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Gestational Diabetes Treatments

Gestational Diabetes - Symptoms, Diagnosis, Treatment

Gestational Diabetes - Symptoms, Diagnosis, Treatment

Diabetes is diagnosed when a person has too much glucose (sugar) in the blood. Gestational diabetes is a variation of the disease that occurs during pregnancy, and is the result of the mother not being able to produce enough insulin. Gestational diabetes may not present obvious symptoms but may be diagnosed during routine pregnancy screening. The condition can adversely affect the pregnancy and health of the baby but can be managed with diet modification and exercise and, if necessary, medication. General information Diabetes mellitus (commonly known as diabetes) is a group of diseases characterised by high blood glucose levels over a prolonged period of time. This page deals with gestational diabetes. Other variations of diabetes include: Type 1 diabetes – usually diagnosed in childhood or adolescence. Type 2 diabetes – associated with a person being overweight. Gestational diabetes accounts for 90% of cases of diabetes in pregnancy, while pre-existing type 2 diabetes accounts for 8% of such cases. It usually develops during the second half of pregnancy but can occur as early as the 20th week. Gestational diabetes is common, with 3000–4000 women being diagnosed with the condition or its recurrence each year in New Zealand. The prevalence of gestational diabetes is increasing (8–9% per year) and is higher in Māori (5–10%), Pacific peoples (4–8%), and Asian Indians (4%) than in New Zealand Europeans (3%). The increasing rate of gestational diabetes appears to be related to increasing rates of obesity. Causes The exact cause of gestational diabetes is not known. However, pregnancy does affect how the body metabolises (breaks down) glucose. Glucose is absorbed into the bloodstream following a meal. The body then uses insulin (a hormone produced by the pancreas Continue reading >>

Gestational Diabetes Treatment

Gestational Diabetes Treatment

Like type 2 diabetes, gestational diabetes develops when liver, muscle, and fat cells don't respond well to insulin — a hormone that regulates glucose (sugar) levels in the blood. As its name suggests, gestational diabetes develops only in pregnant women. It's caused by changes in the body (including changing hormone levels) during pregnancy, and causes high blood glucose levels. If left uncontrolled, the condition may be harmful — or even deadly — to both the woman and her child, and can increase both of their risks of developing type 2 diabetes later in life. The key to treating gestational diabetes is to tightly regulate blood glucose levels through lifestyle changes (diet and exercise) and, if necessary, medications. Gestational Diabetes Diet Treatment for gestational diabetes always includes specialized healthy meal plans — often recommended by a registered dietician — and regular exercise, according to the American Diabetes Association (ADA). Generally speaking, diets for gestational diabetes focus on foods high in fiber and other important nutrients, and low in fat and calories. This means they tend to favor vegetables, fruits, and whole grains, and frown on refined carbohydrates (including sugar). According to a 2008 report in the journal Reviews in Obstetrics and Gynecology, a diet that can help most women with gestational diabetes maintain a normal blood glucose level is one in which 33 to 40 percent of calories come from complex carbohydrates, 35 to 40 percent come from fat, and 20 percent come from protein. Eating regular small meals throughout the day can also help keep your blood glucose level stable. Exercise as Treatment for Gestational Diabetes Regular physical activity is important to help keep your blood glucose under control. Women with ges Continue reading >>

Review Effectiveness Of Gestational Diabetes Treatment: A Systematic Review With Quality Of Evidence Assessment

Review Effectiveness Of Gestational Diabetes Treatment: A Systematic Review With Quality Of Evidence Assessment

