2 Things You Must Know About GESTATIONAL DIABETES

Diabetes is actually quite common in pregnancy, so what we do at the beginning of every pregnancy in my practice is we check a diabetes screen to see what have your sugar's been running over the course of the last six weeks or so.

Must Know About GESTATIONAL DIABETES

Most people will have normal what we call hemoglobin A1C at that point. As the pregnancy progresses, the placenta makes more and more of a hormone that counteracts insulin, and so if you have a predisposition to diabetes that hormone that the placenta is making will push you into it. So basically later in the pregnancy, at about 24 to 28 weeks typically people will say 26 weeks, we'll do another diabetes screen generally that's either the one hour glucose tolerance test or a two-hour glucose tolerance test, depending on what your practice prefers.

1. If you fail that two-hour glucose tolerance test, it basically means that your body's not processing carbohydrates as well as it could, and what that means is that you have sugar in your blood that is elevated over the course of the day. Think about that. So, if your sugar is the same as the baby's sugar because the sugars just passing through, the baby's pancreas makes more insulin and keeps using that sugar up and gets fatter and fatter and fatter and fatter. And so, what we're trying to do when we're controlling gestational diabetes is we're trying to maintain normal growth for that baby. We don't want to end up with a baby that's too big for the mother's pelvis.

2. If we have a baby that's too big for the mother's pelvis, we're much more likely to have a C-section, or much more likely to have a vaginal delivery that ends in fetal injury or a maternal injury. Additionally if diabetes is very very out of control, it can be associated with still birth. After a baby's born if the sugars have been very high especially in the most recent two weeks before the baby's born, the baby's pancreas is still making a lot of insulin but isn't getting that glucose infusion anymore from the mother.

That way when the baby's born the sugars can plummet, and so sometimes those babies need to be in intensive care to get sugar drips over the next couple of days, and we prefer of course with the baby not have to go to intensive care and that the baby is a take-home baby. Other times when diabetes isn't well controlled, you can get delayed maturation of the fetal lungs and so again you might have a full-term baby that ends up in the neonatal intensive care unit for premature lung disease.