Gestational diabetes requires careful monitoring
DEAR DOCTOR K:
I was just diagnosed with gestational diabetes. What are the risks to my baby? And what do I need to do to keep her safe?
Gestational diabetes is high blood sugar that occurs during pregnancy. Normally, the hormone insulin moves sugar (glucose) from the bloodstream into cells that use it for fuel. In gestational diabetes, hormones produced during pregnancy make the body resistant to insulin's effects.
In most pregnant women, the pancreas produces extra insulin to overcome the insulin resistance. In women with gestational diabetes, the pancreas does not produce enough extra insulin. As a result, sugar accumulates in the bloodstream.
If your gestational diabetes is not treated carefully, you are at increased risk of high blood pressure and swelling, a condition called pre-eclampsia. And your baby is at higher risk for prematurity, lung problems at birth and stillbirth.
To prevent these complications you'll need to carefully control your blood sugar through the remainder of your pregnancy. You may be able to do this by managing your diet. If diet does not control your blood glucose, your doctor will prescribe insulin. Insulin will not harm your baby as long as you closely monitor your blood sugar to keep it at safe levels.
It is really important that your obstetrician follow you and your baby carefully during pregnancy, and during labor and delivery.
Gestational diabetes can create complications during delivery. That's because your baby may be larger than normal. Why? Because the baby is exposed in the womb to your high sugar levels. If the baby is too big to exit the birth canal, natural childbirth may be difficult. For this reason, many doctors recommend inducing labor or delivering by surgery if you haven't naturally delivered your baby by 38 weeks.
Complications also can affect your baby right after birth. Before delivery, your baby's pancreas has been making large amounts of insulin because of the high sugar levels in your blood. The minute your baby is born, she is disconnected from your blood supply. For a brief time, there may be too much insulin in your baby's blood, given the normal amount of sugar in her blood. As a result, dangerously low blood sugar may result. If necessary, your baby will be given sugar to counteract this.
Once the baby is born, the hormones that make the body resistant to insulin go away, and the high blood sugar levels return to normal -- until your next pregnancy. However, once you have had gestational diabetes you are also at increased risk of developing Type 2 diabetes later in life. So protect yourself: After your pregnancy, reduce your risk with regular exercise and a reduced-calorie diet.
What I've written may sound frightening: Gestational diabetes does increase your and your baby's risk for various health problems. But with careful medical care, and possibly with lifestyle changes, you can protect both yourself and your baby.
(Dr. Komaroff is a physician and professor at Harvard Medical School. To send questions, go to AskDoctorK.com, or write: Ask Doctor K, 10 Shattuck St., Second Floor, Boston, MA 02115.)
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