Abstract To evaluate the effectiveness of gestational diabetes (GDM) treatment compared to usual antenatal care, in the prevention of adverse pregnancy outcomes. Additionally, to assess the quality of the evidence to support GDM treatment according to GRADE guidelines. Fourteen electronic databases and reference lists of relevant literature were searched for articles published from inception to February, 2012. Controlled clinical trials comparing GDM treatment to usual antenatal care were included. Independent extraction of articles was done by two authors using predefined data fields. Results Seven trials involving 3157 women were included. We found high quality evidence that treatment of GDM reduces macrosomia (RR = 0.47; 95% CI, 0.34–0.65; NNT = 11.4) and large for gestational age birth (RR = 0.57; 95% CI, 0.47–0.71; NNT = 12.2); moderate quality evidence that treatment reduces preeclampsia (RR = 0.61; 95% CI, 0.46–0.81; NNT = 21.0) and hypertensive disorders in pregnancy (RR = 0.64; 95% CI, 0.51–0.81; NNT = 18.1); and low quality evidence that treatment reduces shoulder dystocia (RR = 0.41; 95% CI, 0.22–0.76; NNT = 48.8). No statistically significant reduction was seen for caesarean section. No increase in small for gestational age or preterm birth was found. Treatment of GDM is effective in reducing macrosomia (high quality evidence), preeclampsia and shoulder dystocia. Continue reading >>

Treatments For Gestational Diabetes

Treatments For Gestational Diabetes

Abstract Background Gestational diabetes (GDM) affects 3% to 6% of all pregnancies. Women are often intensively managed with increased obstetric monitoring, dietary regulation, and insulin. However, there has been no sound evidence base to support intensive treatment. The key issue for clinicians and consumers is whether treatment of GDM improves perinatal outcome. Objectives To compare the effect of alternative treatment policies for GDM on both maternal and infant outcomes. Search methods We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (January 2009) and bibliographies of relevant papers. We updated this search on 1 July 2011 and added the results to the awaiting classification section of the review. Selection criteria Randomised controlled trials comparing alternative management strategies for women with GDM and impaired glucose tolerance in pregnancy. Data collection and analysis Two authors and a member of the Cochrane Pregnancy and Childbirth Group's editorial team extracted and checked data independently. Disagreements were resolved through discussion with the third author. Main results Eight randomised controlled trials (1418 women) were included. Caesarean section rate was not significantly different when comparing any specific treatment with routine antenatal care (ANC) including data from five trials with 1255 participants (risk ratio (RR) 0.94, 95% confidence interval (CI) 0.80 to 1.12). However, when comparing oral hypoglycaemics with insulin as treatment for GDM, there was a significant reduction (RR 0.46, 95% CI 0.27 to 0.77, two trials, 90 participants). There was a reduction in the risk of pre-eclampsia with intensive treatment (including dietary advice and insulin) compared to routine ANC (RR 0.65, 95% CI 0.48 to 0.88, one tri Continue reading >>

Metformin Versus Insulin For The Treatment Of Gestational Diabetes

Metformin Versus Insulin For The Treatment Of Gestational Diabetes

Metformin is a logical treatment for women with gestational diabetes mellitus, but randomized trials to assess the efficacy and safety of its use for this condition are lacking. We randomly assigned 751 women with gestational diabetes mellitus at 20 to 33 weeks of gestation to open treatment with metformin (with supplemental insulin if required) or insulin. The primary outcome was a composite of neonatal hypoglycemia, respiratory distress, need for phototherapy, birth trauma, 5-minute Apgar score less than 7, or prematurity. The trial was designed to rule out a 33% increase (from 30% to 40%) in this composite outcome in infants of women treated with metformin as compared with those treated with insulin. Secondary outcomes included neonatal anthropometric measurements, maternal glycemic control, maternal hypertensive complications, postpartum glucose tolerance, and acceptability of treatment. Of the 363 women assigned to metformin, 92.6% continued to receive metformin until delivery and 46.3% received supplemental insulin. The rate of the primary composite outcome was 32.0% in the group assigned to metformin and 32.2% in the insulin group (relative risk, 1.00; 95% confidence interval, 0.90 to 1.10). More women in the metformin group than in the insulin group stated that they would choose to receive their assigned treatment again (76.6% vs. 27.2%, P<0.001). The rates of other secondary outcomes did not differ significantly between the groups. There were no serious adverse events associated with the use of metformin. In women with gestational diabetes mellitus, metformin (alone or with supplemental insulin) is not associated with increased perinatal complications as compared with insulin. The women preferred metformin to insulin treatment. (Australian New Zealand Clinical Continue reading >>

