Gestational Diabetes
Male: If you have diabetes and are planning to become pregnant, it is important to involve a diabetic specialist, registered dietician and diabetic nurse educator in your care to optimize your health before conceiving.
Plan ahead. A poorly controlled diabetes before and during pregnancy leads to an increase risk for miscarriage and a two to three-fold increase risk for birth malformations.
Dr. Corbett: Every mother wants to have the perfect baby and a healthy pregnancy, and all mothers are really motivated to do the best they can to have a baby that is going to be as healthy and thrive in later life.
Pregnancy itself could create stress on your body and the further along you go on your pregnancy the more insulin resistant you have, so the more likely you are to have a result that is abnormal the later you are in pregnancy. And that is why we screen so late at 24 to 28 weeks.
Male: Gestational diabetes mellitus or GDM refers to glucose intolerance that develops during pregnancy.
Three to four percent of pregnant women are at risk of developing GDM.
Undiagnosed or untreated, GDM can lead to large babies. This results in an increase risk of birth trauma to both the mother and the infant.
Furthermore, newborns are at risk for hypoglycemia following delivery, as well as jaundice and respiratory difficulties.
These children may be at increased risk for obesity and glucose intolerance themselves.
Women of Aboriginal, Hispanic, Asian, or African-descent are also in increased risk for GDM.
Dr. Corbett: A screen is not a diagnostic test. It is only a screen and it is just like the set of traffic lights. It makes us do further test and those further tests are much more rigorous test and they will remove those people who just have a transient abnormal result. A vast majority of patients who fail their glucose diabetic screen would in fact have a normal two-hour OGTT which is a two-hour Oral Glucose Tolerance Test.
Male: Screening for GDM may be done between 24 to 28 weeks gestation.
This involves measuring the blood glucose, one hour after ingesting a 50 gram glucose load.
If the one-hour glucose level is greater than or equal to 10.3 mmol/L, GDM is confirmed.
Levels less than or equal to 7.7 mmol/L are considered normal.
Blood glucose levels between 7.8 mmo/L and 10.2 mmol/L are considered indeterminate, and further testing may be required in the form of an Oral Glucose Tolerance Test known as an OGTT.
To perform an Oral Glucose Tolerance Test, fasting glucose levels or FPG are measured. A 75-gram glucose load is then administered. Levels are again collected after one in two hours. Abnormal results include an FPG greater than or equal to 5.3. One hour after administration of oral glucose, the FPG should be less than or equal to 10.6. Two hours after administration of oral glucose, the FPG should be less than or equal to 8.9.
If one of these levels is exceeded, impaired glucose tolerance or IGT of pregnancy is diagnosed. If two levels are exceeded, GDM is diagnosed.
Dr. Corbett: Should she have two abnormal values on this test, she would be referred to our Regional Diabetic Center for all the pregnant mothers with gestational diabetes would go. And that in itself, I would say, is a very good thing because it may help her achieve the optimum result in her pregnancy that she wants.
Male: Women who have been diagnosed with GDM are at an increase risk for developing Type II Diabetes later in life. They should be screened six months after delivery.
Aggressive lifestyle management with nutrition and exercise therapy should be encouraged.
Kendyl: As a new mother, I am here to offer you some words of encouragement in order to help you maintain or start an active lifestyle throughout your pregnancy.
I cannot tell you how important it is and how much easier things will become if you are active during your pregnancy.
And this little guy definitely will keep you active afterwards but during your pregnancy and beforehand, it is easy for your self to make active choices.
For me personally, it did not make sense to do a lot of walking and running and when it was so hard on my back, I ended up having to use a support belt and I had just switched to a stationary—
Dr. Corbett: Follow the diet plan that you have been given. If your doctor suggests you need insulin, do not resist the insulin. We think we get better and help your babies if you need insulin and you take it. Follow your instructions about blood sugar monitoring at home. Bring your record with you when you come to see either your baby doctor or your diabetic doctor.
Your diabetic doctor would work with your obstetric caregiver to ensure that you get the best possible treatment and that decisions that would be made for you will be decisions made to ensure that you and your baby have the healthiest possible outcome and delivery.
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