Gestational diabetes is a type of diabetes that occurs only

during pregnancy. Like other forms of diabetes, gestational diabetes

affects the way your body uses sugar (glucose) — your body's main
source of fuel. Gestational diabetes can cause high blood sugar levels
that are unlikely to cause problems for you, but can threaten the health
of your unborn baby. Any pregnancy complication is concerning, but
there's good news. You can manage gestational diabetes by eating
healthy foods, exercising regularly and, if necessary, taking
medication. Taking good care of yourself can help ensure a healthy
pregnancy for you and a healthy start for your baby.

Fortunately, gestational diabetes is usually short-lived. Blood

sugar levels typically return to normal soon after delivery.

Risk factors

Any woman can develop gestational diabetes, but some women are at
greater risk. Risk factors for gestational diabetes include:

• Being older than age 25. Women older than age 25 are more
likely to develop gestational diabetes.
• Family or personal health history. Your risk of developing
gestational diabetes increases if you have prediabetes — a
precursor to type 2 diabetes — or if a close family member, such
as a parent or sibling, has type 2 diabetes. You're also more likely
to develop gestational diabetes if you had it during a previous
pregnancy, if you delivered a baby who weighed more than 9
pounds, or if you had an unexplained stillbirth.
• Being overweight. You're more likely to develop gestational
diabetes if you're significantly overweight with a body mass
index (BMI) of 30 or higher.
 • Race. For reasons that aren't clear, women who are black,
Hispanic, American Indian or Asian are more likely to develop
gestational diabetes.

Causes

Researchers don't yet know exactly why some women develop

gestational diabetes. To understand how gestational diabetes occurs, it
can help to understand how glucose is normally processed in the body.

Insulin is a substance produced by your pancreas. After you eat, sugar

molecules from food — called glucose — flow into your bloodstream.
Insulin helps glucose move from your bloodstream into cells in your
body where it can be used as energy. During pregnancy, the placenta
that surrounds your growing baby produces high levels of a variety of
hormones. Almost all of them impair the action of insulin in the tissues,
thereby raising blood sugar. Modest elevation of blood sugar after
meals is normal during pregnancy. As your baby grows, the placenta
produces more and more insulin-interfering hormones. In gestational
diabetes, the placental hormones provoke a rise in blood sugar to a
level that can affect the growth and development of your baby.
Gestational diabetes usually develops during the last half of pregnancy
— rarely as early as the 20th week, but often not until later in the
pregnancy.

Symptoms
For most women, gestational diabetes doesn't cause noticeable
signs or symptoms. Rarely, gestational diabetes may cause excessive
thirst or increased urination .If possible, seek health care early — when
you first think about trying to get pregnant — so your doctor can
evaluate your risk of gestational diabetes. Once you become pregnant,
your doctor will address gestational diabetes as part of your regular
prenatal care. If you develop gestational diabetes, you may need more
frequent checkups. These are most likely to occur during the last three
months of pregnancy, when your doctor will carefully monitor your
blood sugar level. In addition, your doctor may refer you to other
health professionals who specialize in diabetes management, such as
an endocrinologist, a registered dietitian or a diabetes educator. They
can help you learn to manage your blood sugar level during your
pregnancy. To make sure that your blood sugar level has returned to
normal after your baby is born, your blood sugar will be checked often
right after delivery and again in six weeks. Once you've had
gestational diabetes, it's a good idea to have your blood sugar level
tested regularly. The frequency of blood sugar level tests will in part
depend on your test results soon after you deliver your baby.

Complications

Most women who have gestational diabetes deliver healthy babies.

However, gestational diabetes that's not carefully managed can lead to
uncontrolled blood sugar levels and cause problems for you and your
baby. If you have gestational diabetes, your baby may be at increased
risk of:

