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Diabetic Pregnancy Risks

Gestational Diabetes

Gestational Diabetes

Gestational diabetes definition and facts Risk factors for gestational diabetes include a history of gestational diabetes in a previous pregnancy, There are typically no noticeable signs or symptoms associated with gestational diabetes. Gestational diabetes can cause the fetus to be larger than normal. Delivery of the baby may be more complicated as a result. The baby is also at risk for developing low blood glucose (hypoglycemia) immediately after birth. Following a nutrition plan is the typical treatment for gestational diabetes. Maintaining a healthy weight and following a healthy eating plan may be able to help prevent or minimize the risks of gestational diabetes. Women with gestational diabetes have an increased risk of developing type 2 diabetes after the pregnancy What is gestational diabetes? Gestational diabetes is diabetes, or high blood sugar levels, that develops during pregnancy. It occurs in about 4% of all pregnancies. It is usually diagnosed in the later stages of pregnancy and often occurs in women who have no prior history of diabetes. What causes gestational diabetes? Gestational diabetes is thought to arise because the many changes, hormonal and otherwise, that occur in the body during pregnancy predispose some women to become resistant to insulin. Insulin is a hormone made by specialized cells in the pancreas that allows the body to effectively metabolize glucose for later usage as fuel (energy). When levels of insulin are low, or the body cannot effectively use insulin (i.e., insulin resistance), blood glucose levels rise. What are the screening guidelines for gestational diabetes? All pregnant women should be screened for gestational diabetes during their pregnancy. Most pregnant women are tested between the 24th and 28th weeks of pregnancy (see Continue reading >>

Gestational Diabetes

Gestational Diabetes

Gestational diabetes develops in women during pregnancy because the mother’s body is not able to produce enough insulin. Insulin is a hormone that enables the body to break down sugar (glucose) to be used as energy. Without sufficient insulin the amount of sugar in the blood rises. High blood sugar levels in the mother’s body are passed through the placenta to the developing baby. This can cause health problems. Gestational diabetes usually begins in the second half of pregnancy, and goes away after the baby is born. This makes it different to the more common forms of diabetes which, once they occur, are permanent. What causes gestational diabetes? The hormones produced during pregnancy work against the action of insulin. Gestational diabetes can happen if the mother’s body can’t produce enough extra insulin to counteract this blocking effect. Who is more likely to get gestational diabetes? Women are more at risk if they: • have a family history of type 2 diabetes • are over the age of 35 • are obese • have previously given birth to a large baby • have previously given birth to a baby born with an abnormality • have previously had a stillbirth late in pregnancy How would I know if I had gestational diabetes and how is it is it diagnosed? The symptoms of gestational diabetes are tiredness and excessive urination. Both of these symptoms are experienced by most pregnant ladies and therefore gestational diabetes may go unnoticed. It is normal to be tested for gestational diabetes in the latter part of the second trimester of pregnancy (24 to 28 weeks). Urine is routinely tested for sugar throughout pregnancy, and high blood sugar, if present, is usually detected between 24 and 28 weeks of pregnancy. The only way to confirm gestational diabetes is with a Continue reading >>

Diabetes During Pregnancy

Diabetes During Pregnancy

What is diabetes? Diabetes is a condition in which the body can't make enough insulin, or can't use insulin normally. Insulin is a hormone. It helps sugar (glucose) in the blood get into cells of the body to be used as fuel. When glucose can’t enter the cells, it builds up in the blood. This is called high blood sugar (hyperglycemia). High blood sugar can cause problems all over the body. It can damage blood vessels and nerves. It can harm the eyes, kidneys, and heart. In early pregnancy, high blood sugar can lead to birth defects in a growing baby. There are 3 types of diabetes: Type 1 diabetes. Type 1 diabetes is an autoimmune disorder. The body's immune system damages the cells in the pancreas that make insulin. Type 2 diabetes. This is when the body can’t make enough insulin or use it normally. It’s not an autoimmune disease. Gestational diabetes. This is a condition in which the blood glucose level goes up and other diabetic symptoms appear during pregnancy in a woman who has not been diagnosed with diabetes before. It happens in about 3 in 100 to 9 in 100 pregnant women. What causes diabetes during pregnancy? Some women have diabetes before they get pregnant. This is called pregestational diabetes. Other women may get a type of diabetes that only happens in pregnancy. This is called gestational diabetes. Pregnancy can change how a woman's body uses glucose. This can make diabetes worse, or lead to gestational diabetes. During pregnancy, an organ called the placenta gives a growing baby nutrients and oxygen. The placenta also makes hormones. In late pregnancy, the hormones estrogen, cortisol, and human placental lactogen can block insulin. When insulin is blocked, it’s called insulin resistance. Glucose can't go into the body’s cells. The glucose stays in Continue reading >>

