Gestational diabetes—for many women the first mention of it may be when their girlfriend tells them you will have to drink this syrup-like liquid for your gestational diabetes test.
Other than knowing they want to pass the test, many woman may be very unfamiliar with gestational diabetes risk factors, treatment and implications on mom and baby.
About 3 to 8 percent of pregnant women in America develop gestational diabetes which occurs only during pregnancy; usually goes away after your baby is born and often does not have symptoms that show.
Today, Donald Wothe, MD, talks about what may a put a woman at a higher risk for developing gestational diabetes and what treatment often looks like.
Selected Podcast
Gestational Diabetes: Risk Factors and Treatment
Featured Speaker:
Learn more about Dr. Wothe
Donald Wothe, MD- OBY GYN
Dr. Wothe is a maternal fetal medicine specialist/perinatologist with Allina Health’s Minnesota Perinatal Physicians, a group that provides high-risk obstetrical care for women and their families in the upper Midwest. Dr. Wothe has been helping families through challenging pregnancies since 1996. He has been boarded in Obstetrics and Gynecology since 1999 and Maternal Fetal Medicine since 2001. His expertise includes treating incompetent cervix; causes for preterm delivery; interpreting complex ultrasounds and providing advice on malformations. Dr. Wothe believes in working with each mother to achieve the optimal outcome for her and her family.Learn more about Dr. Wothe
Transcription:
Melanie Cole (Host): About 3-8% of pregnant women in America can develop gestational diabetes which occurs during pregnancy, usually goes away after your baby is born; however, it often doesn’t have symptoms unless you are with your doctor in this. What puts a woman at a higher risk for developing gestational diabetes? My guest today is Dr. Donald Wolthe. He’s a maternal fetal medicine specialist and perinatologist with Allina Health Minnesota Perinatal Physicians. Welcome to the show, Dr. Wolthe. So, gestational diabetes, first of all, give the listeners a working definition of what this is.
Dr. Donald Wolthe (Guest): Thanks for having me on the show. Gestational diabetes is a form of diabetes that happens just when you’re pregnant. You don’t have to have had diabetes in the past. It actually comes about because of the interaction between you and your baby during pregnancy.
Melanie: Okay. So how would you even know?
Dr. Wolthe: It turns out that it takes a specific test to know that you have diabetes during pregnancy, although your doctor will look for certain risk factors that put you at higher chance of developing diabetes--things such as being overweight, or a family history of diabetes. Also, there’s an increase in diabetes in moms that are carrying twins or triplets. A number of other things can influence your chance for diabetes. Your ethnic group, for example, can influence that. Certainly, if you’ve had an abnormal blood glucose level in the past or have been suspected of having diabetes you could develop diabetes based on that, as well.
Melanie: If you’re somebody who goes into pregnancy with diabetes, as we’re seeing this obesity epidemic and more and more Type 2 diabetes, does that automatically mean you’ll have gestational diabetes? Are they different?
Dr. Wolthe: They are different. When you go into pregnancy with Type 2 diabetes, you will get treated right away with appropriate treatments, either diet or insulin. For women who are diagnosed with gestational diabetes, it’s just during the time that their pregnant that they have a problem with blood sugar.
Melanie: Wow. Okay. So, you have determined that this is something that a woman has or, if they’re at higher risk, you’re going to take a closer look. What do you do for it and what kind of complications can happen if it’s not looked after?
Dr. Wolthe: Well, that’s an excellent question. In order to determine that a woman has gestational diabetes, we do a two-stage test where first, they drink 50 grams of glucose, an unusual number. But they drink a sugary drink and then an hour later, a glucose test is done. Once that glucose test comes back, we can tell if the mom is at risk. If the mom is at risk, they take a second test where they actually get their blood drawn on four different times. If, at the end of that test, the diagnosis is gestational diabetes, then they go through a process to help improve the outcome for both them and their baby.
Melanie: I’d like to just step back for just a second, Dr. Wolthe. What is the average weight for women to gain during pregnancy that will maybe reduce their risk? Or, what do you tell women is the optimal amount of weight to gain?
Dr. Wolthe: It turns out that depends on how much you weigh going into pregnancy. We measure weight, not just in pounds, but actually with a thing called “body mass index” or BMI. If your normal weight, that’s a BMI of about 19-25, that patient should gain about 25-35 pounds during a pregnancy. In contrast, a woman who is overweight—so, we would say a BMI over 30--that person would need to gain only 10-20 pounds. So, that would be a woman who is actually considered obese would be 10-20 pounds.
