diabetestalk.net

Gestational Diabetes Third Trimester

Gestational Diabetes Mellitus In The Last Trimester - A Feature Of Maternal Iron Excess?

Gestational Diabetes Mellitus In The Last Trimester - A Feature Of Maternal Iron Excess?

Abstract AIM: To determine whether non-anaemic women with gestational diabetes mellitus (GDM) diagnosed in third trimester pregnancy have evidence of increased iron stores compared with matched non-diabetic controls. METHODS: In a prospective study, women who had antenatal booking before 20 weeks' gestation and without anaemia or diabetes mellitus were recruited at the time of the oral glucose tolerance test (OGTT) at 28-31 weeks' gestation for the study of serum ferritin, iron and transferrin concentrations. The results were blinded to the managing obstetricians. After delivery, the records were reviewed. The cases diagnosed as GDM were compared with a control group (two controls for each index case matched for parity) selected at random from the at-risk but nondiabetic cases. RESULTS: GDM was diagnosed in 97 of the 401 women recruited. Compared with the 194 controls, there was no difference in the weight, body mass index, booking and third trimester haemoglobin, or third trimester red cell indices, but concentrations of serum ferritin, iron, transferrin saturation, and the post-natal haemoglobin were significantly higher. On multiple regression analysis, maternal BMI and the log-transformed ferritin concentration remained significant determinants of the OGTT 2-h glucose value. CONCLUSION: The results suggest an association between increased iron stores and glucose intolerance at the third trimester in non-anaemic women. The role of iron excess in the pathogenesis of GDM needs to be examined. Continue reading >>

Gestational Diabetes Symptoms

Gestational Diabetes Symptoms

Gestational diabetes occurs during pregnancy. Everyone’s body needs sugar or glucose for energy. When a woman’s blood sugar is higher than normal and she is pregnant, her health and the health of her baby may be in danger. The U.S. Department of Health and Human Services reports, “Out of every 100 pregnant women in the United States, three to eight get gestational diabetes. “ What is gestational diabetes? During pregnancy, the placenta produces high levels of several hormones that can affect your body’s insulin levels, ultimately raising your blood sugar. It’s normal for your blood sugar to spike slightly after eating when you’re pregnant, but for some women, their blood sugar levels get too high, putting them and their baby at risk. Signs and symptoms. According to the Mayo Clinic, most women do not have any noticeable symptoms of gestational diabetes, but there are a few potential warning signs. Unusual or increased nausea can be a symptom of gestational diabetes. Fatigue and blurred vision can be signs and symptoms as well. If you are suffering from bladder infections, you should contact your doctor. He may decide to check you for gestational diabetes. Other potential symptoms. Many pregnant women experience increased urination, especially during the third trimester as the baby grows and often presses on the bladder. Increased urination can be a potential symptom of gestational diabetes, but this is rare. Excessive thirst is another rare but potential symptom. Even if you are not displaying any symptoms, your doctor may test for gestational diabetes between your 24th and 28th week of pregnancy. When to contact your doctor. If you think you might be at risk or you are displaying symptoms of gestational diabetes, contact your doctor or health care provide Continue reading >>

