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Diabetes is a condition in which the body can't make enough insulin, or can't use insulin normally. Insulin is a hormone. It helps sugar (glucose) in the blood get into cells of the body to be used as fuel. When glucose can’t enter the cells, it builds up in the blood. This is called high blood sugar (hyperglycemia).
High blood sugar can cause problems all over the body. It can damage blood vessels and nerves. It can harm the eyes, kidneys, and heart. In early pregnancy, high blood sugar can lead to birth defects in a growing baby.
There are 3 types of diabetes:
Some women have diabetes before they get pregnant. This is called pregestational diabetes. Other women may get a type of diabetes that only happens in pregnancy. This is called gestational diabetes. Pregnancy can change how a woman's body uses glucose. This can make diabetes worse, or lead to gestational diabetes.
During pregnancy, an organ called the placenta gives a growing baby with nutrients and oxygen. The placenta also makes hormones. In late pregnancy, the hormones estrogen, cortisol, and human placental lactogen can block insulin. When insulin is blocked, it’s called insulin resistance. Glucose can't go into the body’s cells. The glucose stays in the blood and makes the blood sugar levels go up.
The risk factors for diabetes in pregnancy depend on the type of diabetes:
There are no common symptoms of diabetes. Most women don't know they have it until they get tested.
Nearly all nondiabetic pregnant women are screened for gestational diabetes between 24 and 28 weeks of pregnancy. A glucose screening test is given during this time. For the test, you drink a glucose drink and have your blood glucose levels tested after 2 hours.
If this test shows a high blood glucose level, a 3-hour glucose tolerance test will be done. If results of the second test are not normal, gestational diabetes is diagnosed.
Treatment will depend on your symptoms, your age, and your general health. It will also depend on how severe the condition is.
Treatment focuses on keeping blood glucose levels in the normal range, and may include:
Most complications happen in women who already have diabetes before they get pregnant. Possible complications include:
Women with gestational diabetes are more likely to develop type 2 diabetes in later life. They are also more likely to have gestational diabetes with another pregnancy. If you have gestational diabetes you should get tested a few months after your baby is born and every 3 years after that.
Possible complications for the baby include:
Not all types of diabetes can be prevented. Type 1 diabetes usually starts when a person is young. Type 2 diabetes may be avoided by losing weight. Healthy food choices and exercise can also help prevent type 2 diabetes.
Special testing and monitoring of the baby may be needed for pregnant diabetics, especially those who are taking insulin. This is because of the increased risk for stillbirth. These tests may include:
A baby of a diabetic mother may be delivered vaginally or by cesarean section. It will depend on your health, and how much your pregnancy care provider thinks the baby weighs. Your pregnancy care provider may advise an amniocentesis in the last weeks of pregnancy. This test takes out some of the fluid from the bag of waters. Testing the fluid can tell if the baby's lungs are mature. The lungs mature more slowly in babies whose mothers have diabetes. If the lungs are mature, the healthcare provider may advise induced labor or a cesarean delivery.
Tips to help you get the most from a visit to your healthcare provider:
Bayhealth is Southern Delaware’s healthcare leader with hospitals in Dover and in Milford. Bayhealth provides a wide range of medical services, including cardiovascular, cancer, orthopaedics and rehabilitation, pediatrics, respiratory care, sleep care, surgical weight loss and women’s services.