Melanie: Wow. So, it doesn’t always mean that you’re eating for two when you only want women of a certain weight or BMI to put on maybe only 10-20 pounds. If you’ve determined that somebody is at risk or they do develop gestational diabetes what kind of treatments are available? Does it automatically mean bed rest? They don’t want to try to lose weight during pregnancy, right?
Dr. Wolthe: That’s correct. It is important to gain at least a little bit of weight during pregnancy because it’s been shown that even in a woman that’s obese, losing weight puts the baby at risk for being too small. There are a number of things that we can do to help a woman who is diagnosed with gestational diabetes address the problem. The first thing is that we put them in touch with a dietary counselor and that person will go over with them the kinds of foods that they eat and what the actual density of calories and density of glucose in those foods is and give them a plan for how to eat to try to minimize the chance of the blood sugar being high.
Melanie: You mentioned insulin, if they were diabetic before they even when on they would stay on their insulin. Are those kinds of things safe for a pregnant woman?
Dr. Wolthe: They are for a couple of reasons. Insulin is one of those interesting hormones that’s made in your own body and they make a pretty exact copy that they use to give to a mom. So, the mom’s body can’t really tell the insulin that she’s being given from the insulin that her own body would make. Furthermore, insulin it turns out, doesn’t cross the placenta at all. So, the baby is making its own insulin which is part of the reason that gestational diabetes can cause problems for the baby as well.
Melanie: So, is it like a double? I mean if the baby is making its own insulin and the mother has diabetes then is this taking away or doubling the baby’s insulin resistance? What is happening to the baby?
Dr. Wolthe: Well, it turns out that, we’ll just say that a mom has gestational diabetes and the control hasn’t been so good. So, her blood sugar is high. The blood sugar or the sugar that the mom has in her blood crosses over very freely to the baby. It’s just the insulin that doesn’t cross. So, in that circumstance the mom’s blood sugar is high, that sugar goes over to the baby and so the baby who does a great job at making insulin because babies don’t ever have diabetes. So, baby is making lots and lots of insulin. The end result is, if that situation goes unchecked, after the baby is born the baby is so accustomed to making lots of insulin to make up for that high blood glucose that it can’t ramp down the insulin quickly enough. So, in the nursery, the baby can actually get very low blood sugars and have seizures because of it.
Melanie: Wow. What an excellent, excellent explanation, doctor. Now, what about after pregnancy? Does this go away or is now this woman at risk for Type 2 diabetes?
Dr. Wolthe: Well, gestational diabetes after pregnancy goes away in the first few days after the baby is born. The effects from the placenta and having the pregnancy resolve but it turns out that you can think of gestational diabetes as an indicator that mom is at risk for Type 2 diabetes later on. So, for example, a mom who’s had gestational diabetes, in the next five years after that pregnancy, has about a 15% chance of developing Type 2 diabetes. If you go out 15 years, they have about a 60% chance. So, it’s not automatic but it does put you at higher risk to develop diabetes later on.
Melanie: Does this necessarily mean cesarean section for birth or can you have a vaginal delivery if you’re somebody with gestational diabetes?
Dr. Wolthe: What happens during the pregnancy really helps to determine whether cesarean section is the best method of vaginal delivery is okay. For moms that have gestational diabetes and have good control during the pregnancy, then the baby won’t gain so much weight. Remember we were talking about that the baby just getting the glucose freely across the placenta but the insulin doesn’t cross over. So, when the baby is getting lots and lots of glucose, it makes lots and lots of insulin and the insulin helps the baby take care of that glucose. It builds up fat, builds up a bigger baby. So, a big problem with babies of moms who have gestational diabetes is that those babies get to be too big. A really big baby puts mom at risk for injury during the birth process, if it’s a vaginal delivery. So, for some of those moms a cesarean section would be recommended. As you can tell, if mom has good control of her gestational diabetes, the baby doesn’t see the high sugar, the baby doesn’t get too big and so then, a vaginal delivery or a normal delivery would be acceptable.
Melanie: Is it inherited, Dr. Wolthe? Is it something that now that baby, when she or he goes to have a baby, it’s going to put them at risk? Well, not “he” but she?
Dr. Wolthe: Sure. That’s a terrific question and we don’t know the full answer to what happens for the baby long-term. We do know that there is a strong component of heredity in diabetes itself so that if your mom had Type 2 diabetes, your risk to get Type 2 diabetes is increased. But, there are many other factors that come in to play. What we don’t know for sure is, if a mom has gestational diabetes and has good control, does that mean that her baby, later on in life, is going to be at lower risk for diabetes compared to the mom who had bad control and so the baby was seeing that extra blood sugar during pregnancy? We don’t know the answer to whether that good control during pregnancy helps later on.