Pregnancy And Diabetes: When And Why Your Blood Sugar Levels Matter Most

Pregnancy And Diabetes: When And Why Your Blood Sugar Levels Matter Most

The following is an excerpt from the book Pregnancy with Type 1 Diabetes by Ginger Vieira and Jennifer Smith, CDE & RD There are two things you can definitely expect will be said to you by total strangers, friends, and several family members because you have diabetes: “Doesn’t that mean your baby will be huge?” “So, is your baby probably going to get diabetes, too?” Both questions are rather rude–sure–but both implications are also very far from accurate. Yes: persistent high blood sugars during pregnancy can lead to a larger baby…but people without diabetes have very large babies, too. And people with diabetes have good ol’ fashioned regularly sized babies, too. There is no way to assure the size of a baby at birth. Skinny women can have huge babies just like an overweight woman can give birth to a very small baby. Women who eat a lot during pregnancy can have small babies! Very little of this is in our control. In the end, you can manage your diabetes extremely tightly and still have a larger than average baby because blood sugar control is not the only thing that impacts the size of your baby at birth, and more importantly, a larger baby is not the only or even most important complication a baby can experience due to mom’s elevated blood sugar levels. No: just because you have diabetes definitely does not mean your baby will have diabetes! And guess what, there’s nothing you can do during pregnancy to prevent or reduce your baby’s risk of developing diabetes…at least not that science and research is aware of at this time. So take a very deep breath, mama, because that is not something you can control, and your baby’s risk of developing type 1 diabetes is actually only about 2 percent higher than the risk of a non-diabetic woman’s baby de Continue reading >>

Original Research Hba1c As A Predictor Of Diabetes After Gestational Diabetes Mellitus

Original Research Hba1c As A Predictor Of Diabetes After Gestational Diabetes Mellitus

Highlights • Third-trimester HbA1c was investigated as a predictor of diabetes following GDM. • After five years, 73/196 (37%) of the women had developed diabetes. • HbA1c ≥36 mmol/mol (≥5.4%) was associated with a 5.5-fold increased risk of diabetes. • HbA1c showed high specificity but low sensitivity to predict diabetes post-partum. • HbA1c could be used as a means of selecting high-risk women for interventions. Abstract We wanted to investigate third-trimester HbA1c as a predictor of diabetes after gestational diabetes mellitus (GDM). Women with GDM were followed up prospectively for five years from pregnancy to detect the development of diabetes. The ability of HbA1c to predict diabetes was evaluated with receiver-operating characteristic (ROC) curves and logistic regression analysis. By five years, 73 of 196 women had been diagnosed with diabetes. An optimal cut-off point for HbA1c of 36 mmol/mol (5.4%) could predict diabetes with 45% sensitivity and 92% specificity. For HbA1c ≥39 mmol/mol (≥5.7%), sensitivity, specificity, and positive predictive value were 30%, 97%, and 91%, respectively. In logistic regression analysis, adjusting for the diagnostic glucose concentration during pregnancy, HbA1c levels in the upper quartile (≥36 mmol/mol) were associated with a 5.5-fold increased risk of diabetes. Third-trimester HbA1c levels in the pre-diabetes range revealed women with post-partum diabetes with high specificity and high positive predictive value. HbA1c testing could be used as a strategy to select high-risk women for lifestyle interventions aimed at prevention of diabetes starting during pregnancy. The results should encourage further validation in other populations using new diagnostic criteria for GDM. Continue reading >>

Gestational Diabetes During Pregnancy

Gestational Diabetes During Pregnancy

Has your doctor diagnosed you with gestational diabetes (GD or GDM), a form of diabetes that appears only during pregnancy? While it might feel overwhelming at first, it turns out that this pregnancy complication is much more common than you might think. In fact, up to 9.2 percent of pregnant women have GD, according to a 2014 analysis by the Centers for Disease Control and Prevention (CDC). Know that with careful monitoring and treatment, it can be managed, and you can have a safe and healthy pregnancy. READ MORE: What causes gestational diabetes? Who's most at risk? What are the symptoms? How is it diagnosed? What are the complications? How can you prevent gestational diabetes? How is it treated? What happens to mom and baby after birth? What causes gestational diabetes? Gestational diabetes usually starts between week 24 and week 28 of pregnancy when hormones from the placenta block insulin — a hormone produced in the pancreas that regulates the body's metabolism of fats and carbs and helps the body turn sugar into energy — from doing its job and prevent the body from regulating the increased blood sugar of pregnancy effectively. This causes hyperglycemia (or high levels of sugar in the blood), which can damage the nerves, blood vessels and organs in your body. Who’s most at risk for gestational diabetes? While researchers aren't certain why some women get gestational diabetes while others don’t, they do know that you may be at an increased risk if: You are overweight. Having a BMI of 30 or more going into pregnancy is one of the most common risk factors for gestational diabetes because the extra weight affects insulin's ability to properly keep blood sugar levels in check. You have a higher level of abdominal fat. Recent research published in the American Di Continue reading >>