What Happens When You Have Untreated Diabetes During Pregnancy?

What Happens When You Have Untreated Diabetes During Pregnancy?

Before Delivery High blood glucose -- the result of uncontrolled diabetes -- exerts profound effects on a mother and her developing fetus. Infants of women who have diabetes at the outset of pregnancy are 5 times more likely to have heart defects and twice as likely to have neural tube defects and urinary tract abnormalities as babies born to nondiabetic mothers. The rate of miscarriage, premature birth and stillbirth among diabetic mothers is similarly elevated, and the infants of diabetic mothers are often larger than normal. For mothers with pre-existing diabetes, the risk for diabetic eye and kidney damage increases during pregnancy, particularly if their diabetes is not controlled. Untreated diabetes -- whether it was present before pregnancy or developed during pregnancy -- significantly increases your risk for high blood pressure, preeclampsia, toxemia and cesarean section. The Northern Diabetic Pregnancy Audit, a British study completed during the 1990s, showed that women whose diabetes is poorly controlled during pregnancy have a 5 times higher death rate than their nondiabetic counterparts. Labor and Delivery In addition to an increased risk for stillbirth and cesarean section, women with uncontrolled diabetes are more likely to encounter difficulties during labor and delivery than nondiabetic women or women whose diabetes has been well controlled. For mothers, large birth-weight infants -- the most common fetal side effect of maternal diabetes -- are associated with difficult or arrested labor and excessive bleeding. Larger birth-weight infants are more likely to experience birth trauma and are at risk for respiratory distress, heart failure and jaundice and other severe metabolic disorders following delivery. Long-Term Effects The problems associated with un Continue reading >>

Diabetes And Pregnancy

Diabetes And Pregnancy

Diabetes and your unborn baby Diabetes is a condition in which the amount of sugar (glucose) in the blood is too high. Glucose comes from the digestion of starchy foods, such as bread and rice. Insulin, a hormone produced by your pancreas, helps your body to use glucose for energy. Three types of diabetes can affect you when you're pregnant: type 2 diabetes – long-term conditions that women may have before they get pregnant (pre-existing diabetes) gestational diabetes – develops only in pregnancy and goes away after the baby is born The information on this page is for women who have pre-existing diabetes in pregnancy. Most women with diabetes have a healthy baby, but diabetes does give you a higher risk of some complications. If you already have diabetes If you already have type 1 or type 2 diabetes, you may be at a higher risk of: having a large baby – which increases the risk of a difficult birth, having your labour induced, or a caesarean section People with type 1 diabetes may develop problems with their eyes (diabetic retinopathy) and their kidneys (diabetic nephropathy), or existing problems may get worse. If you have type 1 or type 2 diabetes, your baby may be at risk of: not developing normally and having congenital abnormalities, particularly heart and nervous system abnormalities being stillborn or dying soon after birth having health problems shortly after birth, such as heart and breathing problems, and needing hospital care developing obesity or diabetes later in life Reducing the risks if you have pre-existing diabetes The best way to reduce the risk to your own and your baby's health is to ensure your diabetes is controlled before you become pregnant. Ask your GP or diabetes specialist (diabetologist) for advice. You should be referred to a diabetic Continue reading >>