Melanie: This is such great information and I know we could go on a long time but, in the last few minutes, doctor, for a woman who was just diagnosed with gestational diabetes, what, really, do you want her to know? What’s your most important bit of information?
Dr. Wolthe: I would say be sure to make your appointments with your obstetrician or provider and follow their directions in terms of helping to keep your glucose under control. By doing that, you decrease your risk for injury during delivery, your risk for preeclampsia, your risk for cesarean section and you help make sure that the baby doesn’t end up too big and unable to control its glucose when it’s in the nursery.
Melanie: Thank you so much for being with us today. You’re listening to The Wellcast with Allina Health. For more information you can go to allinahealth.org. That’s allinahealth.org. This is Melanie Cole. Thanks so much for listening.
Melanie Cole (Host): About 3-8% of pregnant women in America can develop gestational diabetes which occurs during pregnancy, usually goes away after your baby is born; however, it often doesn’t have symptoms unless you are with your doctor in this. What puts a woman at a higher risk for developing gestational diabetes? My guest today is Dr. Donald Wolthe. He’s a maternal fetal medicine specialist and perinatologist with Allina Health Minnesota Perinatal Physicians. Welcome to the show, Dr. Wolthe. So, gestational diabetes, first of all, give the listeners a working definition of what this is.
Dr. Donald Wolthe (Guest): Thanks for having me on the show. Gestational diabetes is a form of diabetes that happens just when you’re pregnant. You don’t have to have had diabetes in the past. It actually comes about because of the interaction between you and your baby during pregnancy.
Melanie: Okay. So how would you even know?
Dr. Wolthe: It turns out that it takes a specific test to know that you have diabetes during pregnancy, although your doctor will look for certain risk factors that put you at higher chance of developing diabetes--things such as being overweight, or a family history of diabetes. Also, there’s an increase in diabetes in moms that are carrying twins or triplets. A number of other things can influence your chance for diabetes. Your ethnic group, for example, can influence that. Certainly, if you’ve had an abnormal blood glucose level in the past or have been suspected of having diabetes you could develop diabetes based on that, as well.
Melanie: If you’re somebody who goes into pregnancy with diabetes, as we’re seeing this obesity epidemic and more and more Type 2 diabetes, does that automatically mean you’ll have gestational diabetes? Are they different?
Dr. Wolthe: They are different. When you go into pregnancy with Type 2 diabetes, you will get treated right away with appropriate treatments, either diet or insulin. For women who are diagnosed with gestational diabetes, it’s just during the time that their pregnant that they have a problem with blood sugar.
Melanie: Wow. Okay. So, you have determined that this is something that a woman has or, if they’re at higher risk, you’re going to take a closer look. What do you do for it and what kind of complications can happen if it’s not looked after?
Dr. Wolthe: Well, that’s an excellent question. In order to determine that a woman has gestational diabetes, we do a two-stage test where first, they drink 50 grams of glucose, an unusual number. But they drink a sugary drink and then an hour later, a glucose test is done. Once that glucose test comes back, we can tell if the mom is at risk. If the mom is at risk, they take a second test where they actually get their blood drawn on four different times. If, at the end of that test, the diagnosis is gestational diabetes, then they go through a process to help improve the outcome for both them and their baby.
Melanie: I’d like to just step back for just a second, Dr. Wolthe. What is the average weight for women to gain during pregnancy that will maybe reduce their risk? Or, what do you tell women is the optimal amount of weight to gain?
Dr. Wolthe: It turns out that depends on how much you weigh going into pregnancy. We measure weight, not just in pounds, but actually with a thing called “body mass index” or BMI. If your normal weight, that’s a BMI of about 19-25, that patient should gain about 25-35 pounds during a pregnancy. In contrast, a woman who is overweight—so, we would say a BMI over 30--that person would need to gain only 10-20 pounds. So, that would be a woman who is actually considered obese would be 10-20 pounds.
Melanie: Wow. So, it doesn’t always mean that you’re eating for two when you only want women of a certain weight or BMI to put on maybe only 10-20 pounds. If you’ve determined that somebody is at risk or they do develop gestational diabetes what kind of treatments are available? Does it automatically mean bed rest? They don’t want to try to lose weight during pregnancy, right?
Dr. Wolthe: That’s correct. It is important to gain at least a little bit of weight during pregnancy because it’s been shown that even in a woman that’s obese, losing weight puts the baby at risk for being too small. There are a number of things that we can do to help a woman who is diagnosed with gestational diabetes address the problem. The first thing is that we put them in touch with a dietary counselor and that person will go over with them the kinds of foods that they eat and what the actual density of calories and density of glucose in those foods is and give them a plan for how to eat to try to minimize the chance of the blood sugar being high.
