Dr. Christopher Kraft shared his insight Gestational Diabetes.
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Gestational Diabetes
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Learn more about Christopher Kraft, MD
Christopher Kraft, MD
Dr. Christopher Kraft attended Ross University, where he received his medical degree. Dr. Kraft is a diligent OB-GYN specialist serving the community of Clearwater, Florida. He practices at BayCare Medical Group. Dr. Kraft is affiliated with the Morton Plant Hospital. Dr. Kraft’s clinical interests include high-risk obstetrics, general gynecology, pelvic floor disorders, and incontinence. He is certified in da Vinci robotic-assisted surgery, as well as basic life support, advanced cardiac life support, pediatric advanced life support, and is a member of the American College of Obstetrics and Gynecology. Dr. Kraft’s goal during consultations and treatment include compassion, efficacy, and teamwork. He focuses on giving patients the highest quality of care while providing them sound advice so that they can also be an active participant in their own well-being. Please provide all insurance details at the time of booking in order to have a successful appointment.Learn more about Christopher Kraft, MD
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Gestational Diabetes
Melanie Cole, MS (Host): Welcome to BayCare HealthChat. I'm Melanie Cole, and I invite you to listen in as we discuss gestational diabetes. Joining me is Dr. Christopher Kraft. He’s an obstetrician gynecologist with BayCare. Dr. Kraft, it’s a pleasure to have you join us again today. Tell us a little bit about gestational diabetes. What is it and how common is it?
Christopher Kraft, MD (Guest): Sure. So gestational diabetes, Melanie, it’s a common complication of pregnancy. Approximately 10 to 20% of all pregnancies can be impacted with gestational diabetes, and we’re actually seeing a number of fluctuations in those prevalent factors across the country depending upon where you may live. Unfortunately, sometimes the American diet can influence whether or not a patient can be impacted with gestational diabetes itself. In its simplest definition, it is an abnormality of carbohydrate metabolism that occurs during pregnancy.
Host: Dr. Kraft, are we only concerned about diabetes during pregnancy or pregestational diabetes as well? Which is more common and why do women need to understand insulin and blood sugar?
Dr. Kraft: So pregestational diabetes is different in and of itself from gestational diabetes. Pregestational diabetes is a diagnosis where a patient usually is a type 1 or type 2 diabetic prior to conception. Gestational diabetes is when diabetes is diagnosed within pregnancy itself. So let’s start with gestational diabetes. All pregnant women will be screened for gestational diabetes as long as they receive adequate prenatal care. Usually that screening is done between 24 and 28 weeks of gestation. The way that it is done is that patients are given a glucose load, typically 50 grams. Their blood sugar is then drawn within one hour, and then we look to see if they are metabolizing glucose appropriately. If they are not metabolizing glucose appropriately, then we challenge them with what's called a three hour oral glucose tolerance test. That test, again, is another glucose load or a sugar load. Basically like a Gatorade drink that the patient would drink, and then we test their blood sugar at the fasting level before they actually drink anything and then one hour following consumption of the drink, two hours, and three hours. So a total of four values is abstracted. So if two of those four hours are considered to be abnormal, then that patient has an abnormality of carbohydrate metabolism, and we diagnose that patient with what’s called gestational diabetes.
The role of insulin in terms of gestational diabetes is quite simple. Insulin is a hormone that’s secreted by the pancreas. All of us secrete insulin in a proper fashion. Some women during pregnancy can have an abnormality that does not make their cells receptive to insulin. Insulin is a hormone, and it’s kind of like a lock and key method. So insulin unlocks the cell door to allow glucose to be uptaken by the cell themselves and use glucose as an energy source. In pregnancy in particular, there is a hormone that is secreted by the placenta, which is called human placental lactogen, which makes women resistant to insulin which makes them resistant to take up glucose in an adequate fashion. It then has a downstream effect and goes directly to the baby. The baby will utilize this hormone as a way of growing appropriately. If you look at the growth of a fetus over the course of pregnancy, the highest interval of growth occurs in a fetus from 28 weeks to the point of delivery which is 40 weeks approximately.
So pregestational diabetes is a little bit different and it has its own host of complications. Normally these patients will be considered with pregestational diabetes to be of significant high risk. They can also have significant abnormalities embryologically with the fetus themselves with cardiac defects or limb defects as well. So these patients already have a carbohydrate metabolism abnormality already coming into pregnancy versus women who are diagnosed with gestational diabetes. It’s usually an abnormality related to the pregnancy itself.