• Excess growth. Extra glucose will cross the placenta, which

triggers your baby's pancreas to make extra insulin. This can
cause your baby to grow too large (macrosomia). Very large
babies are more likely to become wedged in the birth canal,
sustain birth injuries or require a C-section birth.
• Low blood sugar (hypoglycemia). Sometimes babies of
mothers with gestational diabetes develop low blood sugar
(hypoglycemia) shortly after birth because their own insulin
production is high. Severe episodes of this problem may provoke
 seizures in the baby. Prompt feedings and sometimes an
intravenous glucose solution can return the baby's blood sugar
level to normal.
• Respiratory distress syndrome. If your baby is delivered
early, respiratory distress syndrome — a condition that makes
breathing difficult — is possible. Babies born to women with
gestational diabetes have more breathing problems than do
those born to women without the problem, even at the same
gestational age. Babies who have respiratory distress syndrome
might need help breathing until their lungs become stronger.
• Jaundice. This yellowish discoloration of the skin and the whites
of the eyes may occur if a baby's liver isn't mature enough to
break down a substance called bilirubin, which normally forms
when the body recycles old or damaged red blood cells. Although
jaundice usually isn't a cause for concern, careful monitoring is
important.
• Type 2 diabetes later in life. Babies of mothers who have
gestational diabetes have a higher risk of developing obesity and
type 2 diabetes later in life.
• Developmental problems. If you have gestational diabetes,
your child may have an increased risk of problems with motor
skill development, such as walking, jumping, or other activities
that require balance and coordination. An increased risk of
attention problems or hyperactivity disorders also is a concern.

Rarely, untreated gestational diabetes results in a baby's death either

before or shortly after birth. Gestational diabetes may also increase
your personal risk of:

• Preeclampsia. Gestational diabetes increases the risk of

preeclampsia, a condition characterized by high blood pressure
 and excess protein in the urine after the 20th week of pregnancy.
Left untreated, preeclampsia can lead to serious or even life-
threatening complications for both mother and baby.
• Urinary tract infections. Women with gestational diabetes
experience twice the number of urinary tract infections during
pregnancy than other pregnant women experience. This is likely
due to excess glucose in the urine.
• Future diabetes. If you have gestational diabetes, you're more
likely to have it again with a future pregnancy. You're also more
likely to develop diabetes — typically type 2 diabetes — as you
get older. However, making healthy lifestyle choices such as
eating healthy foods and exercising can help reduce the risk of
future type 2 diabetes. Of those women with a history of
gestational diabetes who reach their ideal body weight after
delivery, fewer than 25 percent develop type 2 diabetes.

Tests and diagnosis

Your doctor will likely evaluate your risk factors for gestational
diabetes early on in your pregnancy. Most women will have a screening
test for gestational diabetes sometime during the second trimester of
pregnancy. Screening for gestational diabetes is recommended for
most women. Medical experts haven't established a single set of
screening guidelines. Some question whether gestational diabetes
screening is needed if you're younger than 25 and have no risk factors.
Others say that screening all pregnant women — no matter their age
— is the best way to catch all cases of gestational diabetes. our doctor
will recommend a screening schedule based on your specific risk
factors. For most women with average risk of gestational diabetes, a
blood test known as a glucose challenge test is recommended between
weeks 24 and 28 of pregnancy. If you're at a high risk of gestational
diabetes, your doctor may test you earlier.

• Initial glucose challenge test. You'll begin the glucose

challenge test by drinking a syrupy glucose solution. One hour
later, you'll have a blood test to measure your blood sugar level.
A blood sugar level below 130 to 140 milligrams per deciliter
(mg/dL), or 7.2 to 7.8 millimoles per liter (mmol/L), is usually
considered normal on a glucose challenge test, although this
may vary at specific clinics or labs. If your blood sugar level is
higher than normal, it only means you have a higher risk of
gestational diabetes. Your doctor will diagnose you after giving
you a follow-up test.
• Follow-up glucose challenge tests. For the follow-up tests,
you'll be asked to fast overnight and then have your fasting
blood sugar level measured. Then you'll drink another sweet
solution — this one containing a higher concentration of glucose
— and your blood sugar level will be checked every hour for a
period of three hours. If at least two of the blood sugar readings
are higher than normal, you'll be diagnosed with gestational
diabetes.

If you're diagnosed with gestational diabetes, your doctor

will likely recommend frequent checkups, especially during the
last three months of pregnancy. During these exams, your doctor
will carefully monitor your blood sugar level. Your doctor may
also ask you to monitor your own blood sugar daily, as part of
your treatment plan.

If you're having trouble controlling your blood sugar level, you need
insulin, or you have other pregnancy complications, you may need
additional tests to assess your baby's general health. These tests are
designed to assess the function of the placenta. This is because if your
gestational diabetes is difficult to control, it may affect the placenta
and endanger the exchange of oxygen and nutrients to the baby. One
abnormal test result doesn't necessarily indicate a problem. Your
doctor may do additional tests to more accurately assess how your
baby is doing.