Melanie: You mentioned insulin, if they were diabetic before they even when on they would stay on their insulin. Are those kinds of things safe for a pregnant woman?
Dr. Wolthe: They are for a couple of reasons. Insulin is one of those interesting hormones that’s made in your own body and they make a pretty exact copy that they use to give to a mom. So, the mom’s body can’t really tell the insulin that she’s being given from the insulin that her own body would make. Furthermore, insulin it turns out, doesn’t cross the placenta at all. So, the baby is making its own insulin which is part of the reason that gestational diabetes can cause problems for the baby as well.
Melanie: So, is it like a double? I mean if the baby is making its own insulin and the mother has diabetes then is this taking away or doubling the baby’s insulin resistance? What is happening to the baby?
Dr. Wolthe: Well, it turns out that, we’ll just say that a mom has gestational diabetes and the control hasn’t been so good. So, her blood sugar is high. The blood sugar or the sugar that the mom has in her blood crosses over very freely to the baby. It’s just the insulin that doesn’t cross. So, in that circumstance the mom’s blood sugar is high, that sugar goes over to the baby and so the baby who does a great job at making insulin because babies don’t ever have diabetes. So, baby is making lots and lots of insulin. The end result is, if that situation goes unchecked, after the baby is born the baby is so accustomed to making lots of insulin to make up for that high blood glucose that it can’t ramp down the insulin quickly enough. So, in the nursery, the baby can actually get very low blood sugars and have seizures because of it.
Melanie: Wow. What an excellent, excellent explanation, doctor. Now, what about after pregnancy? Does this go away or is now this woman at risk for Type 2 diabetes?
Dr. Wolthe: Well, gestational diabetes after pregnancy goes away in the first few days after the baby is born. The effects from the placenta and having the pregnancy resolve but it turns out that you can think of gestational diabetes as an indicator that mom is at risk for Type 2 diabetes later on. So, for example, a mom who’s had gestational diabetes, in the next five years after that pregnancy, has about a 15% chance of developing Type 2 diabetes. If you go out 15 years, they have about a 60% chance. So, it’s not automatic but it does put you at higher risk to develop diabetes later on.
Melanie: Does this necessarily mean cesarean section for birth or can you have a vaginal delivery if you’re somebody with gestational diabetes?
Dr. Wolthe: What happens during the pregnancy really helps to determine whether cesarean section is the best method of vaginal delivery is okay. For moms that have gestational diabetes and have good control during the pregnancy, then the baby won’t gain so much weight. Remember we were talking about that the baby just getting the glucose freely across the placenta but the insulin doesn’t cross over. So, when the baby is getting lots and lots of glucose, it makes lots and lots of insulin and the insulin helps the baby take care of that glucose. It builds up fat, builds up a bigger baby. So, a big problem with babies of moms who have gestational diabetes is that those babies get to be too big. A really big baby puts mom at risk for injury during the birth process, if it’s a vaginal delivery. So, for some of those moms a cesarean section would be recommended. As you can tell, if mom has good control of her gestational diabetes, the baby doesn’t see the high sugar, the baby doesn’t get too big and so then, a vaginal delivery or a normal delivery would be acceptable.
Melanie: Is it inherited, Dr. Wolthe? Is it something that now that baby, when she or he goes to have a baby, it’s going to put them at risk? Well, not “he” but she?
Dr. Wolthe: Sure. That’s a terrific question and we don’t know the full answer to what happens for the baby long-term. We do know that there is a strong component of heredity in diabetes itself so that if your mom had Type 2 diabetes, your risk to get Type 2 diabetes is increased. But, there are many other factors that come in to play. What we don’t know for sure is, if a mom has gestational diabetes and has good control, does that mean that her baby, later on in life, is going to be at lower risk for diabetes compared to the mom who had bad control and so the baby was seeing that extra blood sugar during pregnancy? We don’t know the answer to whether that good control during pregnancy helps later on.
Melanie: This is such great information and I know we could go on a long time but, in the last few minutes, doctor, for a woman who was just diagnosed with gestational diabetes, what, really, do you want her to know? What’s your most important bit of information?
Dr. Wolthe: I would say be sure to make your appointments with your obstetrician or provider and follow their directions in terms of helping to keep your glucose under control. By doing that, you decrease your risk for injury during delivery, your risk for preeclampsia, your risk for cesarean section and you help make sure that the baby doesn’t end up too big and unable to control its glucose when it’s in the nursery.
Melanie: Thank you so much for being with us today. You’re listening to The Wellcast with Allina Health. For more information you can go to allinahealth.org. That’s allinahealth.org. This is Melanie Cole. Thanks so much for listening.