a monitor on a woman prior to childbirth to make sure that the baby is doing well and not affected by high sugars.
Gestational diabetes is a temporary condition that is specific to the pregnancy. Once the woman and baby is delivered, the gestational diabetes for a majority of women is resolved and is cured.
Some women do end up having persistent diabetes and it evolves into the type two diabetes that may require further treatment outside of pregnancy.
What can happen is that a baby can grow very large inside a woman’s uterus, and that baby may need to be delivered by C-section.
If a woman decides to attempt a vaginal delivery with a large baby, the baby can get stuck and it may require special maneuvers to be delivered. After a special maneuver, it may result in some babies having a shoulder injury and also injury to the nerves that may paralyze the arm temporarily or permanently.
It is important to have gestational diabetes screening during pregnancy. We now screen every single woman for gestational diabetes during pregnancy. It is important to understand that you should not eat a lot of cookies, sugars, cakes, and increase in vegetable and fruit index.
If you get diagnosed with gestational diabetes, do not panic. Usually it is a well-managed condition. If it’s appropriately managed, usually most of the women have an excellent outcome.
Lightly edited for clarity