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Understanding Hyperglycemia in Pregnancy & Gestational Diabetes

Writer's picture: Sarah Willis, MSN, APRN, FNP-BCSarah Willis, MSN, APRN, FNP-BC




Navigating pregnancy can feel like an exciting yet challenging journey. When gestational diabetes comes into the picture, it's normal to feel a bit overwhelmed. However, mama, rest assured. Today we are here to discuss hyperglycemia (high blood sugar) in pregnancy, specifically concerning gestational diabetes, its symptoms, treatment, and how it can affect your baby. With knowledge comes empowerment, and by understanding these aspects, you can ensure a safe and healthy journey for both you and your little one.


Keeping Sugar Levels in Check

Understanding Hyperglycemia Values Post-Gestational Diabetes Diagnosis

Once you've been diagnosed with gestational diabetes, it becomes crucial to regularly monitor your blood glucose levels to manage your condition effectively and ensure the well-being of both you and your baby.


According to both ACOG and SMFM, target blood glucose levels in women with gestational diabetes should generally be:


  • Fasting: Less than or equal to 95 mg/dL

  • One hour post-meal: Less than or equal to 140 mg/dL

  • Two hours post-meal: Less than or equal to 120 mg/dL


However, these values might vary based on individual circumstances, and your healthcare provider may adjust them according to your specific needs.


Spotting the Signs

Unveiling More Signs and Symptoms of Hyperglycemia

While some symptoms of hyperglycemia are fairly well known, others may be more subtle or less specific. These might include:


  • Excessive thirst

  • Frequent urination

  • Increased hunger

  • Fatigue or tiredness

  • Unexplained weight loss

  • Blurred vision

  • Frequent infections

  • Dry mouth

  • Nausea or vomiting

  • Abdominal pain



Remember, not all women will experience noticeable symptoms, which is why regular prenatal care and glucose testing during pregnancy are critical.


Tackling Hyperglycemia: Treatments and Management

The Power of Diet and Exercise in Managing Hyperglycemia

A well-planned DIET is a cornerstone of managing gestational diabetes. This typically involves evenly distributing carbohydrates throughout the day to avoid spikes in blood sugar. Consulting with a dietitian can help you develop a meal plan that meets your nutritional needs and keeps your blood sugar levels steady.


PHYSICAL ACTIVITY is another key component. Regular exercise, such as walking, swimming, or prenatal yoga, can help lower blood glucose levels by increasing the body's insulin sensitivity. Of course, before starting any new exercise routine, it's important to talk with your healthcare provider to make sure it's safe for you.





Importance of Blood Glucose Monitoring

Navigating Hyperglycemia: The Role of Regular Blood Glucose Monitoring

Regular blood glucose monitoring becomes a vital part of managing gestational diabetes. These readings offer insights into how your diet, exercise, and medication (if prescribed) are affecting your blood sugar levels. Typically, you will need to check your blood glucose levels:

  • Upon waking up (fasting)

  • One to two hours after breakfast, lunch, and dinner

Your healthcare provider will instruct you on how often and when to check your glucose levels, based on your individual condition and treatment plan.

Understanding and keeping track of your blood glucose levels can feel a bit daunting, especially if you're new to this. However, remember, this monitoring is a proactive step toward ensuring the healthiest possible outcome for you and your little one. You're doing great, mama!


Medication

When Diet and Exercise Aren't Enough: The Role of Medication

For some women, diet and exercise may not be enough to keep blood glucose levels in the target range, and medication may be needed.

Insulin is the most commonly used medication for managing gestational diabetes and is safe for the baby. Other options may include oral medications like metformin or glyburide, depending on the healthcare provider's discretion and the mother's preference.






Education and Support


The Importance of Education and Support in Managing Hyperglycemia

Education about gestational diabetes and its management is a vital part of treatment. This includes understanding the condition, learning how to monitor blood glucose levels, recognizing signs of hyperglycemia and hypoglycemia, and understanding the importance of diet and exercise.

Support, both professional and personal, is also incredibly important. A healthcare team that includes your obstetrician, a dietitian, and possibly a diabetes educator can provide invaluable guidance. Personal support from family and friends can also provide emotional backing, which can be a significant aspect of successfully managing gestational diabetes.


Postpartum Follow-Up

After Baby's Arrival: The Role of Postpartum Follow-Up

After the baby's birth, your glucose levels will be checked to make sure they've returned to normal. It's also recommended that women with gestational diabetes have a glucose tolerance test 6 to 12 weeks after delivery and at least every three years thereafter, as they have an increased risk of developing type 2 diabetes in the future.


