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Collection of information about gestational diabetes:University of Pennsylvania Medical Center:"Gestational diabetes usually becomes apparent during the 24th to 28th weeks of pregnancy. In many cases, the blood glucose level returns to normal after delivery. It is recommended that all pregnant women be screened for gestational diabetes during the 24th and 28th weeks of their pregnancy. The symptoms are usually mild and not life-threatening to the pregnant woman. However, the increased maternal glucose levels are associated with an increased rate of perinatal complications, including birth trauma, hypoglycemia, and jaundice. Rarely, late intrauterine fetal death occurs. Maintaining control of blood glucose levels significantly reduces the risk to the offspring. The risk factors for gestational diabetes are advancing maternal age, African or Hispanic ancestry, obesity, a birth weight over 9 pounds in a previous infant, an unexplained death in a previous infant or newborn, a congenital malformation in a previous child, and recurrent infections."
http://www.nlm.nih.gov/medlineplus/ency/article/000896.htm

Who is at risk for developing gestational diabetes and how is it detected?:NICHD:"Any woman might develop gestational diabetes during pregnancy. Some of the factors associated with women who have an increased risk are obesity; a family history of diabetes; having given birth previously to a very large infant, a stillbirth, or a child with a birth defect; or having too much amniotic fluid (polyhydramnios). Also, women who are older than 25 are at greater risk than younger individuals. Although a history of sugar in the urine is often included in the list of risk factors, this is not a reliable indicator of who will develop diabetes during pregnancy. Some pregnant women with perfectly normal blood sugar levels will occasionally have sugar detected in their urine."
nichdclearinghouse@mail.nih.gov
http://www.nichd.nih.gov/publications/pubs/gest1.htm#3

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How is gestational diabestes different and who's at risk:Gale Encyclopedia of Medicine :"In gestational diabetes, the pancreas is not at fault. Instead, the problem is in the placenta. During pregnancy, the placenta provides the baby with nourishment. It also produces a number of hormones that interfere with the body's usual response to insulin. This condition is referred to as "insulin resistance." Most pregnant women do not suffer from gestational diabetes, because the pancreas works to produce extra quantities of insulin in order to compensate for insulin resistance. However, when a woman's pancreas cannot produce enough extra insulin, blood levels of glucose stay abnormally high, and the woman is considered to have gestational diabetes."
http://www.findarticles.com/cf_dls/g2601/0005/2601000592/p1/article.jhtml

Causes of gestational diabetes:ViaHealth:"Although the cause of gestational diabetes is not known, there are some theories as to why the condition occurs. The placenta supplies a growing fetus with nutrients and water, as well as produces a variety of hormones to maintain the pregnancy. Some of these hormones (estrogen, cortisol, and human placental lactogen) can have a blocking effect on insulin. This is called contra-insulin effect, which usually begins about 20 to 24 weeks into the pregnancy. As the placenta grows, more of these hormones are produced, and insulin resistance becomes greater. Normally, the pancreas is able to make additional insulin to overcome insulin resistance, but when the production of insulin is not enough to overcome the effect of the placental hormones, gestational diabetes results."
(585) 922-4000
1425 Portland Avenue
Rochester, New York 14621
webmaster@viahealth.org
http://www.viahealth.org/disease/diabetes/gesta.htm

Gestational diabetes..what to expect with testing and why:BabyCenter, L.L.C :"Most expectant mothers are given a glucose screening test between the 24th and 28th weeks of pregnancy to check for gestational diabetes, a high blood sugar condition that some women get during pregnancy. Unlike other types of diabetes, it usually goes away once the baby is born. Diabetes develops when the body can't efficiently produce or process insulin, a hormone the pancreas makes that allows cells to turn glucose, or sugar, from foods into usable fuel. Your body has to produce extra insulin to meet your fetus's growing energy needs especially from mid-pregnancy on. If your body can't process that additional insulin sufficiently, you'll most likely develop gestational diabetes You'll drink a special sugar solution, which tastes like thick flat soda pop. An hour later, your doctor will take a blood sample and check your blood sugar level. If the reading is abnormal, which happens about 20 percent of the time, you'll be given a similar but lengthier exam called a glucose tolerance test at a later date to verify the results."
http://www.babycenter.com/refcap/1483.html

Gestational diabetes affects both mom and baby:Health Beat:"The bad news is that up to half of women who develop gestational diabetes are at risk for developing Type II (adult onset or non-insulin dependent) diabetes later in life. Women found to have gestational diabetes should have annual check-ups to detect the development of Type II diabetes as soon as possible. "Of the 14 million Americans with Type II diabetes," said Gabbe, "half don't know they have it. Many learn of it only after they suffer a complication of diabetes, like loss of vision or a heart attack." As an insulin-dependent diabetic himself, Gabbe has a special interest in all forms of the disease. Gestational diabetes carries risks for both mother and baby, so it's important to diagnose and control it, either with dietary restrictions and regular exercise or, failing that, with insulin injections. Insulin given by injection does not cross the placenta and so doesn't directly affect the baby. (Oral hypoglycemic medications cross the placenta and enter the baby's bloodstream, so they are not used during pregnancy.) "About two-thirds of the time, gestational diabetes can be controlled with diet and exercise," said Gabbe. About 95 percent of pregnant women in the U.S. are now tested for gestational diabetes as they enter the last three months of pregnancy, allowing for intervention if the condition is detected. The test involves drinking a highly sugared drink and measuring how quickly blood sugar is brought to normal levels with the natural insulin produced by the pancreas. If the mother has a number of risk factors, her obstetrician may order the blood test earlier in pregnancy "
ncr@u.washington.edu
http://uwphysicians.org/hbeat/hb960423.html

