Approximately 2 to 5% of pregnant women are affected by gestational diabetes and trying to adequately treat them can be challenging at best. The diagnosis of diabetes is made between 24 and 28 weeks by giving a 1-hour glucose challenge test where a patient is given 50 grams of glucola, a sweet, syrupy drink and then one hour later her blood is drawn. This test challenges the pancreas to produce more insulin in response to the increased sugar load the body received. Any value greater than 130 is considered abnormal and needs further tests.

Dietary changes are the first step to reduce the glucose (or sugar) level. These changes include the elimination of white flour and sugar products and replacing them with multigrain carbohydrates. Women who have gestational diabetes are seven times more likely to develop Type 2 diabetes later in life. It is extremely important to control gestational diabetes because the baby could get too large. It can also develop breathing problems. If diet is not enough to control the glucose, there are 2 schools are thought and they are confusing. The older trend was to give the patient insulin, the newer trend is to give the patient oral medication, specifically Glyburide and Metformin. However, now there appears to be controversy per Dr. Aaron B. Caughey’s commentary in OBG Management. Caughey is of the opinion that insulin should be used instead of oral medication because it’s faster to get glucose under control and half of the patients that used Metformin eventually needed insulin. He also stated that there was an increased risk of low blood sugar in newborns and increased weight associated with Glyburide.

Dr. E. Albert Reece, a maternal fetal medicine specialist and the Dean of the University School of Medicine recommends early diagnosis, close monitoring and aggressive management regarding gestational diabetics. According to Reece, the three-hour glucose challenge test should be replaced with the 2-hour test. 75 grams of glucola is given after an overnight fast and the blood is drawn two hours later. Aggressive management includes

• If the fasting blood sugars are less than 95 mg/dl, obtain an ultrasound in the 3rd trimester, if baby is not too big, start nonstress tests at 40 weeks and induce at 40 weeks

• If the fasting blood sugars are greater than 95 mg/dl, give insulin, schedule nonstress at 32 weeks, get an ultrasound at 36 weeks and induce labor at 40 weeks or earlier if fetal well being is in doubt

• If a patient is taking insulin, they need “continuous monitoring” that involves checking their blood glucose level at least 7 times per day to reduce the chances of low blood sugar (hypoglycemia)that could adversely affect both mother and baby

Gestational diabetes is challenging but manageable with the proper plan and heightened attention. Remember, a healthy baby doesn’t just happen. It takes a smart mother who knows what to do.

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