• Nonstress test. Sensors placed on your stomach are connected

to a monitor. This test evaluates increases in fetal heart rate that
are expected with fetal movement. If they're absent, the fetus
may not be receiving enough oxygen.
• Biophysical profile (BPP). This test combines a nonstress test
with a fetal ultrasound. Your doctor assesses your baby's
movements, breathing and whether a normal amount of amniotic
fluid is present. The components assessing fetal activity indicate
the baby's oxygen status at the time the test is done. Decreased
fluid means your baby hasn't been urinating enough and could
indicate that over time the placenta has not been working as well
as it should.
• Fetal movement counting. You may perform this simple test at
the same time as the nonstress test or the biophysical profile.
You simply count the number of times your baby kicks within a
certain time frame. Less movement may mean your baby isn't
getting enough oxygen.

Blood sugar testing after you give birth. To make sure that your
blood sugar level has returned to normal after your baby is born, your
doctor will check your blood sugar levels after delivery and again in six
weeks. If your test results are normal, it's a good idea to have your
diabetes risk assessed at least every three years. If your blood sugar
levels indicate diabetes or prediabetes — a condition in which your
blood sugar level is higher than normal, but not high enough to be
classified as diabetes — talk with your doctor about starting a diabetes
treatment plan.

Treatments and drugs

Controlling your blood sugar level is essential to keeping your baby

healthy and avoiding complications during delivery. Your treatment
plan may include:

• Blood sugar monitoring. Your health care provider may ask

you to check your blood sugar level four to five times a day —
first thing in the morning and after meals — to make sure you're
keeping your blood sugar within a healthy range. This may sound
inconvenient and difficult, but it'll get easier with practice. To test
your blood sugar, you draw a drop of blood from your finger
using a small needle (lancet), then place the blood on a test strip
inserted into a blood glucose meter — a device that measures
and displays your blood sugar level.

Your health care provider will also monitor your blood sugar level
during labor. If your blood sugar rises, your baby may release
high levels of insulin — which can lead to low blood sugar right
after birth.

• Diet. Eating the right kind and amount of food is one of the best
ways to control your blood sugar level. Making healthy food
choices also helps prevent excessive weight gain during
pregnancy, which can put you at higher risk of complications.

A healthy diet often means including more fruits, vegetables and

whole grains — foods that are high in nutrition and low in fat and
calories — into your diet and limiting carbohydrates including
sweets. Even so, no single diet is right for every woman. You
 might want to consult a registered dietitian or a diabetes
educator to create a meal plan based on your blood sugar level,
height, weight, exercise habits and food preferences.

• Exercise. Exercise lowers your blood sugar level by transporting

sugar to your cells, where it's used for energy. Exercise also
increases your sensitivity to insulin, which means your body
needs less insulin to transport sugar to your cells. And there's
more. Regular exercise can help prevent some of the discomforts
of pregnancy, such as back pain, muscle cramps, swelling,
constipation and difficulty sleeping. It can also help prepare you
for labor and delivery. With your doctor's OK, aim for moderate
aerobic exercise on most days of the week. If you haven't been
active for a while, start slowly and build up gradually. Walking,
cycling and swimming are often good choices during pregnancy.
Ordinary activities such as housework and gardening also count.

• Medication. If diet and exercise aren't enough, you may need

insulin injections to lower your blood sugar level. About 15
percent of women who have gestational diabetes need insulin
therapy to reach a consistently safe blood glucose level. For
some women, an oral medication, such as glyburide, also is an
option.

Prevention

There are no guarantees when it comes to preventing gestational

diabetes — but the more healthy habits you can adopt before
pregnancy, the better.

• Eat healthy foods. Choose foods low in fat and calories. Focus
on fruits, vegetables and whole grains. Strive for variety to help
 you achieve your goals without compromising taste or nutrition.
• Get more physical activity. Exercising before and during
pregnancy has shown to help protect against developing
gestational diabetes. Aim for 30 minutes of moderate physical
activity a day. Take a brisk daily walk. Ride your bike. Swim laps.
If you can't fit in a long workout, break it up into smaller sessions
spread throughout the day.
• Lose excess pounds. Weight loss during pregnancy isn't
usually recommended. But if you're planning ahead, losing
weight may help you have a healthier pregnancy. Focus on
permanent changes to your eating and exercise habits. Motivate
yourself by remembering the benefits of losing weight, such as a
healthier heart, more energy and improved .

Sources:

http://www.mayoclinic.com/health/gestational-diabetes/DS00316/DSECTION=treatments-and-drugs

http://diabetes.niddk.nih.gov/dm/pubs/gestational/

http://www.mayoclinic.com/health/gestational-diabetes/DS00316/DSECTION=prevention