Adverse Pregnancy Outcomes In Women With Diabetes

Adverse Pregnancy Outcomes In Women With Diabetes

Abstract Pregnancy affects both the maternal and fetal metabolism and even in nondiabetic women exerts a diabetogenic effect. Among pregnant women, 2 to 17.8% develop gestational diabetes. Pregnancy can also occur in women with preexisting diabetes, that can predispose the fetus to many alterations in organogenesis, growth restriction and the mother to some diabetes-related complications like retinopathy and nephropathy or accelerate the course of these complications if they are already present. Women with gestational diabetes generally start their treatment with diet and lifestyle modification; when these changes fail in keeping an optimal glycemic control, then insulin therapy must be considered. Women with type 2 diabetes in use of oral hypoglycemic agents are advised to change to insulin therapy. Those with preexisting type 1 diabetes must start an intensive glycemic control, preferably before conception. All these procedures are performed aiming to keep glycemic levels normal or near-normal as possible to avoid the occurrence of adverse perinatal outcomes to the mother and to the fetus. The aim of this review is to reinforce the need to improve the knowledge on reproductive health of women with diabetes during gestation and to understand what are the reasons for them failing to attend for prepregnancy care programs, and to understand the underlying mechanisms of adverse fetal and maternal outcomes, which in turn may lead to strategies for its prevention. Background Pregnancy affects both the maternal and fetal metabolism and even in nondiabetic women exerts a diabetogenic effect. As normal pregnancy progresses insulin resistance increases and pancreatic β-cells reserve is stressed aiming to maintain glycemia within normal ranges; gestational diabetes results when Continue reading >>

What Is Gestational Diabetes And Its Link To Pre-diabetes?

What Is Gestational Diabetes And Its Link To Pre-diabetes?

Insulin Resistance and obesity-associated Gestational Diabetes are conditions that develop in the third trimester of pregnancy and affect 4-5% of all pregnant women in the U.S. - around 135,000 cases each year. With Gestational Diabetes, the pancreas produces insulin but it doesn't lower the mother's blood sugar levels. The symptoms are only detectable by laboratory testing. Pregnant women get a urine dip stick test with each pre-natal visit. This test may show glucose in the urine, which will prompt a health care provider to carry out further examinations for the presence of Gestational Diabetes, also known as Gestational Diabetes Mellitus (GDM). To determine if a woman has this condition, she should be tested between 24 and 28 weeks if she is at average risk i.e. has no history of prior Gestational Diabetes and is of regular weight. Women at higher risk should be tested earlier. A patient is considered high risk if she is obese, has glycosuria (glucose in the urine) or has a personal or family history of Gestational Diabetes. Laboratory diagnosis of the condition includes a fasting blood glucose measurement of greater than 126 milligrams per deciliter (mg/dl) or a random blood glucose of 200 mg/dl. An Oral Glucose Tolerance Test should also be carried out. If the glucose level exceeds what is considered normal, this could result in a diagnosis of Gestational Diabetes. Pregnancy and Obesity Women who are overweight before they become pregnant are most at risk from this disorder. The best way to avoid it is to lose weight before becoming pregnant via a low insulin, low Glycemic Index (GI) diet and regular exercise. Gestational Diabetes usually disappears after pregnancy, but it can lead to the development of Pre- and Type 2 Diabetes years later. As a baby grows, it is s Continue reading >>

Have Diabetes? 7 Tips For A Healthy Pregnancy

Have Diabetes? 7 Tips For A Healthy Pregnancy

Dealing with disease and pregnancy Pregnancy is full of challenges—and even more so if you have type 1 or type 2 diabetes. So how do you handle a demanding disease and pregnancy? It may not be as hard as you think, says Cheryl Alkon, author of Balancing Pregnancy With Pre-Existing Diabetes. But you do need a plan. Before starting a family, check out these 7 tips that can help you ace diabetes management and have a healthy pregnancy. Get your blood sugar under control If you're thinking about getting pregnant, you need to kick bad habits (like smoking), lose weight (if you're overweight), and take prenatal vitamins. You can add one more item to the list if you have diabetes: Get your blood sugar under control. If your blood sugar levels are too high or too low, you may have a tough time getting pregnant. "In that case, your body may recognize that it's not a hospitable place for a pregnancy," says Alkon. Women with type 2 diabetes are particularly at risk for polycystic ovary syndrome (PCOS), which can also make it difficult to get pregnant. Medications that stimulate ovulation, such as Clomid and Serophene, can help. Assemble a diabetes team Pregnant women with diabetes could have up to three times as many appointments as women at a lower risk of complications. Find a high-risk obstetrician to monitor your pregnancy and check whether your endocrinologist is willing to work with your ob-gyn. "You want doctors who really know what diabetes is all about," says Alkon. The constant monitoring, ultrasounds, and additional blood sugar tests add up. So "make sure you know the ins and outs of your insurance plan," she adds. Consider going off oral medications Most doctors suggest that pregnant women with type 2 diabetes discontinue oral medications, says Alkon. This is because Continue reading >>

