Diabetes in Pregnancy
Pregnancy makes all women diabetic, JUST A LITTLE. There is a specific hormone, human placental lactogen (HPL), which keeps circulating sugar higher during pregnancy because babies use this sugar for energy. In some pregnancies the placenta makes too much HPL, and sugar levels in mom become too high. When mommy blood sugar levels are high, babies get too much food, and can grow too much. Babies who grow to big can get stuck during labor. Babies exposed to high sugar levels during pregnancy can have dangerously low sugar levels after birth.
Symptoms & Testing
Diabetes of pregnancy has no reliable or predictable symptoms so we test everyone. The test consists of drinking a specific amount of sugar and having a blood test one hour later. If the single blood test is elevated, we do a follow up test to confirm it is diabetes of pregnancy. The follow up test is four blood draws in three hours.
Complications from this diabetes of pregnancy can be avoided by keeping sugar levels in the normal range. Dietary changes are enough for almost all women diagnosed with gestational diabetes. However, when diet is not enough we use medicines, either pills or injections of insulin. Patients monitor their sugar control, with diet or medication, by measuring sugar levels before breakfast and after meals.
It is recommended that most women with diabetes of pregnancy are induced and delivered by their due date. Otherwise, pregnancy management, labor, and delivery are essentially NORMAL for women who control their sugar levels with diet, only. Pregnancies requiring medication are usually delivered at 39 weeks.
Effects on Baby
Sometimes we use ultrasound to measure baby size. Babies estimated to be greater than 10 lbs (4.,500 gm) at the due date are considered for cesarean section without labor. The extra growth from diabetes can make the shoulders and body bigger than the head, leading to a dangerous situation at delivery.
All babies born to moms with diabetes during pregnancy can have dangerously low sugar levels immediately after birth. We measure sugar levels in these infants often, during the first day(s) of life, to detect and treat low sugars if they occur.
After delivery, diabetes of pregnancy goes away…usually. There are a few situations in which it stays or comes back which we have tests for. First, it may be that the mom was diabetic before pregnancy, without knowing it. In such cases, diabetes stays. Next, it may be the mom became diabetic during pregnancy, and it does not go away. Finally, the diabetes of pregnancy goes away, and then comes back years later. Women with diabetes of pregnancy should be tested for diabetes six weeks after delivery, and at intervals for the next 30 years.