Diagnosis And Management Of Gestational Diabetes Mellitus

Diagnosis And Management Of Gestational Diabetes Mellitus

Gestational diabetes occurs in 5 to 9 percent of pregnancies in the United States and is growing in prevalence. It is a controversial entity, with conflicting guidelines and treatment protocols. Recent studies show that diagnosis and management of this disorder have beneficial effects on maternal and neonatal outcomes, including reduced rates of shoulder dystocia, fractures, nerve palsies, and neonatal hypoglycemia. Diagnosis is made using a sequential model of universal screening with a 50-g one-hour glucose challenge test, followed by a diagnostic 100-g three-hour oral glucose tolerance test for women with a positive screening test. Treatment consists of glucose monitoring, dietary modification, exercise, and, when necessary, pharmacotherapy to maintain euglycemia. Insulin therapy is the mainstay of treatment, although glyburide and metformin may become more widely used. In women receiving pharmacotherapy, antenatal testing with nonstress tests and amniotic fluid indices beginning in the third trimester is generally used to monitor fetal well-being. The method and timing of delivery are controversial. Women with gestational diabetes are at high risk of subsequent development of type 2 diabetes. Lifestyle modification should therefore be encouraged, along with regular screening for diabetes. Evidence for screening, diagnosing, and managing gestational diabetes mellitus has continued to accrue over the past several years. In 2003, the U.S. Preventive Services Task Force1 (USPSTF) and the Cochrane Collaboration2 found insufficient evidence to recommend for or against screening for or treating gestational diabetes. However, a subsequent randomized controlled trial (RCT) found that screening and intervention for gestational diabetes were beneficial.3 Nonetheless, in 2008, Continue reading >>

Treatment

Treatment

If you have gestational diabetes, the chances of having problems with the pregnancy can be reduced by controlling your blood sugar (glucose) levels. You'll also need to be more closely monitored during pregnancy and labour to check if treatment is working and to check for any problems. Checking your blood sugar level You'll be given a testing kit that you can use to check your blood sugar level. This involves using a finger-pricking device and putting a drop of blood on a testing strip. You'll be advised: how to test your blood sugar level correctly when and how often to test your blood sugar – most women with gestational diabetes are advised to test before breakfast and one hour after each meal what level you should be aiming for – this will be a measurement given in millimoles of glucose per litre of blood (mmol/l) Diabetes UK has more information about monitoring your glucose levels. Diet Making changes to your diet can help control your blood sugar level. You should be offered a referral to a dietitian, who can give you advice about your diet, and you may be given a leaflet to help you plan your meals. You may be advised to: eat regularly – usually three meals a day – and avoid skipping meals eat starchy and low glycaemic index (GI) foods that release sugar slowly – such as wholewheat pasta, brown rice, granary bread, all-bran cereals, pulses, beans, lentils, muesli and porridge eat plenty of fruit and vegetables – aim for at least five portions a day avoid sugary foods – you don't need a completely sugar-free diet, but try to swap snacks such as cakes and biscuits for healthier alternatives such as fruit, nuts and seeds avoid sugary drinks – sugar-free or diet drinks are better than sugary versions; be aware that fruit juices and smoothies contain s Continue reading >>

Gestational Diabetes

Gestational Diabetes

What is gestational diabetes? Gestational diabetes is first diagnosed during pregnancy. Like type 1 and type 2 diabetes, gestational diabetes causes blood sugar levels to become too high. When you eat, your digestive system breaks down most of the food into a sugar called glucose. Glucose enters your bloodstream so your cells can use it as fuel. With the help of insulin (a hormone made by your pancreas), muscle, fat, and other cells absorb glucose from your blood. But if your body doesn't produce enough insulin, or if the cells have a problem responding to it, too much glucose remains in your blood instead of moving into cells and getting converted to energy. When you're pregnant, your body naturally becomes more resistant to insulin so that more glucose is available to nourish your baby. For most moms-to-be, this isn't a problem: When your body needs additional insulin to process excess glucose in blood, the pancreas secretes more. But if the pancreas can't keep up with the increased demand for insulin during pregnancy, blood sugar levels rise too high because the cells aren't using the glucose. This results in gestational diabetes. Gestational diabetes needs to be recognized and treated quickly because it can cause health problems for mother and baby. Unlike other types of diabetes, gestational diabetes isn't permanent. Once a baby is born, blood sugar will most likely return to normal quickly. However, having gestational diabetes does make developing diabetes in the future more likely. Am I at risk of developing gestational diabetes? Anyone can develop gestational diabetes, and not all women who develop the condition have known risk factors. About 5 to 10 percent of all pregnant women get gestational diabetes. You're more likely to develop gestational diabetes if you Continue reading >>

