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A gestational diabetes is a kind of diabetes that can happen during pregnancy. It usually goes away after delivery.Gestational diabetes is treated by controlling blood sugar. Some women can do this with a special diet for diabetes and staying active. Other women will need insulin shots or diabetes pills. It is important to keep being tested for type 2 diabetes regularly after pregnancy. Gestational (jes-TAY-shun-ul) diabetes is a type of diabetes that can happen during pregnancy. It means you have never had diabetes before. Having gestational diabetes means you have a problem with high blood sugar while you are pregnant. The treatment is to control blood sugar. This can help prevent a difficult birth. It also helps keep your baby healthy. What Does This Guide Cover? This guide can help you talk with your doctor or midwife about gestational diabetes. It helps answer these questions. What is gestational diabetes? n How is it treated? n How do I follow up after pregnancy? This guide is based on a government-funded review of research about gestational diabetes. What Is Not Covered in This Guide? This guide does not cover treatment of type 1 or type 2 diabetes during pregnancy. Type 1 and type 2 diabetes are different from gestational diabetes. Diabetes means the body has a problem with insulin. Insulin is a hormone. It helps the body use sugar from the blood for energy. When you have diabetes, your body either does not make enough insulin or does not use insulin as well as it should. Glucose (sugar) builds up in the blood because the body cannot use sugar without the help of insulin. This causes blood sugar to stay high. There are different types of diabetes. Type 1 diabetes—Most people are diagnosed when they are children or in their teens. Treatment is always insulin shots. Type 2 diabetes—Most people are diagnosed when they are adults. Sometimes it can be treated just with diet. Diabetes pills or insulin may also be needed. Gestational diabetes—This diabetes happens during pregnancy. It usually goes away after pregnancy.
Gestational diabetes mellitus (GDM) is glucose intolerance identified for the first time during pregnancy. As a pregnancy progresses, women become insulin resistant due to the increased production of certain placental hormones which are necessary to shunt nutrients to the growing fetus. If the pancreas is unable to meet the increasing insulin demands, the outcome is glucose intolerance resulting in hyperglycemia (high blood glucose). Good nutrition and controlling both carbohydrate and caloric intake will help control blood glucose levels. Optimally, a registered dietitian and/or certified diabetes educator will provide Medical Nutrition Therapy. Medical Nutrition Therapy is a nutritional treatment for a specific condition, in this case gestational diabetes, based on a detailed assessment of individual factors such as pre-pregnancy weight, physical activity level, pregnancy weight gain to date and diet history. The primary goal is to control blood glucose levels by controlling intake of carbohydrates and saturated fats while ensuring adequate nutrition without excessive weight gain. If a registered dietitian or certified diabetes educator is not available in the community to provide Medical Nutrition Therapy, a registered nurse or community health worker may educate on the nutrition principles of gestational diabetes mellitus. ASSESSMENT Gather information on weight history, pre-pregnancy weight, pregnancy weight gain to date, rate of weight gain, physical activity level, and dietary habits. Determine appropriate educational materials based on ability to understand written and spoken information, cultural diversity and individual needs. WEIGHT HISTORY • Identify total weight gain in previous pregnancies, significant weight fluctuations (gain or loss) during pregnancy and/or prior to pregnancy, and dieting habits including a history of or current anorexia or bulimia.
Gestational diabetes mellitus (GDM) is deﬁned as any degree of glucose intolerance with onset or ﬁrst recognition during pregnancy (1). The deﬁnition applies whether insulin or only diet modiﬁcation is used for treatment and whether or not the condition persists after pregnancy. It does not exclude the possibility that unrecognized glucose intolerance may have antedated or begun concomitantly with the pregnancy. Approximately 7% of all pregnancies are complicated by GDM, resulting in more than 200,000 cases annually. The prevalence may range from 1 to 14% of all pregnancies, depending on the population studied and the diagnostic tests employed. Detection and diagnosis Risk assessment for GDM should be undertaken at the ﬁrst prenatal visit. Women with clinical characteristics consistent with a high risk of GDM (marked obesity, personal history of GDM, glycosuria, or a strong family history of diabetes) should undergo glucose testing (see below) as soon as feasible. If they are found not to have GDM at that initial screening, they should be retested between 24 and 28 weeks of gestation. Women of average risk should have testing undertaken at 24 –28 weeks of gestation. Low-risk status requires no glucose testing, but this category is limited to those women meeting all of the following characteristics: ...