Gestational Diabetes

Gestational Diabetes

Gestational diabetes mellitus (GDM) is a condition of abnormally raised blood sugar levels that may occur in the second part of the pregnancy and goes away once the baby is born. Some women with gestational diabetes may need no treatment, some need a strict diet and others may need insulin injections. As GDM is a condition that occurs during pregnancy, it is not the same as having pre-existing diabetes during your pregnancy. Between 5% and 10% of pregnant women develop gestational diabetes, usually around the 24th to 28th week of pregnancy. Typically, women with gestational diabetes have no symptoms. Most women are diagnosed after special blood tests Some women with gestational diabetes (about 30%) have larger than average babies. As a result, they are more likely to have intervention in labour such as a caesarean birth. But the baby will not be born with diabetes. Studies have suggested that women who develop gestational diabetes have an increased risk of developing type 2 diabetes later in life. Testing for gestational diabetes All women are screened for gestational diabetes at their 24 to 28 week routine check up. Women who are at higher risk may be tested more often. You are at higher risk of developing gestational diabetes if you: are overweight over the age of 25 years a family history of type 2 diabetes come from an Aboriginal and Torres Strait Islander or some Asian backgrounds have had gestational diabetes before have had a large baby before. The tests available for gestational diabetes are: Glucose challenge test There is no fasting required and you are given a 50g glucose drink (equivalent to 10 teaspoons of sugar) with a blood test taken one hour after. This is a screening test only and if the result is above a certain level, you will be advised to have a gl Continue reading >>

Real Food For Gestational Diabetes: What You Need To Know

Real Food For Gestational Diabetes: What You Need To Know

Note From Mommypotamus: When I wrote about natural alternatives to the glucola test, many of you asked what to do if gestational diabetes is diagnosed and confirmed. Today I am so excited to welcome Lily Nichols, RDN, CDE, CLT, a registered nutritionist and gestational diabetes educator, who will be filling us in on how to take a real food approach to GD. Lily is the author of Real Food for Gestational Diabetes, a thoroughly researched guide filled with practical guidance and easy-to-follow instructions. It is, hands down, the best resource on the subject that I have found so far. If you or someone you know is looking for information on managing GD with real food, I highly recommend it! Gestational diabetes is never part of any mom’s plan . . . But it is the most common complication of pregnancy, affecting up to 18% of pregnant women. Yet there are many misconceptions about this diagnosis, both in conventional health care and the integrative medicine world. As a registered dietician/nutritionist and certified diabetes educator who specializes in gestational diabetes, I’m going to clear up some of the confusion for you today. Whether or not you have gestational diabetes, this post will help you understand how it develops and why it’s important to maintain normal blood sugar (for all pregnant women, really). I’ll also be sharing why the typical gestational diabetes diet fails and why a real food, nutrient-dense, lower carbohydrate approach is ideal for managing gestational diabetes. What is Gestational Diabetes? Gestational diabetes is usually defined as diabetes that develops or is first diagnosed during pregnancy. However, it can also be defined as “insulin resistance” or “carbohydrate intolerance” during pregnancy. I prefer to rely on the latter descrip Continue reading >>

