Transcription:
Gestational Diabetes: What Expecting Mothers Should Know

Melanie Cole (Host):  The birth of your baby is one of the most exciting events in your life. However, during pregnancy, women can develop gestational diabetes. What does that mean for mom and baby?  My guest today is Dr. Benjamin Byers, with the Center for Maternal & Fetal Care, part of Bryan Physician Network. Welcome to the show, Dr. Byers. What is gestational diabetes?

Dr. Benjamin Byers (Guest):  Gestational diabetes is diabetes that has an onset during a woman's pregnancy.

Melanie:  And, who might be at risk for this?

Dr. Byers:  Well, all pregnant women are at risk for developing gestational diabetes; however, there are certain populations that have a greater risk. Those patients would be people that have a history of Type II Diabetes personally; perhaps a family history of Type II Diabetes, as well, puts them at an increased risk; and there are ethnic variances, as well. If somebody is of Hispanic, African-American, or Native American ethnicity, they are at a slightly increased risk for gestational diabetes. But, probably, the greatest risk factor is obesity.

Melanie:  So, I was going to ask you about that, because obesity is an increased risk for diabetes, Type II, just in the average person. What does it do for someone who is pregnant?

Dr. Byers:  Well, there's definitely a correlation between the prevalence of Type II Diabetes and gestational diabetes. Type II Diabetes affects a large percentage of the American population and five to six percent of pregnancies in the United States are complicated by gestational diabetes. If you look at a map of the United States where the incidence of Type II Diabetes is most prevalent, there's also a greater prevalence of gestational diabetes. Now, getting back to your question about obesity, the problem with diabetes is carbohydrate intolerance and obesity, sedentary lifestyle, and family history of Type II Diabetes lead to a greater risk of carbohydrate intolerance.

Melanie:  If you're having this carbohydrate intolerance and this insulin resistance, you're pregnant, you're a woman who thinks that she's doing healthy things, how would you even know if you have gestational diabetes? Are there some red flags?

Dr. Byers:  Well, really there are not a lot of symptoms that go along with gestational diabetes. Some of the symptoms of untreated severe Type II Diabetes would include polydipsia, which means drinking excess fluid and polyuria, which means excessive urination; however, those symptoms may not be as prevalent during pregnancy so a pregnant woman may not even know that she has gestational diabetes.

Melanie:  What are some complications if she doesn't find out that she has it?

Dr. Byers:  Well, when we talk about complications during pregnancy, we always refer to the maternal side and the fetal side, so the mom and the baby. As a maternal fetal medicine specialist, I have two patients--the mom and the baby. Regarding the maternal possible complications, there's a greater risk for gestational hypertension and preeclampsia; a greater risk for polyhydramnios, which is excessive amount of amniotic fluid; there's a greater risk for having a C-Section during the current pregnancy, and there's a 50% overall lifetime risk for developing Type II Diabetes. Now, regarding the fetal side, there's numerous complication including:  a greater risk for miscarriage; congenital abnormalities; macrosomia, which is a birth weight greater than 4,500 grams; low blood sugar in the baby; high bilirubin in the baby; and also a greater chance of having a difficult delivery complicated by shoulder dystocia, which is when the baby's head is delivered, but the shoulders and body remain inside the birth canal. This is an obstetrical emergency.

Melanie:  So, what do you want women to know about taking care of themselves during pregnancy?

Dr. Byers:  Well, in regards to diabetes and pregnancy, the most important factor is compliance with the recommended diet, compliance with blood glucose monitoring, and compliance with telling their physician about how their blood sugars are doing and any possible symptoms that they may be having.

Melanie:  Now, do you put women with gestational diabetes on medication as you would somebody with Diabetes, Type II.

