By Debbie Verbeck
High blood sugar levels are unhealthy for pregnant women and their developing babies. Left untreated, the condition can cause serious problems for the mother during the pregnancy and the baby during delivery. And to make matters worse, recent research shows gestational diabetes may cause “future” health problems later in life for both.

What it means for baby
Meador Horne, a registered nurse and certified diabetes educator at Culpeper Regional Hospital, says the biggest health risks that occur during pregnancy affect the baby.

“When added blood sugars cross over the placenta, the higher calories cause the baby to grow larger,” Horne says. “The larger size increases the risk of birth trauma, pre-term delivery, and pre-term respiratory distress syndrome.”

In addition, these babies typically experience jaundice and hypoglycemia, or low blood sugar, after delivery.

“When a baby receives higher blood sugars while in utero, the baby starts making more insulin to deal with the higher blood sugars,” Horne explains. “After the delivery, the higher blood sugars from the mother go away, but the baby still has a higher insulin level, which tends to lower the baby’s blood sugar level. These babies need to be closely monitored, sometimes in an ICU setting, for the first 24 hours after delivery.”

And according to the research, Horne says gestational diabetes also appears to predispose babies for obesity later in life. Here’s the reason why: high sugar levels during pregnancy are believed to cause the fetus to develop in an overfed state, which seems to program the baby’s metabolism to store more fat. This increases the risk of obesity later in adulthood, and therefore, increases the likelihood of obesity-related diabetes.

What it means for mom
Horne says all women experience some form of insulin resistance during pregnancy. As the placenta supplies the growing fetus with nutrients and water, it also produces a variety of hormones to maintain the pregnancy. Some of these hormones can have a blocking effect on insulin. As the placenta grows, more of these hormones are produced, and insulin resistance becomes greater. Normally, the mother’s pancreas is able to make additional insulin to overcome the insulin resistance, but when the production of insulin is not enough to overcome the effect of the placental hormones, gestational diabetes results.

“During pregnancy, between 2 to 10 percent of all women will get gestational diabetes,” Horne says. “What determines whether or not a woman gets the condition is how the woman’s body deals with the insulin demand. If the pancreas cannot keep up with the insulin demand, the woman will experience gestational diabetes.”

One of the biggest risks to the woman during pregnancy is preeclampsia, or increased blood pressure.

“And obviously, if the woman’s blood sugars are running high, she will also experience the regular issues associated with diabetes,” Horne adds.

In most cases, the insulin resistance that caused the condition during pregnancy usually improves after pregnancy and the diabetes goes away. But Horne says that’s not always the case. Therefore, the new mother needs to seek follow-up care from her doctor to make sure her blood sugars have returned to normal.

After pregnancy, Horne adds, the mother also faces an increased risk of developing type 2 diabetes later in life.

Prevention and Treatment
Any woman can get gestational diabetes, but there are certain factors that can increase your risk:

• You have a family history of diabetes (mother, father, sister or brother)
• You are older than 25 when you are pregnant
• Your Ethnicity (non-whites have a greater risk)
• You are overweight or obese before pregnancy
• You gave birth to a baby that weighed more than 9 pounds
• You are a smoker
• You have polycystic ovary syndrome (PCOS)
• You have sugar (glucose) in your urine when you see your doctor for a regular prenatal visit
• You have high blood pressure

Talk with your doctor if you are concerned that you are at risk or if you are experiencing what you feel may be symptoms of gestational diabetes. Symptoms may include:

• Blurred vision
• Fatigue
• Increased thirst
• Increased urination
• Frequent infections, including those of the bladder, vagina and skin
• Nausea and vomiting
• Weight loss in spite of increased appetite

You also will do a glucose screen between the 24th and 28th week of pregnancy. If you are overweight, consider decreasing your body mass index (BMI) to a normal range before you get pregnant to help reduce your risk as well.

Treatment typically includes lifestyle modification, such as eating a healthy diet (which includes plenty of vegetables, whole grains and fruits, but limited sugars), and low-impact exercise (such as walking, swimming, gardening and housework). Some women may require medication and/or insulin.

If you are diagnosed with gestational diabetes, your OB may recommend diabetes classes. Meador Horne teaches a diabetes class at Culpeper Regional Hospital. For details, visit www.culpeperhealth.org.

“The most important thing to remember is that if you have any of the risk factors, make sure you discuss them with your obstetrician,” Horne advises. “And even if you don’t have any of the risk factors, it’s a good idea to go ahead and get the glucose screening test between 24 and 28 weeks, just to be safe.”

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