Exercise Benefits For Gestational Diabetes

Exercise Benefits For Gestational Diabetes

Gestational diabetes mellitus (GDM), which is maternal hyperglycemia that arises primarily during the third trimester of pregnancy, is usually diagnosed at 24 to 28 weeks of gestation with an oral glucose challenge. Women who have risk factors for gestational diabetes, however, may have this test earlier in the pregnancy. Using new diagnostic criteria, it is estimated that gestational diabetes affects 18% of pregnancies1. Physical activity performed during pregnancy benefits a woman’s overall health. Instead of detraining, pregnant women undertaking moderate-intensity physical activity can maintain or increase their cardiorespiratory fitness2. Furthermore, maternal exercise during pregnancy does not increase the risk of low birth weight, preterm delivery, or early pregnancy loss. On the contrary, regular exercise participation likely reduces the risk of pregnancy complications, such as preeclampsia and GDM, and shortens the duration of active labor3,4. Physical activity during pregnancy may prevent both GDM and possibly later-onset T2D, and engaging in regular physical activity before pregnancy frequently has been associated with a reduced risk of developing GDM. In a recent clinical trial, a moderate physical activity program performed thrice weekly during pregnancy was found to improve levels of maternal glucose tolerance in healthy, pregnant women5 and higher levels of physical activity participation before pregnancy or in early pregnancy significantly lower the risk of developing GDM6. Similarly a recent meta-analysis reported that pregnant women with GDM who exercised on a cycle or arm ergometer or performed resistance training three times a week for 20–45 min experienced better glycemic control, lower fasting and postprandial glucose levels, and improved cardi Continue reading >>

Insulin Resistance In The Third Trimester Of Pregnancy Suffering From Gestational Diabetes Mellitus Or Impaired Glucose Tolerance

Insulin Resistance In The Third Trimester Of Pregnancy Suffering From Gestational Diabetes Mellitus Or Impaired Glucose Tolerance

Insulin Resistance in the Third Trimester of Pregnancy results in a state of insulin resistance (Dahlgren, 2006) that appears to include a decrease in maximum insulin sensitivity or responsivity (Baban et al., 2010). This insulin resistance abates in the postpartum period (Kuhl, 1991). Insulin resistance is defined as the decrease of the biological action of insulin (Catalano, 2010; Robert, 1995), and it mainly presents as hyperinsulinemia (Baban et al., 2010; Robert, 1995) or decreased ability of insulin The resistance to insulin can be characterized as pre-receptor (insulin antibodies), receptor (decreased number of receptors on the cell surface), or post-receptor (defects in the intracellular insulin signaling pathway). In pregnancy, the decreased insulin sensitivity is best characterized as a post-receptor defect resulting in the decreased ability of insulin to bring about glucose transporter (GLUT4) mobilization from the interior of the cell to the cell Most pregnant women are able to counteract the insulin resistance state by increasing their insulin secretion. However, when the capacity of insulin secretion is not sufficiently large to meet the insulin resistance, glucose intolerance develops and the women develop Gestational diabetes mellitus (GDM) is defined as a carbohydrate intolerance of varying severity with onset or first recognition during the present pregnancy (Kaaja & Rönnemaa, 2008; Damm et al., 1994; Summary and recommendation of the second international workshop conference of gestational diabetes, 1985; Shalayel et al., 2010). GDM has onset or discovery of glucose intolerance during pregnancy (Reece et al., 2009), usually in the second or third trimester (Shalayel et al., 2007). GDM carries long-term implications for the subsequent development of ty Continue reading >>

Third-trimester Maternal Glucose Levels From Diurnal Profiles In Nondiabetic Pregnancies

Third-trimester Maternal Glucose Levels From Diurnal Profiles In Nondiabetic Pregnancies