Host: Well, thank you for describing insulin resistance so well because it does help explain it. Now, is there a genetic component to this? Who’s at risk? Also tell us—you said that women are screened for this. Would there be symptoms? Would they know? Is it something that they would recognize?
Dr. Kraft: Some women can. Other women, they are completely surprised when thy find out that they’ve been diagnosed with gestational diabetes. So one of the greatest screening techniques that we can use for early screening of diabetes or gestational diabetes is current lifestyles. So women who have a BMI greater than 30 are at an increased risk of getting gestational diabetes versus somebody who is not. Other risk factors that are associated with it as well is a family history of gestational diabetes and a lifestyle that has inactivity involved. So certain women that we would screen early on in pregnancy to rule out pregestational diabetes or gestational diabetes are women who in fact tell us “I have a significant family history of type 2 diabetes”, if they have a BMI that’s greater than 30, or if they have a lifestyle that does not incorporate cardiovascular activity on a daily basis.
Host: Is this considered a high risk pregnancy once you determine that someone has gestational diabetes? Tell us a little bit about what's the first line of defense. If it’s considered high risk, does a woman change her provider and go to a high risk group? What happens?
Dr. Kraft: So if we’re talking just about gestational diabetes, typically what we recommend is diet and nutrition counselling. Most of these women since they have an abnormality with carbohydrate metabolism, we can send them to nutrition counselling. From there we can make some modest modifications to their diet where we can actually have gestational diabetes which we call diet controlled gestational diabetes. When you have diet controlled gestational diabetes, although it is considered to be a high risk we still manage these patients appropriately within your general OBGYN practice. What we typically recommend is that women monitor their blood sugar levels on a daily basis four times per day. One would consist of a fasting blood sugar level followed by a blood sugar level after they eat their meal which they would consider to be their breakfast, lunch, or dinner. If 50% of all blood sugar levels are fairly well controlled, then we consider that patient to be diet controlled gestational diabetes. Where it gets complicated is that once these patients are not diet controlled, then we have to introduce medical therapy to control their blood sugar levels.
Host: If a patient does get their blood glucose levels under control and listen to their doctor as say, can they still expect to deliver a healthy baby?
Dr. Kraft: They can.
Host: Then what is the treatment if they do not get their blood sugar levels under control. Would it be similar to someone who has diabetes before they get pregnant? How does that work?
Dr. Kraft: So there are three main medical modalities to control blood sugars in pregnancy. The most common used form would be insulin. The reason why insulin is recommended by ACOG and the American Diabetes Association is because it does not cross the placenta. The problem is that when you introduce insulin therapy to some patients, compliance goes down. What I mean by that is that you're asking patients to stick themselves multiple times per day to check their blood sugar, and then you're also asking them to administer an injection of insulin usually multiple times throughout the course of the day to control their blood sugar. A lot of patients don’t want to do that. So they may skip doses, which then puts them at increased risk. I’ll get into the risks in another second or so. If we have patients that are non-compliant, then typically we would try medical therapy where they can take medications by mouth. The two most common used medications in gestational diabetes is Metformin and also Glyburide. The problem with two of those medications is that we don’t know the long term effects on the fetus because we do know that both of those medications do cross the placenta.
Host: So then let’s talk about lifestyle and behaviors and things because, as you’ve mentioned diet controlled blood glucose levels. Where does exercise fit into the picture because sometimes for women that are pregnant, exercise can be a bit of a limiting factor. Maybe they weren’t an exerciser before they got pregnant, maybe they're off balance, or any of these kinds of things can come up in pregnancy doctor. So what do you tell them about getting regular physical activity?
Dr. Kraft: So that’s a really good question. What I tell all of my patients at the initial presentation of the confirmation of pregnancy is to—Since all pregnant women are at risk of getting gestational diabetes, what I tell them is to incorporate a 30 minute cardiovascular exercise which occurs five out of seven days per week. Even women who live a sedentary lifestyle, I inform them of 30 minutes of dedicated walking a day can have a profound impact on how they metabolize their blood sugars.
Host: Well it certainly can. So how can gestational diabetes impact a mother’s health in the future? Dr. Kraft, what are some complications if she’s left untreated or she delivers a healthy baby? Is she at risk for having it the next baby?