Diabetes And Pregnancy

Diabetes And Pregnancy

Women who have diabetes before they get pregnant have special health concerns. In addition to the new demands that a pregnancy will put on your body, it will also affect your blood sugar levels and diabetes medications. If you're thinking about having a baby, take steps to lessen the risks for both you and your child. A pre-conception counseling appointment will help you be physically and emotionally prepared for pregnancy. Meet with your doctor to find out if your diabetes is controlled well enough for you to stop your birth control method. A blood test called the glycosylated hemoglobin test (HbA1c, or just A1c) can show how well it's been going over the past 8 to 12 weeks. Other medical tests can help prevent complications during pregnancy: Eye exam to see if you have glaucoma, cataracts, or retinopathy Blood work to make sure your kidneys and liver are working Foot exam High blood sugar levels early in the pregnancy (before 13 weeks) can cause birth defects. They also can increase the risks of miscarriage and diabetes-related complications. But many women don't know they're pregnant until the baby has been growing for 2 to 4 weeks. That's why you should have good control of your blood sugar before you start trying to conceive. Keep blood glucose levels within the ideal range: 70 to 100 mg/dL before meals Less than 120 mg/dL 2 hours after eating 100-140 mg/dL before your bedtime snack Use your meals, exercise, and diabetes medications to keep a healthy balance. Continue reading >>

Gestational Diabetes (gd)

Gestational Diabetes (gd)

What is gestational diabetes? Gestational diabetes (GD) happens when you have too much sugar (glucose) in your blood during pregnancy. Your blood sugar levels can go up when your body isn’t producing enough of a hormone called insulin. Insulin helps: the cells in your body to get energy from blood sugar your body to store any blood sugar that isn’t needed During pregnancy, hormones make it harder for your body to use insulin efficiently. So your body has to make extra insulin, especially from mid-pregnancy onwards. If your body can't make enough extra insulin, your blood sugar levels will rise and you may develop GD. Having too much sugar in your blood can cause problems for you and your baby, so you’ll have extra care during your pregnancy. On average, GD affects one mum-to-be in 20. GD goes away after your baby is born, because it's a condition that's only caused by pregnancy. The other types of diabetes, which are not caused by pregnancy, are type 1 diabetes and type 2 diabetes. Some women have diabetes, without realising it, before they become pregnant. If this happens to you, it will be diagnosed as GD during your pregnancy. What are the symptoms of gestational diabetes? You probably won't notice any symptoms if you have GD. That's why you'll be monitored by your midwife, and offered a test if she thinks you're at risk. GD symptoms are like normal pregnancy symptoms, and easy to miss. By the time you have clear symptoms, your blood sugar levels may be worryingly high (hyperglycaemia) . Symptoms of hyperglycaemia include: feeling more thirsty needing to wee more often than usual having a dry mouth feeling more tired getting recurring infections, such as thrush, and UTIs having blurred vision If you have any of these symptoms, tell your midwife or doctor straig Continue reading >>