Impact on Baby's Growth and Development

Effects of Hyperglycemia on Baby's Growth and Development

One of the major effects of untreated hyperglycemia during pregnancy is macrosomia, or having a baby that is significantly larger than average. This happens because the extra glucose in your bloodstream crosses the placenta, which leads to your baby's pancreas producing extra insulin to manage the additional sugar. This can cause the baby to grow larger than usual, often leading to complications during delivery.

Complications at Birth

Hyperglycemia and Complications at Birth


Babies born larger due to gestational diabetes are at an increased risk of birth injuries, such as shoulder dystocia. They may also need to be delivered via C-section due to their size.

Additionally, these babies may experience hypoglycemia, or low blood sugar, shortly after birth because their insulin production is high. They may need glucose supplementation until their blood sugar stabilizes.

Another possible complication is neonatal jaundice, a common condition in newborns where the baby's skin and eyes turn yellow. It's more prevalent in infants of mothers who had gestational diabetes.

Long-Term Health Effects

Hyperglycemia and Long-Term Health Effects for the Baby


Infants born to mothers with uncontrolled gestational diabetes are at a higher risk for obesity and type 2 diabetes later in life. They may also have a higher risk of metabolic syndrome, a cluster of conditions that increase the risk of heart disease, stroke, and type 2 diabetes.

In addition, they may face a higher risk of developing breathing difficulties, known as respiratory distress syndrome, especially if they are born prematurely.

It's important to note that these risks are significantly reduced when gestational diabetes is well-managed. Regular prenatal care, maintaining a healthy diet, staying physically active, and monitoring blood sugar levels closely can greatly contribute to a healthy pregnancy and a healthy baby.

Always discuss any concerns you have with your healthcare provider. Remember, you're not alone in this journey. Many women successfully manage gestational diabetes and have healthy pregnancies and babies.


Concluding Thoughts

Bringing it All Together: Understanding and Managing Hyperglycemia in Pregnancy

Hyperglycemia during pregnancy

particularly when it results from gestational diabetes, is a condition that requires careful monitoring and management. As we've discussed, it can bring challenges and risks for both mom and baby, but with diligent care, these can be significantly reduced.

Understanding your blood glucose targets

knowing the signs and symptoms of hyperglycemia, and staying informed about how it can affect your baby are key to managing this condition. Equally important is the role of a healthy diet, regular exercise, frequent blood glucose monitoring, and possibly medication, all of which come together in an individualized treatment plan.

Remember

each mother's experience with gestational diabetes is unique. While it can be an overwhelming diagnosis, know that with the right care and treatment, most women with gestational diabetes are able to keep their blood sugar levels under control and deliver healthy babies.

Maintain open communication

with your healthcare provider, keeping them informed about any changes or concerns. Regular prenatal care can ensure that you and your healthcare team can promptly address any issues that might arise, safeguarding the health of both you and your baby.

And finally,

REMEMBER to lean on your support system. You're not alone in this journey, and many others have navigated this path before you. Keep your sights on the goal — a healthy, happy baby. You've got this, mama!




References

  1. American Diabetes Association. (2018). Classification and Diagnosis of Diabetes: Standards of Medical Care in Diabetes—2018. Diabetes Care, 41(Supplement 1), S13-S27.

  2. American Diabetes Association. (2013). Management of Diabetes in Pregnancy. Diabetes Care, 36(Supplement 1), S103-S105.

  3. American Diabetes Association. (2018). Management of Diabetes in Pregnancy. Diabetes Care, 41(Supplement 1), S137-S143.

  4. Black MH, Sacks DA, Xiang AH, Lawrence JM. The relative contribution of prepregnancy overweight and obesity, gestational weight gain, and IADPSG-defined gestational diabetes mellitus to fetal overgrowth. Diabetes Care. 2013;36(1):56-62.

  5. Clausen TD, Mathiesen ER, Hansen T, et al. High prevalence of type 2 diabetes and pre-diabetes in adult offspring of women with gestational diabetes mellitus or type 1 diabetes: the role of intrauterine hyperglycemia. Diabetes Care. 2008;31(2):340-346.

  6. Committee on Practice Bulletins—Obstetrics. ACOG Practice Bulletin No. 190: Gestational Diabetes Mellitus. Obstet Gynecol. 2018;131:e49–e64.

  7. Johns Hopkins Medicine. (n.d.). Neonatal Jaundice.

  8. Mayo Clinic. (2018). Gestational diabetes.

  9. Mayo Clinic. (2019). Gestational diabetes.

  10. National Institute of Diabetes and Digestive and Kidney Diseases. (2017). What is Gestational Diabetes?

  11. Society for Maternal-Fetal Medicine (SMFM). Electronic address: pubs@smfm.org, Perni U, et al. SMFM Consult Series #38: Diagnosis and management of gestational diabetes. Am J Obstet Gynecol. 2019;220:B2-B18.

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