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Gestational Diabetes: Good Control, Team
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About one in 20 women who become pregnant develop gestational diabetes, a condition in which the blood sugar level becomes higher than normal. Today, diabetes is the most common medical complication of pregnancy.
Diabetes puts women into the medical high-risk group, though with close supervision and tight blood-sugar control, the norm is an excellent outcome—a healthy baby and a mother with a normal blood sugar level after delivery.
"With today’s emphasis on early detection through routine blood tests, and immediate follow-up and education to control blood glucose, essentially all diabetes-related problems are preventable," says endocrinologist Richard Weinstein, M.D., director of inpatient and outpatient diabetes services at John Muir Medical Center.
What Is Diabetes?
Diabetes is a disease in which the body does not produce or properly use insulin, a hormone made in the pancreas. Insulin is necessary as a "key" to allow glucose, the sugar that comes from our food, to leave the bloodstream and nourish our cells. Without insulin, the blood sugar level rises, and it finally spills into the urine and is eliminated from the body.
When not controlled, diabetes can lead to serious health problems including heart and kidney disease, blindness, nerve damage and foot and leg problems. Women with pre-existing diabetes, either insulin dependent (Type 1) or non-insulin dependent (Type 2), have a special need to be monitored early and constantly for their blood sugar levels before and during pregnancy.
To control diabetes, blood sugar levels must be kept from becoming too high or too low. To do this, food intake must be balanced with exercise and medication (insulin is the only approved medication during pregnancy).
Who Develops Gestational Diabetes?
Pregnant women who are older than 30, obese, or have a family history of diabetes are more likely to develop the disease. But it can happen to any woman. It usually appears after the 20th week of pregnancy.
Risks to the fetus
The fetus may grow too large if the mother has untreated diabetes. This can result in prematurity, trauma during delivery, and an increased chance of a C-section delivery. The baby may also develop an oversupply of insulin, resulting in a low blood sugar reaction at birth.
Risks to the mother
More than 90 percent of women with gestational diabetes regain normal blood sugar levels after delivery. But diabetes is more likely to reoccur in later pregnancies and may return later in life, especially in women who are overweight.
Better Management, Better Outcome
"Today, we’re more aggressive at taking control of glucose, as our guidelines have changed to optimize outcomes," says Roy Kaplan, M.D., an endocrinologist and medical director of the John Muir Diabetes Center - Concord. "The key factors are better glucose control through diet, exercise, and medication," he adds. "If we can’t achieve good control with diet and upper arm exercise, we rapidly go to insulin therapy."
One reason for good outcomes in recent years is the team approach to treatment of women with gestational diabetes. "The best way to deliver care is with this approach," says Dr. Kaplan. The ultimate measure of success, he adds, is: "In our multi-disciplinary program, the incidence of having larger babies is now at the same level as in non-diabetic pregnancies."
Other health professionals, in addition to physicians, specialize in diabetes management during pregnancy. Patients may see certified diabetes educators (CDEs), including RNs, registered dietitians, and counselors, as well as a physical therapist. Intensive education and management are the goals.
For Suzanne Glynn of Antioch, getting into a diabetes management program "was a lifesaver. I felt 100 percent better once I started on the program. I wasn’t so exhausted, or hungry all the time." Glynn learned to check her blood sugar four times a day and to read food labels carefully, monitoring the amount of carbohydrates she took in (carbohydrates convert quickly to sugar). "Some foods are surprising, like yogurt," she says. "They can be low in fat, but very high in carbohydrates."
Today, Glynn and her three-month-old son are healthy. "You do whatever you have to for your baby," she says. "And making the changes wasn’t hard. They had complete follow-through on everything through the program."
"With today’s support, no patient should have anything but an excellent outcome," says Dr. Weinstein.
Healthy Happenings
John Muir Medical Center, Concord Campus and John Muir Medical Center, Walnut Creek Campus offer team-based programs for women who have diabetes prior to becoming pregnant as well as those who develop gestational diabetes. Physician referral is required.
Sweet Success Program
John Muir Diabetes Center - Concord
(925) 674-2077
Diabetes and Pregnancy Program
John Muir Diabetes Center
(925) 930-0244
Both facilities are recognized by the American Diabetes Association for providing quality patient education. For a free brochure on these centers or a resource directory that includes information on programs, classes and services, call (925) 947-5384.