WASHINGTON, D.C. – January 14, 2014 – The U.S. Preventive Services Task Force (Task Force) today released its final recommendation statement advising that all women be screened for diabetes developed during pregnancy, called gestational diabetes, after 24 weeks of pregnancy. “Diabetes that begins during pregnancy can cause serious health problems for expectant mothers and their babies,” says Task Force chair Virginia A. Moyer, M.D., M.P.H. “The good news is that screening all women after 24 weeks of pregnancy is simple, and can result in better health outcomes for both the mother and the baby.” Gestational diabetes is diabetes that develops during pregnancy. Diabetes is a disease in which the body does not make enough insulin (a hormone) or use it correctly. As a result, the body cannot process starches or sugars in food into energy. It usually resolves after birth but can put expectant mothers and their babies at risk for a number of health problems. About 240,000, or about 7 percent, of the approximately 4 million women who give birth each year develop gestational diabetes. The condition is on the rise as obesity, older age during pregnancy, and other risk factors become more common among pregnant women. The Task Force recommends screening for gestational diabetes after 24 weeks of pregnancy in all women who do not have symptoms of the condition. This is a B recommendation. The Task Force found that the current evidence is insufficient to assess the balance of benefits and harms of screening earlier than 24 weeks of pregnancy. Therefore, the Task Force issued an I statement for earlier screening. The Task Force found evidence showing there is an overall benefit to screening expectant mothers after 24 weeks of pregnancy. Screening and treatment lower the risk of preeclampsia and other complications of pregnancy, labor, and delivery. Preeclampsia is a condition in pregnant women characterized by high blood pressure and high levels of protein in the urine, which can result in lifethreatening seizures. Treating diabetes during pregnancy can also prevent babies from growing larger than normal (macrosomia), a condition that can lead to birth injuries. “All women should talk to their doctors or nurses about actions they can take before becoming pregnant to improve their health,” Dr. Moyer says, “including maintaining a healthy weight, quitting smoking, and managing any chronic conditions.” The Task Force’s final recommendation statement is published online in the Annals of Internal Medicine, as well as on the Task Force Web site at www.uspreventiveservicestaskforce.org. A fact sheet that explains the recommendation statement in plain language is also available. Before finalizing this recommendation, the USPSTF posted a draft version for public comment in the spring of 2013. The Task Force is an independent, volunteer panel of national experts in prevention and evidencebased medicine that works to improve the health of all Americans by making evidence-based recommendations about clinical preventive services such as screenings, counseling services, and preventive medications. Contact: Ana Fullmer at Newsroom@USPSTF.net / (202) 350-6668
G estational diabetes complicates between 1% and 14% of pregnancies in the United States, depending on the screening method employed, the diagnostic criteria used, and the population tested. Most studies report prevalence rates of 2%-5%. Individuals with gestational diabetes may have increased risk for perinatal mortality and morbidity and clearly are at increased risk for the later development of diabetes and perhaps cardiovascular disease. Researchers should conduct appropriately blinded and controlled studies to improve our understanding of the risks associated with undiagnosed gestational diabetes and to determine the most appropriate diagnostic thresholds. It is likely that there is a continuum of metabolically related reproductive morbidity, with most cases of preexisting diabetes near one end and most cases of gestational diabetes near the other. The actual position along the continuum, i.e., the amount of reproductive risk, is probably determined by ambient glucose (or other metabolite) values, rather than by the mechanism (insulin resistance versus insulinopenia) responsible for the carbohydrate intolerance. Thus, it is not helpful to argue whether gestational diabetes does or does not exist. Rather, the degree of disturbance of carbohydrate metabolism that can cause measurable reproductive damage needs to be established. publication. As epidemiologic methodology has become more sophisticated, the early studies have been criticized because of issues of possible confounders, bias in population selection that may limit the generalization of conclusions, and the need for validation based on pregnancy outcome rather than subsequent maternal diabetes5. Some epidemiologists have recommended abandoning efforts to detect gestational diabetes until more data become available5. Gestational diabetes, defined as "carbohydrate intolerance of variable severity with onset or first recognition during pregnancy"1, existed as a concept as early as 19462 and was invoked to explain high perinatal mortality rates in pregnancies of women who subsequently developed diabetes. Early studies used the same diagnostic criteria for diabetes in pregnancy that were applied in the nonpregnant state. In 1964 O’Sullivan and Mahan3, recognizing that pregnancy had measurable effects on carbohydrate metabolism, published diagnostic criteria based on the results of 100g, 3-hour oral glucose tolerance tests (OGTTs) performed at various times during pregnancy on 752 unselected women and validated by their predictive value for subsequent diabetes. This study, a classic among early epidemiologic investigations, determined the testing conditions and criteria used today throughout the United States4.