Correlation with sonographic parameters of fetal growth Abstract OBJECTIVE—To assess the 24-h glucose levels in a group of nondiabetic, nonobese pregnant women and to verify the presence of correlations between maternal glucose levels and sonographic parameters of fetal growth. RESEARCH DESIGN AND METHODS—A total of 66 Caucasian nonobese pregnant women with normal glucose challenge tests (GCT) enrolled in the study; from this population, we selected 51 women who delivered term (from 37 to 42 weeks completed) live-born infants without evidence of congenital malformations. The women were requested to have three main meals and to perform daily glucose profiles fortnightly from 28–38 weeks without modifying their lifestyle or following any dietary restriction. All subjects were taught how to monitor their blood glucose by using a reflectance meter. Fetal biometry was evaluated by ultrasound scan according to standard methodology at 22, 28, 32, and 36 weeks of pregnancy. RESULTS—The overall daily mean glucose level during the third trimester was 74.7 ± 5.2 mg/dl. Daily mean glucose values increased between 28 (71.9 ± 5.7 mg/dl) and 38 (78.3 ± 5.4 mg/dl) weeks of pregnancy. We found a significant positive correlation at 28 weeks between 1-h postprandial glucose values and fetal abdominal circumference (AC). At 32 weeks, we documented positive correlations between fetal AC and maternal blood glucose levels 1 h after breakfast, 1 and 2 h after lunch, and 1 and 2 h after dinner. At 36 weeks, there was a positive correlation between fetal AC and 1- and 2-h postprandial blood glucose levels. In addition, there was a negative correlation between head-abdominal circumference ratio and 1-h postprandial blood glucose values. CONCLUSIONS—This longitudinal study first provi Continue reading >>

Gestational Diabetes: Infant And Maternal Complications Of Pregnancy In Relation To Third-trimester Glucose Tolerance In The Pima Indians

Gestational Diabetes: Infant And Maternal Complications Of Pregnancy In Relation To Third-trimester Glucose Tolerance In The Pima Indians

A modified oral glucose tolerance test was done during the third trimester in 811 pregnancies in Pima Indian women over a 13-yr period, and maternal and fetal complications were documented. Diabetes was known to be present in 51 pregnancies. Among those who were not previously known to have diabetes, rates of perinatal mortality, macrosomia, toxemia, and cesarean section varied directly with glucose concentration, but congenital malformation and prematurity rates did not. Rates of all of these complications were higher in known diabetic women than in the remainder of the population. In addition to glucose concentrations, maternal weight and age were predictive of macrosomia and toxemia. Third-trimester glucosuria was found to be of very limited value as a screening procedure for gestational diabetes. In 233 women followed for 4–8 yr, the third-trimester glucose concentration was highly predictive of the subsequent incidence of diabetes. A pilot community-based screening program for gestational diabetes has been in operation in Cleveland, Ohio, since April 1, 1977. A socioeconomic and racially heterogeneous group of pregnant women are being routinely tested at approximately 24–28 wk of gestation by a capillary whole blood glucose determination, 2-h after a 75-g oral challenge. The results of the first 2225 screenings are analyzed in terms of the variables of maternal race, age, and stage of gestation. The overall incidence of positive screenings (≥ 120 mg/dl) is shown to be 11.5%, with significantly more positive tests among the whites than the nonwhites. Follow-up oral glucose tolerance testing results in an overall detection rate for abnormal carbohydrate metabolism of 3.1%. The data suggest that a 2-h screening procedure is more efficient than a 1-h procedure in Continue reading >>