Gestational Diabetes Treatment In 3rd Trimester (query Bank)

Gestational Diabetes Treatment In 3rd Trimester (query Bank)

Question Is there any evidence that treatment of gestational diabetes mellitus (GDM) is beneficial when not diagnosed till late in 3rd trimester? Answer No studies specifically describing treatment of gestational diabetes in women diagnosed late in the third trimester were identified. A 2013 systematic review of the Benefits and Harms of Treating Gestational Diabetes Mellitus (Hartling) concluded that “Treating GDM results in less preeclampsia, shoulder dystocia, and macrosomia; however, current evidence does not show an effect on neonatal hypoglycemia or future poor metabolic outcomes. There is little evidence of short-term harm of treating GDM other than an increased demand for services”. This review cites a report commissioned by the U.S. Preventive Services Task Force in 2008 (Hillier) which found that treatment of women with mild GDM diagnosed after 24 weeks’ gestation improved maternal and neonatal health outcomes. Specifically, on the basis of 1 study (Crowther, “ACHOIS”), the report found a reduction in “any serious perinatal complication,” which included death, shoulder dystocia, bone fracture, and nerve palsy. The median gestational age at entry in the intervention and routine care groups in the Crowther study was 29.1 and 29.2 weeks respectively. (Evidence level Ib) References Crowther CA, Hiller JE, Moss JR, McPhee AJ, Jeffries WS, Robinson JS; Australian Carbohydrate Intolerance Study in Pregnant Women (ACHOIS) Trial Group. Effect of treatment of gestational diabetes mellitus on pregnancy outcomes. N Engl J Med. 2005 Jun 16;352(24):2477-86. Hartling L, Dryden DM, Guthrie A, Muise M, Vandermeer B, Donovan L. Benefits and Harms of Treating Gestational Diabetes Mellitus: A Systematic Review and Meta-analysis for the U.S. Preventive Services Task Continue reading >>

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

If you have , you'll need to get your blood sugar under control, and keep it that way, to protect your health and your baby's. You’ll have to make some lifestyle changes for that to happen. Your doctor might suggest you meet with a registered dietitian to help you make a diet plan you can stick with. It will need to address the gestational diabetes, but still provide your growing baby enough calories and nutrients. Your dietitian will recommend the number of total daily calories a woman your height and weight should get. About 2,200 to 2,500 calories per day is the norm for women of average weight. If you’re overweight, you may need to lower that to about 1,800 calories per day. The dietitian can teach you how to balance your diet. She’ll probably suggest you get: 10% to 20% of your calories from protein sources like meats, cheeses, eggs, seafood, and legumes Less than 30% of your calories from fats Less than 10% of your fat calories from saturated fats The remaining 40% or so of your calories from carbohydrates like breads, cereals, pasta, rice, fruits, and vegetables Your doctor may tell you to you add exercise to your weekly routine if it’s OK for you and the baby. Try to do some kind of mild to moderate activity for 15 minutes or half an hour on most days. This will help your body use insulin better, and that helps control blood sugar levels. Follow your doctor's instructions about how much exercise is right for you. Make sure the diet changes and added exercise get your blood sugar levels under control. Test your levels regularly, before meals and 1 or 2 hours after meals. If you don’t already have a blood glucose meter to use at home, your doctor will probably give you one and teach you how to use it. If your blood sugar remains high despite these change Continue reading >>

