Gestational diabetes - glucose intolerance of pregnancy

Gestational diabetes (also called glucose intolerance of pregnancy) is a temporary condition that occurs during pregnancy. It affects two to four per cent of all pregnancies and involves an increased risk of developing diabetes for both mother and child.

Treatment

Controlling your blood sugar is essential to keeping your baby healthy and avoiding complications during delivery. Almost all women are able to control their blood sugar simply with diet and exercise, although a few may need to use medication in addition to lifestyle changes. In either case, monitoring your blood sugar is a key part of your treatment program because it tells you whether your blood sugar is staying within a normal range.

Monitoring blood sugar
If you've just learned you have diabetes, monitoring your blood sugar may sound inconvenient and difficult. But once you learn how it's done, you'll likely grow more comfortable with the procedure.

To test your blood sugar, you draw a drop of blood from your finger using a small needle (lancet), then place the blood on a test strip inserted into a blood glucose monitor — a small, computerized device that measures and displays your blood sugar level.

Your blood sugar fluctuates throughout the day and is highest one to two hours after you eat. What and how much you eat and even the time of day also can have an effect. For that reason, your doctor may ask you to check your blood sugar in the morning before you eat breakfast and then two hours after you eat. You may also need to check your blood sugar in midafternoon. Your goal is to make sure you're keeping your blood sugar levels within a healthy range.

Your doctor will also monitor your blood sugar during labor. If your blood sugar levels rise, your baby's blood sugar will rise, too. This can cause your baby to have high levels of insulin, which may lead to low blood sugar right after birth.

• Low blood sugar

Eating a healthy diet
A healthy diet is important for every pregnant woman, but it's even more important if you have gestational diabetes. Eating the right kind and amount of food is one of the best ways to control your blood sugar levels.

But contrary to what you may have heard, this doesn't mean you have to eat tiny portions of bland, boring foods. In general, you'll eat more fruits, vegetables and whole grains — foods that are high in nutrition and low in fat and calories — and fewer animal products and sweets. This is essentially the diet all Americans should follow.

Even so, no one diet is right for every woman. Fortunately, you don't have to figure it out alone. A registered dietitian can help you put together a meal plan based on your blood sugar level, weight, exercise habits and food preferences.

Exercise
In general, the more active you are, the lower your blood sugar. Physical activity causes sugar to be transported to your cells where it's used for energy, lowering the levels in your blood. Exercise also reduces blood sugar by increasing your sensitivity to insulin: Your body requires less insulin to transport glucose into your cells.

In addition, regular exercise can help prevent some of the discomforts of pregnancy, such as back pain, muscle cramps, swelling, constipation and difficulty sleeping. It can also help prepare you for labor and delivery. The increased muscle strength and endurance you develop reduce stress on your ligaments and joints during delivery, help you during labor, and shorten your recovery time.

• back pain

• constipation

See your doctor before beginning any exercise program. Once you have the go-ahead, take some time to think about which activities you enjoy and are likely to continue after your baby is born. Walking, cycling and swimming are good ways to get a safe aerobic workout. And although aerobic exercises are especially good, ordinary activities such as housework and gardening also can lower your blood sugar.

Aim for at least 30 minutes of aerobic exercise most days. But if you haven't been active for a while, start slowly and build up gradually. For best results, combine your aerobic activity with stretching and strength-training exercises. Exercising at the same time every day, varying your fitness routine and working out with other pregnant women can help you stay motivated.

Medications
Sometimes diet and exercise may not be enough. In that case, you may need to take daily medication to help lower your blood sugar to safe levels.

Until recently, insulin was the only option for women with gestational diabetes because it doesn't cross the placental barrier. But the oral anti-diabetes drug, glyburide, has been shown to be safe and effective in controlling blood sugar in gestational diabetes. Talk to your doctor about the best choice for you.

Keeping your baby healthy before birth
Your obstetrician will likely recommend close monitoring of your baby's growth — usually using ultrasound. This is a test that combines high-frequency sound waves and computer processing to generate pictures of the inside of your uterus. Although ultrasound can give a good idea of your baby's size, it tends to be less accurate as your baby gets bigger.

Your obstetrician may also recommend a nonstress test (NST) or biophysical profile to make sure your baby is getting enough oxygen and nourishment, especially as you approach your due date.

A nonstress test is just that — a noninvasive test that causes no stress to your baby. In fact, it shouldn't be stressful for you either. NST usually takes less than 30 minutes and requires no hospitalization. It's a simple procedure that checks how often your baby moves and how much his or her heart rate increases with movement. A biophysical profile combines an ultrasound with NST to provide more information about your baby's breathing, tone, movement and the volume of amniotic fluid in your uterus.

In most cases, your doctor will try to prevent your pregnancy from going longer than 40 weeks because being overdue may increase the risk of gestational diabetes. Although your baby will almost always be born healthy, labor with gestational diabetes isn't routine, and a Caesarean delivery is much more likely.