When Pregnancy Becomes Risky: Gestational Diabetes

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Q: WHAT IS GESTATIONAL DIABETES?

A: Gestational diabetes is diabetes that is found for the first time when a woman is pregnant. Diabetes means that your blood glucose (also called blood sugar) is too high. You and your baby use glucose for energy. But too much glucose in your blood can be harmful and when you are pregnant, too much glucose is not good for you or your baby.

Changing hormones and weight gain are part of a healthy pregnancy. Both changes make it harder for your body’s insulin to do its job. When that happens, glucose levels may increase in your blood, leading to gestational diabetes.

Pregnant women are usually tested for gestational diabetes between 24 and 28 weeks of pregnancy, using a blood test. Gestational diabetes occurs more frequently among women with a family history of diabetes; oversight and obese women; and, African American, Hispanic/Latino and American Indian women.

Treatment for gestational diabetes includes healthy eating and physical activity. Sometimes insulin or oral medication is needed. Most of the time, gestational diabetes goes away after the baby is born. However, it is estimated that about half of all women who had gestational diabetes will go on to develop type 2 diabetes later in life. That’s why it’s important for women with a history of gestational diabetes to continue to get tested for diabetes.

 Q: WHY ARE WOMEN OVER 35 AT A GREATER RISK FOR DEVELOPING HIGH BLOOD PRESSURE AND GESTATIONAL DIABETES DURING A PREGNANCY COMPARED TO YOUNGER WOMEN?

A: Many women in their 30s and beyond deliver healthy babies. While there is nothing magical about age 35, research has shown that mothers giving birth over the age of 35 may have an increased risk of developing pregnancy-related health problems such as high blood pressure and gestational diabetes.

While age is one risk factor for gestational diabetes, if the mom has additional risk factors such as being overweight or obese, or having a family history of diabetes, the risk for gestational diabetes is greater. It’s important for women to stay healthy – at any age – when preparing for a pregnancy.

Q: HOW CAN GESTATIONAL DIABETES AFFECT MOM AND BABY?

A: Gestational diabetes may increase a woman’s risk of high blood pressure during pregnancy and could increase the need for cesarean section at delivery. Untreated or uncontrolled gestational diabetes can mean problems for the baby, such as being born very large and with extra fat, which can make delivery difficult and more dangerous for the baby. These babies may also experience low blood glucose right after birth as well as breathing problems.

Q: WHAT CAN A WOMAN DO IF SHE IS DIAGNOSED WITH GESTATIONAL DIABETES?

A: Managing gestational diabetes means taking steps to keep blood glucose levels in a target range. Many women who have gestational diabetes see a dietitian or diabetes educator to guide them in developing healthy habits during pregnancy. Women with gestational diabetes can manage their blood glucose with healthy eating, being active, and by monitoring their blood glucose. Some women may need insulin or other medications. All women with gestational diabetes should work closely with their health care team to help ensure a healthy outcome for both mother and baby.

Q: WHY IS GESTATIONAL DIABETES A CONCERN AFTER THE PREGNANCY?

A: Having gestational diabetes increases a woman’s future chances of developing diabetes. It is estimated that half of all women who had gestational diabetes will go on to develop type 2 diabetes later in life. Additionally, the children of pregnancies where the mother had gestational diabetes may also be at increased risk for obesity and type 2 diabetes throughout their lives.

 Q: WHAT FOLLOW-UP MONITORING OR CARE DOES A WOMAN WITH GESTATIONAL DIABETES NEED AFTER SHE DELIVERS THE BABY?

A: Women with a history of gestational diabetes should be tested for diabetes no later than 12 weeks after their baby is born. In many cases, their blood glucose levels return to normal after delivery. Although they no longer have gestational diabetes, they are at high risk for developing type 2 diabetes in the future.

If the test results show that your blood glucose (sugar) is higher than normal, but not high enough to be diabetes — also called prediabetes — get tested for diabetes every year. If the test is normal, get tested every 3 years.

If your test results show that you could get diabetes and you are overweight, ask your doctor about what changes you can make to lose weight and for help in making them. Your doctor may recommend that you take medicine such as metformin to help prevent type 2 diabetes based on findings from the NIH-funded Diabetes Prevention Program.

Even after the baby is born, it is important for women with a history of gestational diabetes to reach and maintain a healthy weight by making healthy food choices, such as following an eating plan lower in fat and calories and high in fiber, and being active for at least 30 minutes a day, 5 days a week. Even if you do not reach your “goal” weight, research shows that maintaining a healthy lifestyle can help lower a person’s chances for developing type 2 diabetes in the future.

Women with a history of gestational diabetes should also talk to her doctor if she plans to become pregnant again.

Q: WHAT IS THE LONG-TERM IMPACT OF GESTATIONAL DIABETES ON THE HEALTH OF THE MOM AND THE BABY?

A: Most of the time, gestational diabetes goes away after pregnancy, but sometimes diabetes stays. It is important to get tested for diabetes after the baby is born. Women with a history of gestational diabetes need to know that they have a greater chance of developing type 2 diabetes later in life and should continue to get tested for diabetes every 1 to 3 years.

A child born from a pregnancy affected by gestational diabetes may also be at risk for obesity and type 2 diabetes later in life. Tell your child’s doctor if you had gestational diabetes while you were pregnant with that child. This fact is an important part of your child’s health history and can alert your child’s doctor to monitor growth charts more closely.

Q: WHAT CAN A WOMAN WITH A HISTORY OF GESTATIONAL DIABETES DO TO PROTECT HER OWN HEALTH, AND THE HEALTH OF HER CHILD?

A: Women with a history of gestational diabetes can take modest but important steps — for themselves and their children — to prevent or delay type 2 diabetes. Here are a few tips:

    • Keep up healthy habits – even after the baby is born. This includes making healthy food choices and staying active.
    • Women with gestational diabetes — like all mothers — are encouraged to breastfeed their babies, if possible. Breastfeeding gives your baby the right balance of nutrients and helps the mom burn calories.
    • Try to reach your pre-pregnancy weight 6 to 12 months after your baby is born. Even if you do not reach your “goal” weight, research shows that maintaining a healthy lifestyle can help reduce a person’s risk for developing diabetes in the future.
    • Be more active each day. Try to get at least 30 minutes of activity, 5 days a week. It’s okay to be active for 10 minutes at a time, 3 times a day.
    • Do things together as a family, such as making healthy meals or playing active games together. This approach can yield a lifetime of healthy rewards for the entire family.

Dr. Rodgers answers your Text Tom questions on the next page.

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