As of 2010, the CDC estimates that over 26 million Americans over the age of 20 are living with diabetes. Of those, over 12 million are women. It is estimated that 1.9 million Americans are diagnosed with diabetes each year. The majority is diagnosed after the age of 45, and almost 500,000 are diagnosed between 20 and 44. As obstetricians, we see our fair share of diabetics in pregnancy.
Diabetes is a metabolic disease due to high blood sugar or glucose. There are several ways to get this disease. One way is when our bodies stop making insulin.
Insulin helps glucose get into our cells. Our cells use the glucose as energy or fuel. Insulin is like a “key” that unlocks the “door”, and allows glucose to enter the “house”. Without insulin, glucose stays in the blood and our cells starve. This is typically called Type I diabetes or insulin dependent diabetes.
Another way occurs when our bodies don’t make enough insulin or our cells do not respond to the insulin anymore. The “key” doesn’t fit the lock anymore. This is called Type II diabetes or non insulin dependent diabetes. Once again, our blood sugar levels become high and our cells don’t get the glucose.
During pregnancy, a woman who was not diabetic can get what is called gestational diabetes. Gestational diabetes often occurs in the 3rd trimester. What happens in the 3rd trimester? The baby is getting ready for birth and so is the placenta. The placenta starts releasing human placental lactogen which is thought to interfere with insulin. If insulin can’t do its job to unlock the “door”, the blood sugar levels rise.
Anywhere from 3 to 10% of pregnancies can be affected by gestational diabetes. Women who have gestational diabetes are at higher risk of developing Type II diabetes later in life. It is important to get tested after the birth as some women will continue to have diabetes. The rest should get tested on a regular basis thereafter.
Treatment plans for gestational diabetes typically involve dietary evaluations or modifications. Sometimes the mom to be has to change what she is eating to keep her sugar levels normal. Sometimes medications such as insulin or glyburide are required. The mom to be will also have to do blood sugar testing, undergo extra fetal ultrasounds, and/or fetal monitoring of the baby’s heartbeat.
Women with gestational diabetes are at higher risk of having a large baby. This is because the higher sugar levels in the blood also go to the baby. The excess sugar causes the baby to grow larger and heavier. This in turn puts her at higher risk of having a complicated vaginal delivery and/or cesarean section.
The newborn is also at higher risk of having low sugar immediately after birth. This may require admission into the neonatal intensive care unit (NICU) until the baby can regulate his or her own sugar. The baby doesn’t have all that sugar from mom anymore. Just as sugar can’t be too high, it can’t be too low either.
If you have diabetes and are considering pregnancy, you may want to see a doctor that specializes in high risk pregnancy for preconceptional counseling. Whether or not you are pregnant, if you have a history of diabetes in pregnancy, let your doctor know. If you are already pregnant and are wondering why you have to do that “sugar” test, now you know why.
Cynthia Wilkes MD
Stafford Womens Health Associates