Dr. Kraft: So let’s look at two different aspects. Let’s look at the immediate or short term care. So poorly controlled blood sugars in pregnancy. If you talk to any obstetrician who has taken care of women who have diabetes, the greatest risk or concern that a physician may have is what’s called intrauterine fetal demise. Sometimes these babies can get enlarged hearts, exposes them to an arrhythmia, and then sudden cardiac death in utero. Now, that’s the worst of all complications. In addition to that, they can have other complications associated with pregnancy. One of them, which would be preeclampsia which is a hypertensive disorder of pregnancy, preterm delivery, and also macrosomia or large for gestational age or a large baby. Then you can also have complications at the form of delivery which could result in what's called a shoulder dystocia. So gestational diabetics are at risk of delivering larger babies. Some of these babies have fat deposits that are located around the shoulders which can cause the babies to potentially get stuck in the birth canal increasing risk of neurological compromise or potentially death at the point of birth.
Host: Wow. This is a pretty serious condition. I'm not sure many women all realize this. As we wrap up. Dr. Kraft, you're so informative. What a great guest you are. Please give us your best advice about lifestyle and management, possible prevention, what you’d like women to know about hopefully preventing gestational diabetes in the first place. Things they can do before they get pregnant, when they're planning to get pregnant, and then after they are pregnant what you’d like them to know.
Dr. Kraft: So, I tell the majority of women—Hopefully, women are going to the gynecologist on an annual basis. They're doing pregenetic screening with their physician. I tell all women who’ve established care with me, and we have developed a relationship, one of the easiest things that they can do—even if they know nothing about dietary modification—is to stick to some really easy basics. One would be when a woman is going grocery shopping, stick to the perimeter of the store. If you stick to the perimeter of the store, you're likely to eat a plant based diet that introduces proteins. When you go into the aisles, that’s where you're getting more of processed food and carbohydrates. In addition to that, I tell women something as simple as going for a walk that’s dedicated to cardiovascular exercise on a daily basis will increase your ability to metabolize carbohydrates much easier than as if you stick to a sedentary lifestyle. When patients come into my office, I try to make it as simple as possible and very easy to follow. I tell my patients if you're walking into the aisles of the grocery store, walk out and stick to the perimeter.
Host: That’s really great advice. As an exercise physiologist, I would give the same advice because activity and shopping the perimeter is really such a healthy way, especially to begin a pregnancy and onward. Thank you so much Dr. Kraft, for such great information today. To learn more about BayCare’s maternity services, please visit our website at baycarematernity.org for more information and to get connected with one of our providers. That concludes this episode of BayCare HealthChat. Please remember to subscribe, rate, and review this podcast and all the other BayCare podcasts. I'm Melanie Cole.
Gestational Diabetes
Melanie Cole, MS (Host): Welcome to BayCare HealthChat. I'm Melanie Cole, and I invite you to listen in as we discuss gestational diabetes. Joining me is Dr. Christopher Kraft. He’s an obstetrician gynecologist with BayCare. Dr. Kraft, it’s a pleasure to have you join us again today. Tell us a little bit about gestational diabetes. What is it and how common is it?
Christopher Kraft, MD (Guest): Sure. So gestational diabetes, Melanie, it’s a common complication of pregnancy. Approximately 10 to 20% of all pregnancies can be impacted with gestational diabetes, and we’re actually seeing a number of fluctuations in those prevalent factors across the country depending upon where you may live. Unfortunately, sometimes the American diet can influence whether or not a patient can be impacted with gestational diabetes itself. In its simplest definition, it is an abnormality of carbohydrate metabolism that occurs during pregnancy.
Host: Dr. Kraft, are we only concerned about diabetes during pregnancy or pregestational diabetes as well? Which is more common and why do women need to understand insulin and blood sugar?
Dr. Kraft: So pregestational diabetes is different in and of itself from gestational diabetes. Pregestational diabetes is a diagnosis where a patient usually is a type 1 or type 2 diabetic prior to conception. Gestational diabetes is when diabetes is diagnosed within pregnancy itself. So let’s start with gestational diabetes. All pregnant women will be screened for gestational diabetes as long as they receive adequate prenatal care. Usually that screening is done between 24 and 28 weeks of gestation. The way that it is done is that patients are given a glucose load, typically 50 grams. Their blood sugar is then drawn within one hour, and then we look to see if they are metabolizing glucose appropriately. If they are not metabolizing glucose appropriately, then we challenge them with what's called a three hour oral glucose tolerance test. That test, again, is another glucose load or a sugar load. Basically like a Gatorade drink that the patient would drink, and then we test their blood sugar at the fasting level before they actually drink anything and then one hour following consumption of the drink, two hours, and three hours. So a total of four values is abstracted. So if two of those four hours are considered to be abnormal, then that patient has an abnormality of carbohydrate metabolism, and we diagnose that patient with what’s called gestational diabetes.
