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Gestational diabetes screening, treatment important for health of mother and child

By Irene Maher
Photos by JIM DAMASKE | Times
Sarah Ricca holds Abigail, her 7-month-old daughter, at Edgewater Park in Dunedin as her son, 4-year-old Elliott, looks on.

When Sarah Ricca learned she had gestational diabetes last year during her second pregnancy she was surprised. But she also understands why it happened. With her first pregnancy, the results of her blood sugar screening were just on the borderline. Her doctor didn't think treatment was necessary. Three years later, the screening test with daughter Abigail was not ambiguous. "This time I failed miserably," said Ricca, a 33-year-old labor and delivery surgical tech at Morton Plant Hospital in Clearwater. "I thought it would be the same as with my son."

An estimated 6 to 10 percent of pregnant women develop gestational diabetes, usually in their second trimester, but it can occur earlier. Doctors aren't exactly sure why it happens.

Insulin is made by the body to move sugar or glucose (made from the food we eat) out of the bloodstream and into our cells, where it is used for energy. During pregnancy, a change occurs that increases the mother's blood sugar so more nutrients get to the baby. The mother's body makes more insulin to help normalize the blood sugar levels. But in a small number of women, it's not enough insulin to keep blood sugar in the normal range, so they develop gestational diabetes. Over time, if left untreated, the mother's blood sugar may rise to dangerous levels that can be harmful to the developing baby.

But gestational diabetes typically doesn't produce any noticeable symptoms, so it takes a test — drinking a sugary solution followed, after a period of time, by a blood draw — to detect the condition. Most women have the screening done between 24 and 28 weeks of pregnancy as a routine part of their prenatal care. But, if the woman has other risk factors, she may be screened earlier. That's what happened to Ricca. Because she had borderline screening results with her first pregnancy, was in her 30s for this pregnancy and has a parent who has diabetes, her doctor ordered the screening earlier, in her third month of pregnancy.

Getting treatment, if necessary, is important. "There are risks to the baby before and after birth and risks that mom may have Type 2 diabetes later in life if gestational diabetes is not treated," said Dr. Judette Louis, director of maternal fetal medicine at USF Health. Among the complications are preterm birth and the possibility of having a C-section delivery. "Also, the baby can grow too large, making delivery much more difficult, the baby is more likely to have breathing problems after birth and is more likely to develop diabetes and obesity in childhood," Louis said.

In many cases, gestational diabetes can be managed by checking your blood sugar throughout the day and making some dietary changes to control carbohydrates. Patients are usually sent to a class or sessions with a registered dietitian who specializes in diabetes management to learn how and what to eat to keep their blood sugar within allowable limits. That usually means combining carbs with a protein, such as cheese and crackers, and also eating carbs in smaller amounts throughout the day. "We recommend eating three small meals and three small snacks between meals, to distribute the carbs throughout the day," said Grace Lau, a registered dietitian and certified diabetes educator at St. Joseph's Hospital's Diabetes Self Management Center in Tampa. "You can't save up all your carbs for one day or one week and have them all at one time. No."

Lau said that many women come to her classes thinking they have to avoid all carbs and starches such as bread, rice and potatoes to control their blood sugar. But that's a misunderstanding that probably stems from low-carb diets commonly used for weight loss. "Cutting out all carbs is not a good idea when pregnant. They allow for fetal growth and brain development," said Lau. "Patients need to know how many grams of carbs they should have, usually no less than 175 to 180 grams per day, and spread that out during the day. Restrict carbs and calories too much and the baby won't have enough nutrition."

Exercise is also recommended to keep blood sugar under control. It doesn't have to be strenuous physical activity. Twenty to 30 minutes of walking or swimming or any physical activity your doctor approves, particularly after meals, will help lower blood sugar.

Ricca, whose husband works in security at the Tampa Bay Times, followed the diet and checked her blood sugar first thing in the morning and within two hours after eating every day for a month. "It was very challenging because you pretty much have to make all your meals at home and, working nights, I had to figure out when to eat all those meals and snacks, but I did it faithfully, only it wasn't enough," she said, to keep her blood sugar within the recommended limits. So, for the remaining five months of the pregnancy, her doctor put her on a daily oral medication that helps control blood sugar. Some women may need insulin to control their blood sugar.

When Abigail was born on Feb. 8, her blood sugar was tested right away, something that isn't routinely done with newborns, but is if the mom has gestational diabetes. It was low, so Abigail was fed right away and was given supplemental donor breast milk, which helps when mom isn't yet producing enough breast milk of her own. Within 24 hours Abigail's blood sugar was within normal limits. The newborn was able to stay in her mother's hospital room and went home with mom two days later. Today, Abigail is a healthy, happy 7-month-old.

In most women, the diabetes goes away within a couple of months after delivery. For about 10 to 15 percent, though, it will remain a lifelong condition. "In these patients, many of them were predisposed to diabetes anyway and the pregnancy just triggered it.

Some of them probably had diabetes before they became pregnant and didn't know it, they were just not diagnosed yet," Louis said. That's why testing of all mothers who had gestational diabetes is recommended at about six to 12 weeks after giving birth. But, Louis said, only about 30 percent of women follow through and get tested. According to the American College of Obstetricians and Gynecologists, all women who had gestational diabetes and their children are considered at high risk for developing diabetes later in life. "The good news is, breast-feeding helps you lose the pregnancy weight and it reduces the (mother's) risk of Type 2 diabetes later on, so that's something good you can do for the baby and for your own health," adds Louis.

Contact Irene Maher at [email protected]