Controlling Blood Sugar Levels Is Key In Caring For Gestational Diabetes

“We can’t prevent a large baby, but we can reduce the likelihood by controlling the blood sugars.” — John Busowski, M. D.

Dr. John Busowski, Assistant Professor of Obstetrics and Gynecology and Director of Maternal-Fetal Medicine, is well attuned to the health care needs of women as they balance the physical demands of pregnancy and diabetes. Proper prenatal care and effective management of blood sugar are essential for women with diabetes, whether they were diabetic before conception or are diagnosed during pregnancy with gestational diabetes mellitus.

Gestational Diabetes

When routine blood glucose testing between 24 and 28 weeks of pregnancy determines that a woman has gestational diabetes, in most instances Dr. Busowski’s initial course of action is to manage the patient’s condition through diet modification. “It can be hard to convince these women that they need to follow the regimen of a strict diet and to call the office when their sugars are abnormal because they don’t feel sick. I have to tell them that they are doing it for their baby, and often they’ll listen to that,” he said. Patients are also referred to a nutritionist and/or diabetic instructor to learn about the dietary guidelines established by the American Diabetes Association and how to make the appropriate food choices.

Because a woman with gestational diabetes has high sugar levels, the extra blood sugar causes her growing baby to make extra fat. This can lead to macrosomia or a fat baby, which carries a risk of complications at delivery and a number of health problems for the infant immediately after birth. “We can’t prevent a large baby, but we can reduce the likelihood by controlling the blood sugars,” said Dr. Busowski.

In some instances women’s gestational diabetes cannot be controlled by diet, and insulin injections become necessary. These women require more medical attention with prenatal checkups every week or two. “A big part of their care is to make sure that their sugars are under control,” Dr. Busowski said. Antenatal testing is utilized to monitor the fetus’ health, and growth measurements are taken every three to four weeks to make sure the baby does not get too large in the womb.

After the baby is born, in most cases a woman’s blood sugars revert back to normal. Yet Dr. Busowski cautions, “The big issue with these women is developing Type 2 diabetes down the road,” he said. Just as obesity is a contributing factor to gestational diabetes, it also plays a significant role in the development of Type 2 diabetes. “Diet is a major part of it. Obesity increases their risk,” Dr. Busowski said. He also noted that these women should adopt a proactive approach to their increased risk for diabetes. “They need to be tested six weeks postpartum and then yearly for the rest of their lives,” he said.

Diabetes Before Pregnancy

Unlike the mother who develops gestational diabetes, the woman who was diabetic before conception is more likely to have a smaller infant because of a poor blood supply to the baby. These women also need to be followed closely during pregnancy, particularly for the impact of the pregnancy on their diabetes. “Problems with their eyes, kidneys and vascular system can all accelerate during pregnancy,” Dr. Busowski said. Since high blood sugars early in pregnancy affect development, these babies have a higher risk of structural and cardiac anomalies.

Because of the potential risks to the baby and mother, Dr. Busowski stresses that women with diabetes receive preconceptual counseling before considering pregnancy. He also advocates having their blood sugars in control and taking folic acid for three months before getting pregnant, along with undergoing a thorough physical and eye exam. "It's like going on a long trip and getting your tires and breaks checked out before you go. Some people spend more time planning their vacation than their pregnancy," Dr. Busowski said.

Reprinted from Connections newsletter, July 2002

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