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Pancreas
Pancreas


Gestational Diabetes
Gestational Diabetes


Definition:

Gestational diabetes is high blood sugar (diabetes ) that starts or is first diagnosed during pregnancy.



Alternative Names:

Glucose intolerance during pregnancy



Causes, incidence, and risk factors:

Risk factors for gestational diabetes include:

  • African or Hispanic ancestry
  • Being older than 25 when pregnant
  • Family history of diabetes
  • Giving birth to a previous baby that weighed more than 9 pounds
  • Obesity
  • Recurrent infections
  • Unexplained miscarriage or death of a newborn


Symptoms:

Usually there are no symptoms, or the symptoms are mild and not life threatening to the pregnant woman. Often, the blood glucose level returns to normal after delivery.

Symptoms may include:

However, high blood sugar levels in the mother can cause problems in the baby. These problems can include:

  • Birth injury (trauma) because of the baby's large size
  • Increased chance of diabetes and obesity
  • Jaundice
  • Large size at birth
  • Low blood sugar (hypoglycemia )

Rarely, the unborn baby dies in the womb late in the pregnancy. Mothers with gestational diabetes have an increased risk for high blood pressure during pregnancy and delivery by c-section.



Signs and tests:

Gestational diabetes may not cause symptoms. All pregnant women should receive an oral glucose tolerance test between the 24th and 28th week of pregnancy to screen for the condition.



Treatment:

The goals of treatment are to keep blood glucose levels within normal limits during the pregnancy, and to make sure that the fetus is healthy.

Your health care provider should closely check both you and your fetus throughout the pregnancy. Fetal monitoring to check the size and health of the fetus often includes ultrasound and nonstress tests.

A nonstress test is a very simple, painless test for you and your baby. A machine that hears and displays your baby's heartbeat (electronic fetal monitor) is placed on your abdomen. When the baby moves, its heart rate normally increases 15 - 20 beats above its regular rate.

Your health care provider can look at the pattern of your baby's heartbeat compared to its movements and find out whether the baby is doing well. The health care provider will look for increases in the baby's normal heart rate, occurring within certain period of time.

Managing your diet can give you the calories and nutrients you need for your pregnancy and to control blood glucose levels. You may have nutritional counseling with a registered dietician.

See also: Diabetes diet

If managing your diet does not control blood glucose levels, you may be prescribed diabetes medicine by mouth or insulin therapy. You will need to monitor your blood glucose levels during treatment.



Support Groups:



Expectations (prognosis):

There is a slightly increased risk of the baby dying when the mother has untreated gestational diabetes. Controlling blood sugar levels reduces this risk.

High blood glucose levels often go back to normal after delivery. However, women with gestational diabetes should be watched closely after giving birth and at regular doctor's appointments to screen for signs of diabetes. Many women with gestational diabetes develop diabetes within 5 - 10 years after delivery. The risk may be increased in obese women.



Complications:
  • Delivery-related complications due to the infant's large size
  • Development of diabetes later in life
  • Increased risk of newborn death
  • Low blood glucose or illness in the newborn


Calling your health care provider:

Call your health care provider if you are pregnant and you have symptoms of diabetes .



Prevention:

Beginning prenatal care early and regular prenatal visits helps improve the health of you and your baby. Knowing the risk factors for gestational diabetes and having prenatal screening at 24 - 28 weeks into the pregnancy will help detect gestational diabetes early.



References:

Screening for gestational diabetes mellitus: Recommendation statement. Rockville, MD. US Preventive Services Task Force; May 2008: Ann Intern Med; 148(759-765).

ACOG Practice Bulletin. Clinical management guidelines for obstetrician-gynecologists. Obstet Gynecol. 2001 Sep;98(3):525-38.

Landon MB, Catalano PM, Gabbe SG. Diabetes mellitus complicating pregnancy. In: Gabbe SG, Niebyl JR, Simpson JL, eds. Obstetrics - Normal and Problem Pregnancies. 5th ed. Philadelphia, Pa: Elsevier Churchill Livingstone; 2007:chap 37.

Cunnigham FG, Leveno KL, Bloom SL, et al . Antepartum assessment. In: Cunnigham FG, Leveno KL, Bloom SL, et al, eds. Williams Obstetrics. 22nd ed. New York, NY; McGraw-Hill; 2005:chap 15.

Cunnigham FG, Leveno KL, Bloom SL, et al . Diabetes. In: Cunnigham FG, Leveno KL, Bloom SL, et al, eds. Williams Obstetrics. 22nd ed. New York, NY; McGraw-Hill; 2005:chap 52.




Review Date: 10/28/2008
Reviewed By: Linda Vorvick, MD, Seattle Site Coordinator, Lecturer, Pathophysiology, MEDEX Northwest Division of Physician Assistant Studies, University of Washington School of Medicine; and Susan Storck, MD, FACOG, Chief, Eastside Department of Obstetrics and Gynecology, Group Health Cooperative of Puget Sound, Redmond, Washington; Clinical Teaching Faculty, Department of Obstetrics and Gynecology, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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