11 Tips To Surviving Early Pregnancy With Type 1 Diabetes

11 Tips To Surviving Early Pregnancy With Type 1 Diabetes

Congratulations – you’re pregnant! (Or, alternatively: uh oh – you’re pregnant!) Either way, this is where your adventures in pregnant blood sugar management will truly begin. You have a challenging road ahead of you, but the good news is that there’s a lot you can do to increase your chances of a healthy pregnancy and a healthy baby. (For preconception tips see here). 1. (Keep up the) work on your A1c: Hopefully by this point your HbA1c is at the target level that you and your doctor agreed upon before conception. This is important because very high blood sugar over time is associated with an increased risk of birth defects and miscarriage. (Though, on the more optimistic flip side, the closer your blood sugar is to normal, the lower the chance of problems.) If your A1c was extremely high in the months before conception, you need to have a frank conversation with your doctor about what impact these levels may have had on your developing embryo, and what this might determine about whether to continue the pregnancy (or what your risk is of losing it). If it’s a go, you need to immediately start working on bringing your blood sugar under control. 2. Test, test, test. In order to come anywhere close to the super-human blood glucose targets of pregnancy (60-99 mg/dl fasting, a peak of 100-129 mg/dl after meals, an average daily blood glucose of 110 mg/dl, and an A1c of less than 6.0%[1] ), you need to be testing your blood glucose a lot. As in, probably more than a dozen times a day. As noted in our pre-conception tips, a Continuous Glucose Monitoring System (CGMS) can be enormously helpful in tracking your pregnancy blood sugars, since it gives you a nearly real-time graph of where your blood glucose has been and where it’s heading — and having advance warn Continue reading >>

Type 1 Diabetes And Pregnancy – Symptoms, Risks And Management

Type 1 Diabetes And Pregnancy – Symptoms, Risks And Management

Type 1 Diabetes and Pregnancy This article will cover everything you need to know about Type 1 diabetes and pregnancy. Deciding to have a baby is a big decision for most people, and for women with Type 1 diabetes, it’s one which means a lot of thought and planning. Taking care of your health and that of your baby is important, as it is for all pregnant women, and if you have Type 1 diabetes it’s crucial. Type 1 diabetes can be difficult to manage on its own, and a pregnancy can complicate it further. Yet many women have successfully met the challenges of diabetes during pregnancy, and have enjoyed healthy pregnancies and healthy babies. What Is Type 1 Diabetes? Previously known as insulin-dependent or juvenile diabetes, Type 1 diabetes is an autoimmune disease. The body’s immune system attacks and destroys the cells in the pancreas that produce insulin. Insulin helps the body to process a type of sugar (glucose) to create energy. In Type 1 diabetes, the body doesn’t produce insulin, and without it the body’s cells can’t convert glucose (sugar) into energy. Science doesn’t know what causes this autoimmune condition, and there is no prevention or cure. Symptoms of Type 1 diabetes include: Excessive thirst Passing more urine Feeling tired and lethargic Constant hunger Slow healing of wounds and cuts Skin infections Blurred vision Unexplained weight loss Mood swings Headaches Feeling dizzy Leg cramps These symptoms can occur suddenly, and usually first affect people under the age of 30. People with Type 1 diabetes need to replace the insulin their bodies can’t make every day. To manage the condition, they must test their blood glucose levels several times daily, and maintain a healthy lifestyle. Getting Pregnant With Type 1 Diabetes Research has shown those Continue reading >>

Patient Education: Care During Pregnancy For Women With Type 1 Or 2 Diabetes Mellitus (beyond The Basics)

Patient Education: Care During Pregnancy For Women With Type 1 Or 2 Diabetes Mellitus (beyond The Basics)

INTRODUCTION Before insulin became available in 1922, women with diabetes mellitus were at very high risk of complications of pregnancy. Today, most women with diabetes can have a safe pregnancy and delivery, similar to that of women without diabetes. This improvement is largely due to good blood glucose (sugar) control, which requires adherence to diet, frequent daily blood glucose monitoring, and frequent insulin adjustment. This topic review discusses care of women with type 1 or 2 diabetes during pregnancy, as well as fetal and newborn issues. It does not address gestational diabetes, which is diabetes that is first diagnosed during pregnancy. (See "Patient education: Gestational diabetes mellitus (Beyond the Basics)".) IMPORTANCE OF BLOOD GLUCOSE CONTROL Glucose in the mother's blood crosses the placenta to provide energy for the baby; thus, high blood glucose levels in the mother lead to high blood glucose levels in the developing baby as well. High blood glucose levels can cause several problems: Early in pregnancy, high glucose levels increase the risk of miscarriage and birth defects. These risks are highest when glycated hemoglobin (hemoglobin A1C or A1C) is >8 percent or the average blood glucose is >180 mg/dL (10 mmol/L). In the last half of pregnancy and near delivery, high blood glucose levels can cause the baby's size and weight to be larger than average and increase the risk of complications during and after delivery (see 'Newborn issues' below). In particular, women with large babies are more likely to have difficulty with a vaginal birth and have a higher chance of needing a cesarean delivery. In the last half of pregnancy, women with diabetes are more prone to developing pregnancy-induced hypertension (preeclampsia) and an excessive amount of amniotic Continue reading >>