How To Treat Gestational Diabetes

How To Treat Gestational Diabetes

One of the most common complications during pregnancy, gestational diabetes (GD) is a condition that develops during the second trimester. According to Lisa Weston, registered midwife and vice president of the Association of Ontario Midwives, 3 to 4 percent of pregnant women develop this condition. Diagnosis of gestational diabetes During pregnancy, the placenta produces hormones that block the effects of insulin, making the mother insulin resistant. This insulin resistance is usually noticeable around the 20 to 24 weeks of pregnancy when the high blood sugar in the mother’s blood stimulates the baby to make more insulin. Extra sugar is then absorbed by the baby, causing extra weight gain. Testing The risk of gestational diabetes is greater in women who have a body mass index over 30, are over 30 years of age, have a history of gestational diabetes or large babies, or have a family history of diabetes. According to Weston, women of aboriginal, Hispanic, Asian, South Asian, and African descent also have a higher risk of developing GD. ‘There is also a greater chance for women who have had it in a previous pregnancy or have had a very large baby,’ says Weston. She recommends that women with more than one risk factor be tested for GD during the first three months of pregnancy and reassessed in the next two trimesters. Women can be screened for GD between 24 and 28 weeks’ gestation using a gestational diabetes test called the oral glucose tolerance test. The test itself is simple ‘ oral glucose is ingested and an hour later, a woman’s blood sugar levels are measured. If the blood sugar is above the recommended range, the test will be administered again with a large amount of oral glucose. If the blood sugar levels are still above the recommended range, a diagnos Continue reading >>

Treatments For Gestational Diabetes And Impaired Glucose Tolerance In Pregnancy.

Treatments For Gestational Diabetes And Impaired Glucose Tolerance In Pregnancy.

Abstract BACKGROUND: Gestational diabetes and impaired glucose tolerance (IGT) in pregnancy affects between 3 and 6% of all pregnancies and both have been associated with pregnancy complications. A lack of conclusive evidence has led clinicians to equate the risk of adverse perinatal outcome with pre-existing diabetes. Consequently, women are often intensively managed with increased obstetric monitoring, dietary regulation, and in some cases insulin therapy. However, there has been no sound evidence base to support intensive treatment. The key issue for clinicians and consumers is whether treatment of gestational diabetes and IGT will improve perinatal outcome. OBJECTIVES: The objective of this review was to compare alternative policies of care for women with gestational diabetes and IGT in pregnancy. SEARCH STRATEGY: We searched the Cochrane Pregnancy and Childbirth Group trials register (12 September 2002) and the bibliographies of relevant papers. The Cochrane Central Register of Controlled Trials was also searched (The Cochrane Library, Issue 3, 2002). SELECTION CRITERIA: Randomised controlled trials comparing alternative management strategies for women with gestational diabetes and IGT in pregnancy. DATA COLLECTION AND ANALYSIS: Quality was assessed according to the criteria defined by the Cochrane Reviewers' Handbook. Data were extracted and checked independently by two reviewers. Any disagreements were resolved through discussion with the third reviewer. MAIN RESULTS: Three studies with a total of 223 women were included. All three included studies involved women with IGT. No trials reporting treatments for gestational diabetes met the criteria. There are insufficient data for any reliable conclusions about the effect of treatments for IGT on perinatal outcome. T Continue reading >>

Treatments For Gestational Diabetes

Treatments For Gestational Diabetes

Maintaining a normal blood sugar level is vital to the health of both the mother and the baby. Treatments for gestational diabetes work to achieve and maintain normal blood sugar until the condition resolves after labor. Depending on the patient’s health, age, tolerance for medications and preference, doctors at Florida Hospital may recommend different or specialized treatments for gestational diabetes. These are some of the ways our team helps patients maintain a healthy blood sugar level and monitor the fetal development: Specialized dietary recommendations that reduce carbohydrates Exercise routine that is safe for the mother and fetus Monitoring of the blood glucose levels periodically Insulin injections if necessary Monitoring of fetal growth and well-being through: Ultrasound Fetal movement counting Biophysical profile Doppler flow study Nonstress testing Especially when the fetus is larger than normal (a potential complication of diabetes during pregnancy), delivery may be required a few weeks early to prevent injury and difficulty during labor. While these are the most common treatments for gestational diabetes, each patient has different needs. Schedule an appointment at Florida Hospital to speak to our specialists. We provide comprehensive, individualized care for patients throughout their pregnancy and after delivery. Our goal is to help mothers, babies and families maintain their highest level of health through holistic, comprehensive, compassionate care. 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 >>

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