The role of insulin in terms of gestational diabetes is quite simple. Insulin is a hormone that’s secreted by the pancreas. All of us secrete insulin in a proper fashion. Some women during pregnancy can have an abnormality that does not make their cells receptive to insulin. Insulin is a hormone, and it’s kind of like a lock and key method. So insulin unlocks the cell door to allow glucose to be uptaken by the cell themselves and use glucose as an energy source. In pregnancy in particular, there is a hormone that is secreted by the placenta, which is called human placental lactogen, which makes women resistant to insulin which makes them resistant to take up glucose in an adequate fashion. It then has a downstream effect and goes directly to the baby. The baby will utilize this hormone as a way of growing appropriately. If you look at the growth of a fetus over the course of pregnancy, the highest interval of growth occurs in a fetus from 28 weeks to the point of delivery which is 40 weeks approximately.
So pregestational diabetes is a little bit different and it has its own host of complications. Normally these patients will be considered with pregestational diabetes to be of significant high risk. They can also have significant abnormalities embryologically with the fetus themselves with cardiac defects or limb defects as well. So these patients already have a carbohydrate metabolism abnormality already coming into pregnancy versus women who are diagnosed with gestational diabetes. It’s usually an abnormality related to the pregnancy itself.
Host: Well, thank you for describing insulin resistance so well because it does help explain it. Now, is there a genetic component to this? Who’s at risk? Also tell us—you said that women are screened for this. Would there be symptoms? Would they know? Is it something that they would recognize?
Dr. Kraft: Some women can. Other women, they are completely surprised when thy find out that they’ve been diagnosed with gestational diabetes. So one of the greatest screening techniques that we can use for early screening of diabetes or gestational diabetes is current lifestyles. So women who have a BMI greater than 30 are at an increased risk of getting gestational diabetes versus somebody who is not. Other risk factors that are associated with it as well is a family history of gestational diabetes and a lifestyle that has inactivity involved. So certain women that we would screen early on in pregnancy to rule out pregestational diabetes or gestational diabetes are women who in fact tell us “I have a significant family history of type 2 diabetes”, if they have a BMI that’s greater than 30, or if they have a lifestyle that does not incorporate cardiovascular activity on a daily basis.
Host: Is this considered a high risk pregnancy once you determine that someone has gestational diabetes? Tell us a little bit about what's the first line of defense. If it’s considered high risk, does a woman change her provider and go to a high risk group? What happens?
Dr. Kraft: So if we’re talking just about gestational diabetes, typically what we recommend is diet and nutrition counselling. Most of these women since they have an abnormality with carbohydrate metabolism, we can send them to nutrition counselling. From there we can make some modest modifications to their diet where we can actually have gestational diabetes which we call diet controlled gestational diabetes. When you have diet controlled gestational diabetes, although it is considered to be a high risk we still manage these patients appropriately within your general OBGYN practice. What we typically recommend is that women monitor their blood sugar levels on a daily basis four times per day. One would consist of a fasting blood sugar level followed by a blood sugar level after they eat their meal which they would consider to be their breakfast, lunch, or dinner. If 50% of all blood sugar levels are fairly well controlled, then we consider that patient to be diet controlled gestational diabetes. Where it gets complicated is that once these patients are not diet controlled, then we have to introduce medical therapy to control their blood sugar levels.
Host: If a patient does get their blood glucose levels under control and listen to their doctor as say, can they still expect to deliver a healthy baby?
Dr. Kraft: They can.
Host: Then what is the treatment if they do not get their blood sugar levels under control. Would it be similar to someone who has diabetes before they get pregnant? How does that work?
