American Medical Association Family Medical Guide - American Medical Association [288]
Symptoms
Gestational diabetes seldom causes symptoms in the early stages. For this reason, all women are offered a glucose screening test (see page 512) during pregnancy. If your blood glucose level is found to be elevated on the screening test, you will then have a more accurate diagnostic test called the glucose tolerance test. For this test, you will be asked to eat a high-carbohydrate diet for 3 days and then to fast overnight (for 10 to 14 hours) before the test. You will be given a strong solution of glucose to drink, and blood samples will be taken and evaluated every hour for 3 hours to determine if you have a high glucose level, indicating gestational diabetes.
Treatment
Gestational diabetes is usually treated with a carefully controlled diet. If you are diagnosed with gestational diabetes, your doctor will prescribe a diet to help keep your blood glucose level in the normal range. The doctor will probably refer you to a registered dietitian, who can help you plan meals to meet your needs. Most women with gestational diabetes require three meals a day and a bedtime snack. Meals should be evenly spaced, and calories should be distributed evenly throughout the day. Avoid high-fat foods and cooking methods such as frying, which can make you gain too much weight (excess weight can raise blood glucose levels). Regular exercise can also help keep your glucose level, as well as your weight, down.
Your doctor will want to test your glucose level regularly and will ask you to test it frequently at home to see if your diet is keeping your glucose level in the healthy range. If your blood glucose cannot be controlled with diet, you will need to have insulin injections throughout the rest of your pregnancy and labor. Most women do not need the insulin after delivery because their blood glucose level returns to normal immediately. However, you are at increased risk of developing gestational diabetes in a future pregnancy and of developing type 2 diabetes (see page 894) later in life. For this reason, your doctor will recommend a glucose screening test 2 months after delivery and early in any subsequent pregnancies as well as routine blood tests at future checkups to monitor your glucose level.
In addition to monitoring your health, the doctor will monitor the fetus’s condition throughout your pregnancy and labor to make sure that no complications develop.
Complications During Pregnancy
Some infections that a woman has during pregnancy, and lifestyle factors such as her drinking alcohol or smoking cigarettes, can harm a fetus. A severe genetic abnormality in the embryo or a disorder of a woman’s reproductive system that can affect implantation of a fertilized egg can cause serious complications, including miscarriage. During the first 3 months after conception (the first trimester), the fetus is especially vulnerable because it is going through many major developmental changes. In the fourth through the sixth month (the second trimester), most pregnancies continue smoothly, and women usually feel generally well because the physical changes associated with the development of the fetus proceed more slowly at this time.
Most fetuses have a better chance of survival the closer the pregnancy is to full term when they are born. Some women may receive treatment during the final 3 months of pregnancy (third trimester) to prevent them from going into labor too soon (preterm labor; see page 529). If a doctor thinks that a baby has a better chance of survival outside the uterus before the pregnancy is full term, he or she will induce labor (see page 533) or deliver the baby