Gestational Diabetes: Causes, Symptoms And Treatments

Gestational Diabetes: Causes, Symptoms And Treatments

Gestational diabetes has become one of the most common pregnancy complications in the US, with about 7 percent of pregnant women developing the condition. But just because it’s more widespread doesn’t mean it comes without risks. So what is gestational diabetes—and how can you minimize your chances of getting it? In this article What is gestational diabetes? What causes gestational diabetes? Gestational diabetes symptoms Gestational diabetes treatment How to prevent gestational diabetes What Is Gestational Diabetes? Gestational diabetes means your body can’t properly regulate your blood sugar levels while you’re pregnant—either because you don’t produce enough insulin or your body can’t properly use the insulin it does produce. That causes your blood sugar levels to spike when you eat, leading to a condition called hyperglycemia. Most moms-to-be diagnosed with gestational diabetes experience diabetes only during pregnancy, and the condition clears up soon after birth. But 5 to 10 percent of women continue to have type 2 diabetes after pregnancy, and those whose diabetes clears up after childbirth are still at a 20 to 50 percent risk of developing type 2 diabetes within the next 10 years. So why are doctors so concerned about this condition? “Gestational diabetes puts the mom and baby at increased risk for pregnancy complications,” says Sherry A. Ross, MD, a Santa Monica, California-based ob-gyn and author of She-ology: The Definitive Guide to Women’s Intimate Health. Period. For moms, those include: High blood pressure Preeclampsia Preterm labor C-section Gestational diabetes effects on baby can increase the risk of: Higher birth weight Shoulder dystocia (when the shoulders get stuck in the birth canal) Congenital malformations (such as abnormal sp Continue reading >>

Gestational Diabetes

Gestational Diabetes

Home » About Diabetes » Pregnancy » Gestational Diabetes Gestational Diabetes Gestational diabetes is the type of diabetes that occurs during pregnancy. Like other forms od diabetes, gestational diabetes affects the way the body uses the glucose [sugar] in the blood and as a result the blood sugars rise too high. The glucose in the blood is the body’s main source of energy. If gestational diabetes is untreated or uncontrolled, it can result in a variety of health problems for both that mother and baby. So it is important that a treatment plan is worked out to keep blood sugars within the normal range. The good news is that controlling blood sugars can help to ensure a healthy pregnancy and a healthy baby. Signs and Symptoms Most women do not have any signs or symptoms of gestational diabetes but your healthcare professional will check for gestational diabetes as part of your prenatal care. When signs and symptoms do occur they include: Excessive thirst Increased urination. About 3 to 5% of all pregnant women develop gestational diabetes. The Causes of Gestational Diabetes Normal metabolism Normally during digestion the body breaks down the carbohydrates you eat into simple sugars [glucose] and this glucose is absorbed into the blood and transported around the body by the blood vessel system to provide the energy needed for all our activities. This process cannot take place without insulin. Insulin is produced in the pancreas, a gland behind the stomach, and helps the glucose to pass into the cells to provide energy and maintains normal levels of glucose in the blood. The liver also plays a part in maintaining normal blood glucose levels. When there is more glucose in the cells than your body needs for energy, it is removed from the blood and stored it in the liver Continue reading >>

Third Trimester With Type 1 Or 2 Diabetes

Third Trimester With Type 1 Or 2 Diabetes

Many women with diabetes have to take three or four times the normal dose of insulin at this point in the pregnancy. In fact, if your insulin needs start to drop at this stage rather than increasing, you should contact your diabetes team as this may show that your placenta is not working well. From 28 weeks you will have regular ultrasound scans to monitor your baby’s growth and the amount of amniotic fluid around your baby, checking for polyhydramnios (too much amniotic fluid). If your previous eye checks were clear, you will be given another test. If they were not, you will already be receiving treatment. Colostrum harvesting From about 36 weeks you can start manually expressing colostrum (the nutrient-rich fluid that comes from your breasts before your milk comes in. When your baby is born, if he isn’t able to breastfeed, or if he needs some extra milk because his blood glucose level is low, the team can then give him your colostrum rather than formula. Some healthcare teams may not actively promote this approach but may be happy to help you if you ask. If you would like to know more, ask your team how to do it, and how to store it. 'Expressing and storing colostrum in the weeks leading up to birth helped me feel empowered and proactive. My stored colostrum was invaluable when baby was mildly hypo for 24 hrs after birth.' Zoe, mum of one Planning your labour and birth By 36 weeks your team should be working with you to plan your delivery. This may have begun far sooner as some women with diabetes will have delivered their babies by 37 weeks. You can expect to talk about: what type of birth will be best for you – vaginal or caesarean ways to control your blood glucose levels during the birth contraception and follow-up care. If you feel unclear about any of thes 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 >>

More in diabetes