Dr. Byers:  Yes. So, in general, this is how gestational diabetes is managed. After the diagnosis--and that's based on a glucose tolerance test that's done between 24 and 28 weeks of gestation. Part one of the test is a one-hour glucose tolerance test in which a woman consumes 50 grams of glucose solution and then gets her blood drawn one hour later. If the blood glucose value is greater than or equal to 135, then she must do the three-hour test which involves an overnight fast, 100 grams of glucose solution is consumed and she gets her blood drawn four different times:  once, fasting--or before the glucose is consumed--and then at one hour, two hours, and three hours after. Gestational diabetes is diagnosed if two of the four values are elevated. Now, what we typically do for starting therapy is have the patient see a certified dietician where they undergo nutrition counseling and also glucometer training. A glucometer is a device that checks the blood sugar. So, regarding the diet, the patient is placed on a carbohydrate restricted diet. Then, for glucose monitoring, we have the patient check their blood sugar four times a day. The first time is before their first meal of the day. We call that the “fasting”. Then, we check it two hours after each meal. So, two hours after breakfast, two hours after lunch and two hours after dinner. We use those values to determine if her blood sugar control is adequate on diet alone or if she needs further therapy. Further therapy may include oral medications or insulin. Historically, gestational diabetes was treated with insulin, which comes in the form of injections. However, in the last 10 years or so, it's been noted that oral medications are safe and effective during pregnancy. Our two main oral medications are Glyburide and Metformin. Either one of those is acceptable.

Melanie:  Dr. Byers, where does exercise fit in?  Exercise has an insulin-like effect on the body but when you're pregnant, you can be a little bit limited in what you're able to do.

Dr. Byers:  Yes. Well, interestingly, exercise during pregnancy is, as much as it hurts me to say it, has not been shown to improve blood glucose values significantly in women with gestational diabetes. So, what we typically recommend is that whatever exercise pattern somebody's in prior to pregnancy, that they continue that. However, placing them on a structured exercise program during the pregnancy will not significantly impact their blood sugar control. The reason being is that the pregnancy hormones have an effect on the blood sugar and these pregnancy hormones are mainly human placental lactogen. That's just something that's out of the control of the patient and, unfortunately, exercise can't do anything about the hormones of pregnancy.

Melanie:  Another sort of confusing thing for women is that they've been told you can lower your risk for diabetes by losing weight but you can't lose weight while you're pregnant, so how do you keep that worry in perspective and tell women about whether this is a cause for concern and will it go away once they're done being pregnant?

Dr. Byers:  Well, I do agree that excessive weight loss during pregnancy is not recommended, so I never recommend a new diet plan during the pregnancy. I do tell patients that gestational diabetes is cured after delivery and that we still need to monitor the blood glucose for a short time, just in the short-term or immediately after delivery, but after that time period, then at her follow-up appointment, which is typically six or eight weeks after delivery, it is recommended that she have a repeat glucose tolerance test. Some women, albeit rare, do have persistent diabetes that lasts immediately after a pregnancy. However, most women will not be found to have diabetes at that time. However, as I mentioned before, there is a 50% lifetime risk of developing Type II Diabetes for any patient that had gestational diabetes; therefore, it's going to be important for that patient let their primary care manager know that they did have gestational diabetes so appropriate screening can take place in the future.

Melanie:  In just the last few minutes, and it's such great information, Dr. Byers, tell the listeners why they should come to the Center for Maternal and Fetal Care at Bryan Health.

Dr. Byers:  Well, we have two board certified maternal fetal medicine specialists here that have a particular interest in diabetes in pregnancy. Of course, nationally, the diabetes level has increased and so we're seeing more and more of that during pregnancy, as well. We have dedicated physicians, sonographers, and nurses that deal with gestational diabetes on a daily basis and we're concerned about the maternal and also the baby side and will give great care to ensure a positive pregnancy outcome for both.

Melanie:  Thank you so much for being with us today. You're listening to Bryan Health Radio. For more information, you can go to BryanHealth.org. That's BryanHealth.org. This is Melanie Cole. Thanks so much for listening.