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What Is Diabetes? Diabetes is a health problem that results in too much sugar in the bloodstream and not enough in cells where it can be used for energy. The problem occurs when the body is not able to make the hormone insulin (type 1 diabetes) or the insulin that is made doesn’t work very well (type 2 diabetes). Gestational diabetes (GDM) is diabetes that occurs during pregnancy. Why Is GDM a Problem for Pregnant Women? Women with GDM don’t make enough insulin during pregnancy. This results in high levels of sugar in the blood, which is transferred to the baby. The baby turns the extra sugar into fat — mostly around his or her belly. This extra birth fat increases your baby’s chance of having obesity, high blood pressure, heart disease, and type 2 diabetes later in life. In addition, the baby may have difﬁculty being born if he or she is too big, and can have low blood sugars that require special care right after birth. Should I Have a Blood Test to Screen for Diabetes During My Pregnancy? Women who have any risk factor that increases the chance of having GDM should have a screening blood test for GDM at the beginning of the ﬁfth or sixth month (24-28 weeks). Most women have some risk factors for GDM. This is why most health care providers offer the test to all pregnant women. A few women have a high risk for getting GDM during pregnancy. To learn your risk for gestational diabetes, check each box below that applies to you:... I am over 25 years old I was overweight before being pregnant I had GDM during a prior pregnancy I have a history of several miscarriages, a stillborn baby, a very large baby, a baby with birth defects, or a baby who got “stuck” during delivery I have a mother, father, sister, or brother with diabetes I had sugar in my urine at the ﬁrst prenatal visit I have a condition called polycystic ovarian syndrome (PCOS) I am taking a medication called Glucophage (metformin) I am Hispanic, African American, Native American, South or East Asian, or from the Paciﬁc Islands
Dear Patient, The feelings that surround pregnancy—excitement, anxiety, and hope—often give way to many questions. Will my child’s eyes be blue or brown? When will I have my baby? How big will my baby be? What does the future hold for my family? Finding out that you have a “condition,”even a manageable one,can raise a different set of questions. Will my baby be healthy? Will the condition affect my ability to have other children? What can I do to ensure my own health and the health of my baby? For the last 40 years, the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) has been working to answer these types of questions through research and clinical practice to improve the health of mothers, children, and families. Managing Gestational Diabetes: A Patient’s Guide to a Healthy Pregna ncy provides some general guidelines for keeping yourself healthy and for promoting the best outcomes for your baby if you have gestational diabetes. The booklet describes gestational diabetes, its causes, and its features and includes a general treatment plan to help control the condition. Using this information, you and your family can make informed decisions about your care. You will also be better able to work with your health care provider to develop a treatment plan that addresses your specific needs situation to ensure that you and your baby are healthy. I hope this booklet helps you meet the challenges of gestational diabetes that you will face over the next few months, and that you will enjoy the new addition to your family when he or she arrives. Sincerely yours, Alan E. Guttmacher, M.D. Director, NICHD
What is gestational diabetes? Gestational (jes-TAY-shun-ul) diabetes is diabetes that is found for the first time when a woman is pregnant. Out of every 100 pregnant women in the United States, three to eight get gestational diabetes. Diabetes means that your blood glucose (also called blood sugar) is too high. Your body uses glucose for energy. But too much glucose in your blood can be harmful. When you are pregnant, too much glucose is not good for your baby. This booklet is for women with gestational diabetes. If you have type 1 or type 2 diabetes and are considering pregnancy, call the National Diabetes Information Clearinghouse at 1–800–860–8747 for more information and consult your health care team before you get pregnant. Gestational diabetes is diabetes that is found for the first time when a woman is pregnant.
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.