Diabetes Mellitus And Pregnancy

Diabetes Mellitus And Pregnancy

Practice Essentials Gestational diabetes mellitus (GDM) is defined as glucose intolerance of variable degree with onset or first recognition during pregnancy. A study by Stuebe et al found this condition to be associated with persistent metabolic dysfunction in women at 3 years after delivery, separate from other clinical risk factors. [1] Infants of mothers with preexisting diabetes mellitus experience double the risk of serious injury at birth, triple the likelihood of cesarean delivery, and quadruple the incidence of newborn intensive care unit (NICU) admission. Gestational diabetes mellitus accounts for 90% of cases of diabetes mellitus in pregnancy, while preexisting type 2 diabetes accounts for 8% of such cases. Screening for diabetes mellitus during pregnancy Gestational diabetes The following 2-step screening system for gestational diabetes is currently recommended in the United States: Alternatively, for high-risk women or in areas in which the prevalence of insulin resistance is 5% or higher (eg, the southwestern and southeastern United States), a 1-step approach can be used by proceeding directly to the 100-g, 3-hour OGTT. The US Preventive Services Task Force (USPSTF) recommends screening for gestational diabetes mellitus after 24 weeks of pregnancy. The recommendation applies to asymptomatic women with no previous diagnosis of type 1 or type 2 diabetes mellitus. [2, 3] The recommendation does not specify whether the 1-step or 2-step screening approach would be preferable. Type 1 diabetes The disease is typically diagnosed during an episode of hyperglycemia, ketosis, and dehydration It is most commonly diagnosed in childhood or adolescence; the disease is rarely diagnosed during pregnancy Patients diagnosed during pregnancy most often present with unexpected Continue reading >>

Risk Of Type 2 Diabetes Mellitus Following Gestational Diabetes Pregnancy In Women With Polycystic Ovary Syndrome

Risk Of Type 2 Diabetes Mellitus Following Gestational Diabetes Pregnancy In Women With Polycystic Ovary Syndrome

Journal of Diabetes Research Volume 2017 (2017), Article ID 5250162, 5 pages Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA Academic Editor: Daniela Foti Copyright © 2017 Joan C. Lo et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Background. This study examines gestational diabetes mellitus (GDM) in women with polycystic ovary syndrome (PCOS) and the risk of type 2 diabetes mellitus (DM) following GDM pregnancy. Methods. A cohort of 988 pregnant women with PCOS who delivered during 2002–2005 was examined to determine the prevalence and predictors of GDM, with follow-up through 2010 among those with GDM to estimate the risk of DM. Results. Of the 988 pregnant women with PCOS, 192 (19%) developed GDM. Multivariable predictors of GDM included older age, Asian race, prepregnancy obesity, family history of DM, preconception metformin use, and multiple gestation. Among women with PCOS and GDM pregnancy, the incidence of DM was 2.8 (95% confidence interval (CI) 1.9–4.2) per 100 person-years and substantially higher for those who received pharmacologic treatment for GDM (6.6 versus 1.5 per 100 person-years, ). The multivariable adjusted risk of DM was fourfold higher in women who received pharmacologic treatment for GDM (adjusted hazard ratio 4.1, 95% CI 1.8–9.6). The five-year incidence of DM was 13.1% overall and also higher in the pharmacologic treatment subgroup (27.0% versus 7.1%, ). Conclusions. The strongest predictors of GDM among women with PCOS included Asian race and prepregnancy obesity. Pharmacologic treatment of GDM is associated with fourfold higher risk Continue reading >>

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