Studies Show Gestational Diabetes Risk Increases with Every Pregnancy

Newborn

Newborn (Photo credit: Wikipedia)

People often say that each pregnancy is different. What you may experience during your first pregnancy may not be the same as your experiences in your subsequent pregnancies. However, a recent study published in the American Journal of Obstetrics and Gynecology showed that women with gestational diabetes during their first pregnancy have higher risks of developing the same condition in their subsequent pregnancies. In fact, according to this study, the risk increases with each pregnancy.

In the research, 65,132 first-time pregnant women with gestational diabetes were used as the sample population by a group of researchers led by Dr. Darius Getahun. One of the findings was that the risk of these women getting gestational diabetes during their second pregnancy is 13.2% increased. There is also an increase of 6.3% in the third pregnancy of women who initially had gestational diabetes but did not suffer from the condition during their second pregnancies. Those who have experienced gestational diabetes during the first and second pregnancies had a 26% risk for developing the same condition during the third pregnancy. Getahun was quick to point out that having gestational diabetes during the first pregnancy already means that the woman will likely also have the same condition in her second pregnancy.

Aside from the aforementioned risks, women with gestational diabetes are also at risk for developing type 2 diabetes mellitus. That is why it is highly recommended by the American Diabetes Association and the American College of Obstetrics and Gynecology for women with gestational diabetes to undergo counseling when it comes to lifestyle modifications, like diet, exercise, and weight loss or maintenance.

One of the limitations of the study was that the researchers did not look into other lifestyle factors that may have had contributed to a woman’s increased risk on gestational diabetes. They did not consider that the obesity of a woman can actually contribute in increasing the risk of developing gestational diabetes. Instead, the researchers recommend that early identification of pregnant women who are at risk for developing gestational diabetes and timely postpartum care should be exercised so as to prevent gestational diabetes and other adverse pregnancy situations from happening.

The study also showed that a person’s race or ethnicity may play a role in the return of gestational diabetes. According to the survey in the said study, Hispanic and Asian/Pacific islander women had the highest risk of developing gestational diabetes among other races. This can be due to the fact that the food in these races contains a high glycemic index, which means that they easily affect the levels of glucose in the bloodstream, thus causing sudden spikes.

According to Dr. Manju Monga of the University of Texas Health Sciences Center in Houston, the findings in the aforementioned study reflect consistency in the results of more recent studies as of late.

As a recommendation, Dr. Monga further advises women with gestational diabetes to have themselves screened for type 2 diabetes after six months of giving birth. This will give them a head start on modifying their lifestyle to avoid developing type 2 diabetes later on in life.

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What Is An OGTT or a 3 Hour Glucose Tolerance Test?

What Is An OGTT or a 3 Hour Glucose Tolerance Test?

English: Photograph of abdomen of a pregnant woman

English: Photograph of abdomen of a pregnant woman (Photo credit: Wikipedia)

3 Hour Glucose Tolerance Test Is the Gold Standard

OGTT is an oral glucose tolerance test.  For most women, around week 24-28, they do a 1 hour glucose test in the doctor’s office.  Now, if you had gestational diabetes with an earlier pregnancy or your risk factors are high, you might get tested earlier in your pregnancy, and your doctor might go straight to the 3 hour glucose tolerance test.

The doctor is doing a quick check to see if you need to take the 3 hour glucose tolerance test.  So, if you fail the 1 hour test, they send you for an OGTT.  OGTT is the standard to measure and diagnose you with gestational diabetes.  This test also tells your doctor how “bad” your gestational diabetes is.  So, he/she will know if you are going way high or just a little over.  That information may or may not affect their decision about medication and diet.

So, you arrive at the lab for your 3 hour glucose tolerance test.  You will sit in the lab waiting area for a little over 3 hours so bring something to read or write to keep you busy.  It’s a lonely place and the only thing on the TV’s is the news or Jerry Springer.  Not much fun.  Trust me, you will need something in addition to the 3 year old magazines they have in the lobby.

You come in fasting, not having eaten anything after midnight the night before.  You may or may not be able to drink water.  If you can, drink water so that your blood is easier to draw.  The last thing you want is to be dehydrated and not be able to get blood or take forever.  They take your blood sugar level first as a fasting level for the baseline of the 3 hour glucose tolerance test, then you drink a “glucola” which is a concentrated sugary drink.  (I would say it tastes like coke, but it doesn’t.) It’s pretty sugary, and there may or may not be flavor options.  Then in 1 hour increments they take a sample of your blood to measure.  Otherwise, you sit in the waiting area between blood draws for the 3 hour glucose tolerance test.

Then What Happens?

Once it’s over, you leave and your doctor gets the results fairly quickly.  Then you find out if your body has done a good job of removing the sugar from your blood stream or not.  Some women view it initially as a judgement and feel that they have done something wrong.  You should know that it’s just the hormones and your body is not handling the amount of hormones well, but that does not make you a good or a bad person.

Either way, you will be fine and so will your baby.  Gestational diabetes is very treatable with diet, exercise and sometimes medication.  Read about gestational diabetes meal planning in my recently published book on amazon, and find out how to plan your day to make your pregnancy healthier and happier.

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I Have Gestational Diabetes, When Will The Doctor Put Me On Insulin?

You May Be Wondering If You Will Need Insulin

One question that routinely pops up if an expectant mother has gestational diabetes, is at which stage of the pregnancy should insulin become a part of the medication prescribed. Most doctors prefer to treat patients the ‘natural’ way that is by altering the patient’s diet and encouraging a stricter exercise regime which could be beneficial in keeping excess weight off in addition to stabilizing sugar levels in the blood. If you face a similar problem of high blood sugar levels, it is quite possible that your doctor will conduct routine blood tests every few weeks or so, to test the effectiveness of the diet and exercise combination. In most cases, sugar levels can be brought under control and extra insulin shots are not necessary, but if your doctor advises it, just remember that it is these shots which can help to prevent further pregnancy complications.  This usually happens after 1-2 months of trying diet and exercise, but it depends on your doctor’s practice.

