New federal recommendations in the United States are for all pregnant women to be screened for gestational diabetes at 24 weeks of pregnancy, even when they have no symptoms of the condition.
The new guidelines from the U.S. Preventive Services Task Force (USPSTF), published in the Annals of Internal Medicine, are now the same as those of other medical organizations, including the American Diabetes Association (ADA) and the American College of Obstetricians and Gynecologists (ACOG).
Screening pregnant women for gestational diabetes has been the norm in the U.S. for some years; the fact that the federal government has now added its weight to the issue underlines the importance of diabetes screenings during pregnancy. In its website, the ADA says that about 18 percent of all pregnant women develop gestational diabetes around the 24th week of pregnancy (even when they never had diabetes before).
Being diagnosed with gestational diabetes does not mean that a woman had diabetes before pregnancy, or that she will have it after giving birth. But it does mean that her blood glucose levels are currently high, so, she needs to follow her doctor’s advice about regulating blood sugar levels.
Doctors don’t know what causes gestational diabetes; but they believe that hormonal changes during pregnancy are involved. Hormones from the placenta help the fetus to grow; but they also lessen the ability of the mother’s system to use insulin in her blood. Insulin is a hormone that helps the body convert blood sugar, glucose, into energy. When the body cannot use its insulin properly, it is called insulin resistance; if untreated, the condition leads to high levels of sugar in the mother’s blood (hyperglycemia).
Because gestational diabetes occurs later in the pregnancy, after the baby’s body has been formed, the condition does not cause the serious birth defects that can develop in infants born to women who had diabetes before they got pregnant.
However, gestational diabetes can still harm the baby, as its blood sugar gets high also (while the mother’s insulin does not cross the placenta, glucose and other nutrients do). This results in the baby’s pancreas working overtime to produce more insulin; but as the baby’s blood sugar still remains high, the extra sugar is stored as fat, resulting in a “fat” baby being born. This in turn can damage nerves in the baby’s shoulders during birth or increase the likelihood of a caesarean delivery. It can also put the infant at risk for being obese in childhood and getting type-2 diabetes as an adult.
Gestational diabetes also carries risks for the mother; one of the more serious conditions that can stem from gestational diabetes is preeclampsia, in which the mother develops high blood pressure and has high levels of protein in her urine. If left untreated, preeclampsia can result in eclampsia, a condition that can cause the mother to have seizures, and can rarely lead to death.
Gestational diabetes can be successfully treated with the help of your health care providers. Treatment will always include modifications to your diet (cutting down on sweets and starches, and eating more vegetables, fruits and whole grains) and increasing your physical activity to a moderate level. Treatment may also include daily blood glucose monitoring and insulin injections.
To help prevent the possibility of gestational diabetes, doctors recommend that women eat a healthy diet, be physically active and get to a healthy weight before they become pregnant.
By Lisa Pecos