Dr. Kraft: So there are three main medical modalities to control blood sugars in pregnancy. The most common used form would be insulin. The reason why insulin is recommended by ACOG and the American Diabetes Association is because it does not cross the placenta. The problem is that when you introduce insulin therapy to some patients, compliance goes down. What I mean by that is that you're asking patients to stick themselves multiple times per day to check their blood sugar, and then you're also asking them to administer an injection of insulin usually multiple times throughout the course of the day to control their blood sugar. A lot of patients don’t want to do that. So they may skip doses, which then puts them at increased risk. I’ll get into the risks in another second or so. If we have patients that are non-compliant, then typically we would try medical therapy where they can take medications by mouth. The two most common used medications in gestational diabetes is Metformin and also Glyburide. The problem with two of those medications is that we don’t know the long term effects on the fetus because we do know that both of those medications do cross the placenta.
Host: So then let’s talk about lifestyle and behaviors and things because, as you’ve mentioned diet controlled blood glucose levels. Where does exercise fit into the picture because sometimes for women that are pregnant, exercise can be a bit of a limiting factor. Maybe they weren’t an exerciser before they got pregnant, maybe they're off balance, or any of these kinds of things can come up in pregnancy doctor. So what do you tell them about getting regular physical activity?
Dr. Kraft: So that’s a really good question. What I tell all of my patients at the initial presentation of the confirmation of pregnancy is to—Since all pregnant women are at risk of getting gestational diabetes, what I tell them is to incorporate a 30 minute cardiovascular exercise which occurs five out of seven days per week. Even women who live a sedentary lifestyle, I inform them of 30 minutes of dedicated walking a day can have a profound impact on how they metabolize their blood sugars.
Host: Well it certainly can. So how can gestational diabetes impact a mother’s health in the future? Dr. Kraft, what are some complications if she’s left untreated or she delivers a healthy baby? Is she at risk for having it the next baby?
Dr. Kraft: So let’s look at two different aspects. Let’s look at the immediate or short term care. So poorly controlled blood sugars in pregnancy. If you talk to any obstetrician who has taken care of women who have diabetes, the greatest risk or concern that a physician may have is what’s called intrauterine fetal demise. Sometimes these babies can get enlarged hearts, exposes them to an arrhythmia, and then sudden cardiac death in utero. Now, that’s the worst of all complications. In addition to that, they can have other complications associated with pregnancy. One of them, which would be preeclampsia which is a hypertensive disorder of pregnancy, preterm delivery, and also macrosomia or large for gestational age or a large baby. Then you can also have complications at the form of delivery which could result in what's called a shoulder dystocia. So gestational diabetics are at risk of delivering larger babies. Some of these babies have fat deposits that are located around the shoulders which can cause the babies to potentially get stuck in the birth canal increasing risk of neurological compromise or potentially death at the point of birth.
Host: Wow. This is a pretty serious condition. I'm not sure many women all realize this. As we wrap up. Dr. Kraft, you're so informative. What a great guest you are. Please give us your best advice about lifestyle and management, possible prevention, what you’d like women to know about hopefully preventing gestational diabetes in the first place. Things they can do before they get pregnant, when they're planning to get pregnant, and then after they are pregnant what you’d like them to know.
Dr. Kraft: So, I tell the majority of women—Hopefully, women are going to the gynecologist on an annual basis. They're doing pregenetic screening with their physician. I tell all women who’ve established care with me, and we have developed a relationship, one of the easiest things that they can do—even if they know nothing about dietary modification—is to stick to some really easy basics. One would be when a woman is going grocery shopping, stick to the perimeter of the store. If you stick to the perimeter of the store, you're likely to eat a plant based diet that introduces proteins. When you go into the aisles, that’s where you're getting more of processed food and carbohydrates. In addition to that, I tell women something as simple as going for a walk that’s dedicated to cardiovascular exercise on a daily basis will increase your ability to metabolize carbohydrates much easier than as if you stick to a sedentary lifestyle. When patients come into my office, I try to make it as simple as possible and very easy to follow. I tell my patients if you're walking into the aisles of the grocery store, walk out and stick to the perimeter.
Host: That’s really great advice. As an exercise physiologist, I would give the same advice because activity and shopping the perimeter is really such a healthy way, especially to begin a pregnancy and onward. Thank you so much Dr. Kraft, for such great information today. To learn more about BayCare’s maternity services, please visit our website at baycarematernity.org for more information and to get connected with one of our providers. That concludes this episode of BayCare HealthChat. Please remember to subscribe, rate, and review this podcast and all the other BayCare podcasts. I'm Melanie Cole.