Conditions InDepth: Gestational Diabetes

Gestational diabetes complicates about 3%-5% of all pregnancies—affecting approximately 200,000 women each year in the United States.

Gestational diabetes is a form of diabetes that begins during pregnancy and usually resolves after the baby is born. According to the American Diabetes Association, women who already have a diagnosis of diabetes , prior to becoming pregnant, would not be classified as having gestational diabetes.

During pregnancy, placental hormones (growth hormone, prolactin, cortisol, placental lactogen, progesterone) are produced that can block the effectiveness of insulin, leading to a relative insulin resistance. Insulin is a hormone that helps the body convert food into energy. Without insulin, glucose from the food you eat cannot enter cells, and glucose builds up in the blood.

In most women, the pancreas increases insulin production enough to offset this resistance. When the pancreas fails to keep pace, gestational diabetes occurs. In addition to causing problems for the mother, the excess sugar in the blood can cross the placenta and cause problems for the baby.

Complications affecting the fetus or infant include: macrosomia or large baby, hypoglycemia, low blood calcium, respiratory distress, high bilirubin(jaundice) and red blood cell count, and high death rates. By definition, large baby means birth weight over 4,000 grams. This occurs in approximately 30% of women with gestational diabetes as compared to 10% in nondiabetic pregnancies. The risk of having a large baby at birth increases if a woman has the following conditions: birth trauma, multiple pregnancies, high blood glucose, high body mass index (BMI), and older age.

Complications for women with gestational diabetes mellitus include: increased chance of cesarean delivery (by twofold), high blood pressure , increased risk of developing the metabolic syndrome or type 2 diabetes later on, and pre-eclampsia .

As stated above, women who have had gestational diabetes are at increased risk of developing type 2 diabetes later in life. In one study, nearly 50% of women with a history of gestational diabetes developed type 2 diabetes or impaired glucose tolerance seven to ten years after their pregnancy.

Children whose mothers had gestational diabetes are at higher risk for certain health problems:

  • As babies, they are at higher risk for respiratory distress syndrome (RDS), a disease that makes it hard for the baby to breathe.
  • As children or adults, they are more likely to be obese or very overweight, which can lead to other health problems.
  • They are at higher risk of having diabetes, or high blood sugar, as they get older.

If you have gestational diabetes, maintaining good control over your blood glucose levels during pregnancy significantly reduces the risk of complications to you and to your baby.

What are the risk factors for gestational diabetes?
What are the symptoms of gestational diabetes?
How is gestational diabetes diagnosed?
What are the treatments for gestational diabetes?
Are there screening tests for gestational diabetes?
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Where can I get more information about gestational diabetes?

References:

American Diabetes Association website. Available at: http://www.diabetes.org/home.jsp .

American Diabetes Association. Gestational diabetes mellitus (position statement). Diabetes Care . 2004;25(suppl):S88-S90.

Buchanan TA, Xiang AH. Gestational diabetes mellitus. J Clin Invest. 115:485-491.

Carpenter MW: Gestational diabetes, pregnancy hypertension and late vascular disease. Diabetes Care. 2007;Suppl2: S246-50.

Hollander MH, Paarlberg KM, Huisjes AJ. Gestational diabetes: a review of the current literature and guidelines. Obstet Gynecol Surv. 2007;62:125-136.

Metzger BE, Buchanan TA, Coustan DR et al: summary and Recommendations of the Fifth International Workshop-Conference on Gestational Diabetes Mellitus. Diabetes Care. 2007;30:S251-S260.

Metzger BE: Long-term Outcomes in Mothers Diabnosed With Gestational diabetes Mellitus and Their Offspring. Clin Obst Gyn. 2007;50:972-79.

National Institute of Child Health & Human Development website. Available at: http://www.nichd.nih.gov/ .

Setji TL, Brown AJ, Feinglos MN. Gestational diabetes mellitus. Clinical Diabetes. 2005; 23: 17-24



Last reviewed June 2008 by David Juan, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.


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