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What are the risks factors associated with gestational diabetes?:UNIVERSITY OF MARYLAND MEDICAL SYSTEM:"Although any woman might develop gestational diabetes during pregnancy, some of the factors that may increase risk are: obesity family history of diabetes having given birth previously to a very large infant, a still birth, or a child with a birth defect having too much amniotic fluid (polyhydramnios) women who are older than 25 are at greater risk than younger women Although increased glucose in the urine is often included in the list of risk factors, it is not believed to be a reliable indicator for gestational diabetes"
UNIVERSITY OF MARYLAND MEDICINE
22 South Greene Street
Baltimore, MD 21201
ph: 1-800-492-5538
TDD: 410-328-9600
http://www.umm.edu/diabetes-info/gesta.htm

Gestational diabetes may increase risks for other complications during pregnancy:Daniela Contage Siccardi, Obstetrics & Gynecology Resident:"The growth and maturation of the fetus are closely associated with the delivery of maternal nutrients, particularly glucose. This is most crucial in the third trimester and is directly related to the duration and degree of maternal glucose elevation. Thus, the negative impact is as highly diverse as the variety of carbohydrate intolerance that women bring to pregnancy. For the mother with GDM there is a higher risk of hypertension, preeclampsia, urinary tract infections, cesarean section, and future diabetes. Many of the problems associated with overt diabetic pregnancies can be seen in infants of gestational diabetic pregnancies, such as macrosomia, neural tube defects, neonatal hypoglycemia, hypocalcemia, hypomagnsemia, hyperbilirubinemia,birth trauma, prematurity syndromes, and subsequent childhood and adolescent obesity."
cereis@br.homeshopping.com.br
http://www.medstudents.com.br/ginob/ginob4.htm

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Changes you will need to make if you are diagnosed with gestational diabetes:American Academy of Family Physicians:"You will need to follow a diet suggested by your doctor, exercise regularly and have blood tests to check your blood sugar level. You may also need to take medicine to control your blood sugar level Your doctor may ask you to change some of the foods you eat. You may be asked to see a registered dietitian to help you plan your meals. You should avoid eating foods that contain a lot of simple sugar, such as cake, cookies, candy or ice cream. Instead, eat foods that contain natural sugars, like fruits. If you get hungry between meals, eat foods that are healthy for you, such as raisins, carrot sticks, or a piece of fruit. Complex sugars, which are found in foods like pasta, breads, rice, potatoes and fruit, are good for both you and your baby. It's also important to eat well-balanced meals. You may need to eat less at each meal, depending on how much weight you gain during your pregnancy. Your doctor or dietitian will talk to you about this."
Attn: Special Projects Dept.
American Academy of Family Physicians
11400 Tomahawk Creek Parkway
Leawood, KS
66211-2672
email@familydoctor.org
http://familydoctor.org/handouts/075.html

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Exercise: An Alternative Therapy for Gestational Diabetes by Raul Artal, MD:The McGraw-Hill Companies:"In Brief: Exercise can play a significant role in managing blood glucose levels in women who develop gestational diabetes and in women with type II diabetes who become pregnant. Because contracting muscles help stimulate glucose transport, exercise can help women control gestational diabetes without insulin. After constraints typical of pregnancy are taken into account--such as soft-tissue laxity and fetal status--an exercise program can be tailored to the individual needs of patients. Although fit, active women may tolerate more strenuous exercise, relatively sedentary women may benefit most from non-weight-bearing exercises. Moderate workouts appear to be safe for most women who have gestational diabetes. One long-accepted therapeutic principle of diabetes management is that physical activity should be combined with an appropriate diet. This cost-effective approach has not been applied to women who have gestational diabetes, primarily out of fear that exercise could affect the developing fetus, but also because of a lack of proven safety and efficacy for the woman. However, obstetricians and other primary care providers can include exercise as an important component of controlling gestational diabetes."
http://www.physsportsmed.com/issues/1996/03_96/artal.htm

Can Gestational diabetes be prevented?:KMom@Vireday.Com:"If you are at increased risk for gestational diabetes, is there anything you can do to help prevent its occurrence? The truth is that no one knows for sure. Few studies have focused on preventing gd through proactive health measures, and few physicians are trained enough in nutrition issues to use it proactively, preferring to deal with it once it appears instead. Traditionally, physicians' emphasis is on INTERVENTION instead of PREVENTION, and this is often particularly true in obstetrics. Thus most women, even those at most risk for gd, are not given much guidance about possibly ways to lower their risk. Most OBs prefer to simply test more often instead, hoping to catch it early. There is some mixed evidence that careful attention to nutrition may help prevent at least some cases of Pregnancy-Induced Hypertension; could this also help with gestational diabetes? Many midwives report anecdotally that they prevent or reduce the number and severity of gd cases through the use of proactive nutrition and exercise. Since this is 'only' anecdotal and not documented by double-blind, randomized studies, many physicians tend to dismiss the efficacy of this approach. However, it may be worth exploring further, especially if you have a number of risk factors for gd. It is important to re-emphasize that this has not been studied adequately to determine scientifically the value of this approach. In the absence of such research, however, it makes sense to take the anecdotal reports seriously, as limited as that can be, instead of just waiting for the gd to happen and then treating it. Taking a very proactive attitude towards healthy habits during pregnancy (good diet and exercise, etc.) can only help and not hurt, as long as the approach used is reasonable and safe. What have you got to lose, except a possible diagnosis of gd and all the trouble that can buy?"
Kmom@vireday.com
http://www.plus-size-pregnancy.org/gd/gd_prevention.htm

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Last updated by Andrew Lopez, RN on Wednesday, September 29, 2010


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