What Is Insulin Used For In Gestational Diabetes?

Insulin is an important hormone that is secreted by the pancreas and which enables the conversion of glucose absorbed from food into energy. Sometimes, a pregnant mother may not even be aware that she has untreated gestational diabetes and in such cases, the pancreas works even harder to meet the body’s insulin requirement. However in such circumstances, there is also a chance that existing glucose levels in the mother’s blood can reach the baby through the placenta, which in turn forces the baby’s pancreas to product extra insulin for faster energy conversion. Extra glucose is then stored as fat and in many cases, such babies are later born with health problems including trouble in breathing properly.

What are insulin shots for gestational diabetes?

After conducting a thorough analysis of your blood test and sugar levels, your doctor will suggest the right type of insulin and the dosage to take. Insulin shots can either be rapid acting insulin or long acting insulin and usually U-100 is prescribed unless a patient requires a higher concentrated dose. You’ll find that insulin is packed in small glass bottles sealed with a rubber lid or in pen like cartridges which are stored in pharmacies at cooler temperatures. Insulin can be administered as an injection in the arm or thigh, given through a pump or by a jet indicator which sprays the insulin directly on the skin. Oral insulin medication is usually not advised for pregnant women.

Insulin pen needle

Insulin pen needle (Photo credit: Aki Hänninen)

Self-administration of insulin may take plenty of practice but it is important to follow your doctor’s instructions properly. And it doesn’t hurt to let your doctor know if you have a fear of needles either! Hundreds of women all over the world take insulin shots to prevent the possibility of complications in the baby and also to reduce weight gain in the baby and the mother from continually high blood sugars. But remember- even if you are advised to take insulin shots, it’s still important to take care of yourself by following a healthy diet and getting your daily dose of exercise. Although you may find self-injection uncomfortable and even painful, it will all be worth it in the end when you hold your healthy newborn in your arms!

Let me know if you have been told you will need insulin shots, and how you feel about it!  You will get some training from the nurse and doctors about the best way to administer a shot but you will have to get over the poking yourself issue.  You may already be over that with the 4 times daily blood sugar checks, though, and your insulin needle is very small – many women state it doesn’t hurt much at all.

Speaking of being on a gestational diabetic diet to control your blood sugars in conjunction with exercise and other medications – click here to get our book with meal plans and other great information about gestational diabetes.  The book is on amazon, and it’s a great resource with meal patterns and recipes for you.

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Pregnancy Induced Diabetes: Your Questions Answered

We’ve gathered some of the most common questions asked about pregnancy induced diabetes, and brought them together to provide you with some answers.

Gestational diabetes is defined as diabetes that is diagnosed during pregnancy and was not present prior to pregnancy.  Sometimes people call it pregnancy induced diabetes.  Because you have the condition only while you’re pregnant.  And once you deliver the baby and the placenta, typically you can return to normal eating pattern.  Today I’m going to review some questions and provide answers for the most commonly asked items related to pregnancy induced diabetes.

How Common Is Pregnancy Induced Diabetes?

Nationally, between 1 to 2 women in 10, develop gestational diabetes during their pregnancy.  The guidelines are somewhat stricter for the development of the disease because of the fact that you’re pregnant and they want to take extra caution caring for your baby.  Even though it is fairly common, it’s not clear what women can do to prevent developing pregnancy induced diabetes.

What Are the Causes of Gestational Diabetes?

As you may be aware of, when you’re pregnant your hormones in your body do all kinds of things to your emotions, physical body amongst other things.  Hormones are the root cause of development of pregnancy induced diabetes as well.  As your pregnancy progresses, insulin sensitivity decreases.  Women who are overweight when they get pregnant may already have pre-diabetes and their body can’t manage the changes in insulin sensitivity.  Insulin resistance is also increased because of placental hormones.  Some of these hormones are cortisol, estrogen, and progesterone.  As the baby develops your placenta gets larger and also secretes more hormones.  This further causes insulin sensitivity to decrease.  So as your pregnancy progresses, if your body can’t make enough insulin to adjust to the amount that your body needs, you develop gestational diabetes.  This is also why they tend to test for gestational diabetes during the 24th through 28th week, because by that point it will have developed enough to show in a blood test.

How Does My Doctor Screen and Diagnose Pregnancy Induced Diabetes?

Your obstetrician initially determines your risk level for developing pregnancy induced diabetes and that helps them to determine when to test you.  If the determination is made to give you the initial test, for screening women are typically given 50 g of sugar.  This is called an oral glucose challenge because you drink a sugary sweet liquid.  Blood is drawn at 1 hour, and tested.  Typically, your physician will consider you for further testing if your 1 hour glucose challenge lab result is over 130 mg/dL.  If you fail the one hour glucose challenge test, your doctor will require you to do a 3 hour oral glucose tolerance test [OGTT].  In this testing, women are given 100 g of glucose and their blood is taken every hour for 3 hours.  Your doctor will determine the thresholds and how to diagnose.  Even if your blood sugar seems just a little bit elevated you should consider following a gestational diabetes diet plan to keep from having a larger baby or gaining too much weight.

Even if you have pregnancy induced diabetes, it’s important to realize that it’s easily managed using a meal pattern, exercise, and sometimes medication.  Most women view it as something that they have to tolerate for the duration of the pregnancy knowing that after the placenta is delivered, the condition typically goes away.  Click here now to learn more about our gestational diabetes meal plan and get an e-book that tells you even more about diabetes during pregnancy and how you can manage it.