Gestational diabetes occurs in 3 to 6 percent of pregnant women overall. It is defined as carbohydrate intolerance that begins in pregnancy and is characterized by high blood glucose levels. Because high blood glucose levels in pregnancy impair fetal growth and may threaten fetal survival, pregnant women in many countries are given a screening test for this condition between twenty-four and twenty-eight weeks of pregnancy.
Gestational diabetes occurs in 3 to 6 percent of pregnant women overall. It is defined as carbohydrate intolerance that begins in pregnancy and is characterized by high blood glucose levels. Because high blood glucose levels in pregnancy impair fetal growth and may threaten fetal survival,
pregnant women in many countries are given a screening test for this condition between twenty-four and twenty-eight weeks of pregnancy. If this test is positive, a three-hour oral glucose tolerance test is given. If blood glucose levels are found to be high, the diagnosis of gestational diabetes is made.
Gestational diabetes in three out of four women can be managed by diet; one in four requires both a special diet and insulin injections. Insulin may be recommended if dietary control of blood glucose levels is not achieved within a week or two after the diagnosis of gestational diabetes. Very high blood glucose levels may be treated with insulin immediately.
The primary goal of the treatment of gestational diabetes is the delivery of a healthy baby. This is most likely to occur if blood glucose levels remain within the normal range during pregnancy.
Prevention and Treatment of Gestational Diabetes
Little is known about the prevention of gestational diabetes. Although it is difficult to predict which individuals will develop this condition, women who enter pregnancy obese, who had gestational diabetes in a previous pregnancy, or who are over the age of thirty five develop gestational diabetes more often than other women.
The management of gestational diabetes generally involves eating a prescribed diet; monitoring food intake, blood glucose levels, and weight; exercise; and (if needed) insulin injections. Women with gestational diabetes often attend instructional classes and many health care providers organize support groups for them.
Diet is the mainstay of the treatment of gestational diabetes whether women use insulin or not. To achieve good control of blood glucose levels, diets have to be individually developed (preferably by a registered dietitian with expertise in gestational diabetes) based on a woman's blood glucose level, weight, exercise habits, and food preferences. Because protein and fat in foods raise the blood glucose levels less than carbohydrates, diets prescribed for women with gestational diabetes are relatively high in protein and fat and low in carbohydrate. The number of calories prescribed and the amount of protein, fat, and carbohydrate in the diet is often modified during the course of pregnancy depending on blood glucose control and weight gain.
Because diets for women with gestational diabetes have to be individualized and blood glucose response to the diet monitored, there is no one dietary prescription that fits all women with this problem. There are, however, several common characteristics of recommended diets:
1. Caloric intake is set at a level that promotes adequate weight gain.
The weight-gain goals for women with gestational diabetes are the same as those for women without this condition. Since both weight loss and excessive weight gain can interfere with fetal growth, development, and health and impair blood glucose control, weight gain among women with gestational diabetes should stay within the recommended range.
2. The diet provides all of the nutrients needed for pregnancy.
Diets prescribed for women with gestational diabetes contain a healthy array of foods. No special foods are required, but women should restrict their intake of sweets. Artificial sweeteners do not raise blood glucose levels and are okay to use.
3. Food intake is divided into three meals and one to three snacks.
Regular, preplanned meals and snacks are a key element in blood glucose control. Because carbohydrates in food raise blood glucose levels the most, intake of high-carbohydrate foods is spread out across the day's meals and snacks. Breakfast often contains the least carbohydrate. Women with gestational diabetes may be taught to ''carbohydrate count'' to help them plan their carbohydrate intake for the day.
If insulin is necessary, dietary prescriptions will be adjusted to account for the reduced blood glucose levels that result from insulin. To keep blood glucose levels normal, it is important to remain on the prescribed diet when insulin is used.