When you are pregnant and have diabetes, you have special nutrition needs. Use MyPlate for Gestational Diabetes to help you manage your blood sugar. This will help keep you and your baby healthy. Every day, eat the number of servings/choices of food shown below. Talk to a registered dietitian (RD) to develop a meal and exercise plan that will meet your needs. Limit Your Carbohydrates. When you have gestational diabetes, the type and amount of carbohydrates matter. Vegetables, Grains, Fruits, and Dairy contain carbohydrates. Some have more and some have less. Eating too many or the wrong type of carbohydrate may raise your blood sugar. Avoid foods with added sugar or white flour, such as cookies, candy and soda. This is my plan until I meet with a registered dietitian (RD) for my personal meal and exercise plan. EVERY day, I will: Eat 3 meals and 3 snacks, 2 to 3 hours apart. Eat my bedtime snack so that no more than 10 hours pass before I eat breakfast the next day. Drink plenty of fluids. I will choose caffeine-free, sugar-free beverages. I will limit coffee to 2 cups daily & not drink alcohol. Limit artificial sweeteners to 1 - 2 servings a day. Try to walk for 10 - 15 minutes after each meal, especially breakfast. Include protein and carbohydrates at each meal and snack. Eat at least 175 grams (g) of carbohydrates a day. For the amount of carbohydrates in one serving of food, see below: Non-starchy Vegetables = 5g Protein = 0g Grains, Beans and Starchy Vegetables = 15g Fruit = 15g Dairy = 15g
Be a Champion for Change in Your Kitchen You can become a Champion for Change for your family by making meals and snacks packed with plenty of fruits and vegetables and making sure your family is physically active every day. Eating the right amount of fruits and vegetables as part of a lowfat, high fiber diet may lower your risk of serious problems like obesity, type 2 diabetes, heart disease, stroke, and certain types of cancer. The amount of fruits and vegetables that is right for you depends on your age, gender, and physical activity level. View the Recommended Cups of Fruits and Vegetables chart on pages 4 and 5 to find out how many cups of fruits and vegetables each person in your family needs. Don’t forget to be active, too! Being physically active gives you more energy. It helps lower stress. And, it helps you keep a healthy body weight. To take care of your health and lower the risk of serious health problems, you need at least 30 minutes of moderate-intensity physical activity every day (like dancing, walking, or doing yard work). Children need at least 60 minutes of physical activity every day. Start using these low-cost, easy-to-make recipes today to keep your family healthy and happy! For more information about the Network for a Healthy California, call 1-888-328-3483 or visit us at www.cachampionsforchange.net.
This report studies the global wound care market from the period of 2011 and 2016. The wound care market is driven by increase in the ageing population, rise in chronic diseases (such as diabetes and hypertension), and technological advancements. The demand for portable and easy-to-use devices is expected to drive the growth of the wound care market in the coming years. At the same time, tissue-engineered products like skin substitutes and biological growth factors are expected to drive the market in the long term.
Around 3,000 professionals and scientists are expected at ACC Liverpool’s Diabetes UK Professional Conference and accompanying exhibition in March. http://www.exhibitionandtradeshow.com/
For information on reprint requests of more than 101 and commercial reprints contact: Authors: Philip E. Cryer, Lloyd Axelrod, Ashley B. Grossman, Simon R. Heller, Victor M. Montori, Elizabeth R. Seaquist, and F. John Service Co-sponsoring Associations: American Diabetes Association, European Association for the Study of Diabetes, and European Society of Endocrinology Affiliations: Washington University School of Medicine (P.E.C.), St. Louis, Missouri; Massachusetts General Hospital and Harvard Medical School (L.A.), Boston, Massachusetts; Barts and the London School of Medicine, Queen Mary University of London (A.B.G.), London, United Kingdom; University of Sheffield (S.R.H.), Sheffield, United Kingdom; University of Minnesota (E.R.S.), Minneapolis, Minnesota; and Mayo Clinic (V.M.M., F.J.S.), Rochester, Minnesota Disclaimer Statement: Clinical Practice Guidelines are developed to be of assistance to endocrinologists by providing guidance and recommendations for particular areas of practice. The Guidelines should not be considered inclusive of all proper approaches or methods, or exclusive of others. The Guidelines cannot guarantee any specific outcome, nor do they establish a standard of care. The Guidelines are not intended to dictate the treatment of a particular patient. Treatment decisions must be made based on the independent judgment of health care providers and each patient’s individual circumstances. The Endocrine Society makes no warranty, express or implied, regarding the Guidelines and specifically excludes any warranties of merchantability and fitness for a particular use or purpose. The Society shall not be liable for direct, indirect, special, incidental, or consequential damages related to the use of the information contained herein. Evidence-based reviews for this guideline were prepared under contract with The Endocrine Society. Menna Burgess Reprint Sales Specialist Cadmus Professional Communications Phone: Fax: Email: 410.819.3960 410.684.2789 reprints2@ cadmus.com