| Gestational diabetes is the onset of diabetes during pregnancy. When a woman is pregnant, the production of certain hormones can change the way the body uses sugar. These hormones can partly block the effect of insulin, another hormone that controls the amount of sugar in the blood. After delivery, this diabetic condition usually, but not always, resolves.
Pregnant women should be screened for gestational diabetes between the twenty-fourth and twenty-eighth weeks of pregnancy, which is the period during which this condition first begins. Women with known risk factors should be screened for diabetes at the first prenatal visit. Risk factors include sugar in the urine (glycosuria); a history of gestational diabetes, stillbirth, or miscarriage; congenital malformation; a body mass index (BMI) greater than 27 (obesity); and a history of delivering babies larger than or equal to 9 pounds.Risk: As with type I and type II diabetes, gestational diabetes is more common in women with a family history for diabetes. Black, Native American, Hispanic, and Asian women have a higher risk of gestational diabetes. The percentage of white women with gestational diabetes is 1.5% to 2%; of Hispanic, Black, and Asian populations, 5% to 8%; and of Native Americans, 15% (Moore). Incidence and Prevalence: Diabetes complicates 4% of all pregnancies in the US, of which 90% are caused by gestational diabetes (Moore). In countries where chronic malnutrition is a problem, the prevalence of gestational diabetes tends to be higher than surrounding areas. |
Source: Medical Disability Advisor
| History: Individuals may report symptoms similar to diabetes mellitus, such as excessive thirst and increased urine production. Typically, however, there are no symptoms. Physical exam: The exam includes assessment of the mother's vital signs (blood pressure, pulse), body weight, and nutritional status. Tests: The diagnosis is confirmed by a glucose screening test and, if positive, a follow-up test. A nonfasting 50-gram glucose challenge test administered at 24 to 28 weeks screens for normal blood glucose values. An abnormal result can be confirmed with a 100-gram oral glucose tolerance test, in which blood is drawn after fasting more than 8 hours prior to the test, and then hourly over the 3-hour test period. During the test, the individual must remain seated and should not smoke. Two or more abnormal values are diagnostic for gestational diabetes. |
Source: Medical Disability Advisor
| Treatment of gestational diabetes consists of modifying the diet, monitoring blood sugar levels, and exercising regularly. Diet modification includes eating well-balanced meals and reducing intake of foods high in sugar. The American Diabetes Association (ADA) recommends nutritional counseling and a diet that meets the needs of pregnancy but restricts carbohydrates to 35% to 40% of daily caloric intake (Turok). Depending on weight gain during pregnancy, the doctor may recommend eating less at each meal. In some cases, insulin replacement may be required. The glucose level should be monitored weekly at varying times during the day.
Regular prenatal visits to a physician or maternity clinic are essential for a healthy, safe pregnancy, delivery and postpartum period. |
Source: Medical Disability Advisor
| The condition usually resolves after delivery, although it may take several weeks. Breastfeeding improves glycemic control after delivery. In some cases, if the woman becomes pregnant again, gestational diabetes may return. Gestational diabetes also increases the risk of developing diabetes mellitus later in life.
If gestational diabetes is not recognized and treated, the risk for fetal and newborn death increases. Alterations in lifestyle and reduction of risk factors can delay or prevent this development. |
Source: Medical Disability Advisor
| Complications include an increased risk of pre-eclampsia, miscarriage, fetal growth problems, and intrauterine fetal demise (IUFD), as well as the complications associated with diabetes mellitus. Nausea and vomiting during pregnancy can complicate the management of gestational diabetes. Babies of mothers who developed gestational diabetes may grow somewhat larger than average due to the extra sugar in the blood that feeds the baby more. If the baby is very large (macrosomic), the mother may have a difficult labor or need a cesarean section. There is an increased risk of birth injury to large babies delivered vaginally.
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Source: Medical Disability Advisor
| Individuals may need frequent meals and restroom breaks. In more severe cases, insulin therapy is needed. |
Source: Medical Disability Advisor
| If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case. Regarding diagnosis:
- Was there a family history for diabetes?
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Was individual screened for diabetes at the appropriate stage of pregnancy?
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Was diagnosis of gestational diabetes confirmed?
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Were other conditions associated with impaired glucose tolerance ruled out?
Regarding treatment:
- Does individual keep regular follow-up appointments?
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Was individual adequately instructed in diet modification and exercise recommendations?
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Does individual continue to have elevated blood sugars despite diet and activity changes?
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Is individual compliant in following the recommendations? Are barriers preventing her from complying (language barrier, lack of motivation, lack of understanding)?
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Was more aggressive treatment initiated (such as insulin replacement)?
Regarding prognosis:
- Did gestational diabetes respond to treatment?
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Has pregnancy been completed? Was a cesarean section necessary?
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Did mother or infant experience any complications related to the gestational diabetes? Are complications being addressed in the overall treatment plan?
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Has elevated blood sugar continued after delivery of the baby?
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Does individual continue with diet modifications and exercise recommendations? If not, what can be done to enhance compliance?
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Would individual benefit from consultation with an endocrinologist?
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Source: Medical Disability Advisor
| Moore, Thomas R., and Carri Warshak. "Diabetes Mellitus and Pregnancy." eMedicine. Eds. Robert K. Zurawin, et al. 3 Nov. 2004. Medscape. 2 Jan. 2005 <http://emedicine.com/med/topic3249.htm>.Turok, D. K. "Management of Gestational Diabetes Mellitus." American Family Physician 68 9 (2003): 1767-1772. MD Consult. 1 Nov. 2003. Elsevier, Inc. 2 Jan. 2005 <http://home.mdconsult.com/das/journal/view/43596082-2/N/14166594?sid=279901380&source=MI>. |
Source: Medical Disability Advisor