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Gestational Diabetes: What Expecting Mothers Should Know
Preparing for a new baby is exciting, but some women develop gestational diabetes during pregnancy. Dr. Nicholas Wulf, Obstetrician-gynecologist at Columbus Women's Healthcare, discusses gestational diabetes.
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Learn more about Nicholas Wulf, DO
Nicholas Wulf, DO
Dr. Nick Wulf graduated from the University of Nebraska, Lincoln, where he received his Bachelor of Science degree in Nutritional Science in 2001. He went on to receive his Masters in Nutritional Science in 2004 from UNL. He completed medical school in 2008 at Kansas City University of Medicine and Biosciences and completed his residency in Obstetrics and Gynecology at Creighton University. Dr. Wulf joined Columbus Women’s Healthcare in July of 2012.Learn more about Nicholas Wulf, DO
Transcription:
Bill Klaproth (Host): Getting ready to welcome a new baby is an exciting time especially for an expecting mother. But there are several things to watch out for when mothers get close to delivery. One of those is gestational diabetes. And joining us now to talk more about that is Dr. Nicholas Wulf, an Obstetrician Gynecologist at Columbus Women’s Healthcare. Dr. Wulf, thank you so much for joining us. So, let’s start with this. Can you tell us what is gestational diabetes?
Nicholas Wulf, DO (Guest): So, gestational diabetes is very common. It’s basically carbohydrate intolerance in pregnancy. It’s caused by a hormone that the placenta produces. And it affects about 7% of all women in pregnancy.
Host: Wow, that’s really interesting. So, how does gestational diabetes differ from type 1 and type 2 diabetes, which we hear a lot about?
Dr. Wulf: Well gestational diabetes is something that only occurs in pregnancy secondary to some physiology that changes during pregnancy mainly because of the placenta and the hormone that the placenta creates. And it makes your body’s insulin less efficient. Now type 1 and type 2 diabetes have more to do with your cells and insulin production and usage in your body. So, gestational diabetes is something completely separate from overt diabetes.
Now that being said though, about 70% of women with gestational diabetes will go on to get type 2 diabetes later on in life.
Host: So, how and when is a woman typically screened or diagnosed with gestational diabetes?
Dr. Wulf: So, typically, we like to screen women before 24 and 28 weeks and that’s the recommendation by the American College of Obstetrics and Gynecology. It’s a pretty simple test. We send you home with a basically a sugary drink. It contains about 50 grams of glucose. So, it’s basically like drinking a soda. You drink that about 45 minutes before your appointment. And then one hour after you drink it, we take your blood sugar. And then we like to have that blood sugar less than 140. And it’s just done by a simple blood draw in the office.
Host: So, tell us more about this test. How does it work?
Dr. Wulf: So, the first test if you fail that, that is a screening test; then what we do is you do what’s called a three hour glucose tolerance test where you actually have to go into the lab. You drink a 100 gram glucose drink. So, it’s like drinking two sodas. And then we take your blood sugar when you are fasting, one hour, two hours and then three hours after you’ve had the glucose drink. If you fail that, which is failing two out of four of the values; then you are diagnosed with gestational diabetes. So, it’s really a two part test; a screening test done in the office, if that’s failed, then we do the three hour test in the lab.
Host: Okay and are some women more prone to this?
Dr. Wulf: Well, we used to only screen women based on risk factors but then in about 2014, we found that risk factors alone would leave out about 50% of women diagnosed with gestational diabetes. So, there are some risk factors. Now obviously, if you’ve had it once before in pregnancy, you are more likely to have it again, twin gestations, or moms at extremes of age, very young moms, older moms are a little bit more likely to have gestational diabetes as well. And then weight and activity also plays a part in that.
Host: So, knowing that you may have a higher risk factor or even if you don’t, is there anything that can be done to prevent this from occurring?
Dr. Wulf: Well, there’s a couple things. First off, if you do have some increased risk factors or say you’ve been diagnosed before; then we might actually screen you a little earlier just to make sure we are not headed down that road at an earlier time. So, for those women that we screen early, if they pass their test, great. We still always go on to screen women at that 24 to 28 week still regardless. And if they fail the test early on; then we might go ahead and just start some counseling.
Now for those women that we would like to decrease their risk of developing gestational diabetes; sometimes we send women just to diabetic education where we talk about special ways to eat during pregnancy and then the other thing, we do is we recommend just regular physical activity. And in fact, you know, exercising for about 30 minutes in the morning before you have eaten anything is shown to really decrease your risk of gestational diabetes and if you have gestational diabetes; it really does help control that.
Host: So, you were talking about diagnosis earlier. So, if a woman is diagnosed with gestational diabetes; how do you treat that?
Dr. Wulf: Well once they are diagnosed, we send them to a diabetic educator and they talk to them about really diet, the amount of carbohydrate in their diet and then kind of spacing that out throughout the day. We also talk to them about regular physical activity, approximately 30 minutes a day, five days a week. Now if you can do that in the morning, that’s great, however wherever you can fit it in during your day helps. And even if it’s ten minutes here and ten minutes there; that all adds up. So, those are the two big factors we use, really diet and exercise. And about 90% of women will be controlled with just diet and lifestyle changes alone.
Now for those women that aren’t controlled on diet and lifestyle changes; we do have medications that we put women on. Insulin is really the gold standard as far as medications go to control blood sugars. For those women that are not able to take that though we do have some oral medications that we use that work very well also.
Host: And what happens if this goes untreated?
Dr. Wulf: If it goes untreated, there’s risk factors. So, for either those who go untreated or those who are not controlled well with either diet or with medications; there are some risk factors for mom. The biggest risk factor; well you are at increased risk for other complications in pregnancy such as preeclampsia or high blood pressure in pregnancy. You are actually at an increased risk for C-section as well. You are at increased risk for having a large baby which could increase your risk of a shoulder dystocia which could be a complication of delivery and complication for baby at delivery. There’s also an increased risk for babies of increased NICU admission or having to go to the high risk nursery and a lot of times, that’s because their blood sugars are also somewhat uncontrolled if mom’s blood sugars are uncontrolled.
Host: So, treating and management of this is really, really important. And what about after delivery? Does it typically go away?
Dr. Wulf: So, typically, it does go away after delivery. Now at about six weeks after delivery, we like to test again. For those women that might have been an overt diabetic or a type 2 diabetic, so we do what’s called a two hour glucose tolerance test. Very similar – you drink a 75 gram glucose load and then we take a fasting blood sugar, and then we take one two hours after the glucose has been drank. And then from that, we can prove that you are not diabetic.
Host: So, is there anything else we should know about gestational diabetes Dr. Wulf as we wrap up?
Dr. Wulf: Well I think the big things are, it’s important – anything you can do to prevent any complications during pregnancy is something we want to focus on. So, eating a regular diet, continuing to be active during pregnancy; those are important things. For women that have had gestational diabetes in the past; it’s important that you get screened at your yearly exam to make sure that you don’t become an overt diabetic as well. So, I think those are primarily the big things we are looking for.
Host: Yeah, really good information. Dr. Wulf, thanks so much for talking with us today, and thank you for your time.
Dr. Wulf: Thank you for having me.
Host: That’s Dr. Nicholas Wulf, Obstetrician Gynecologist at Columbus Women’s Healthcare. And if you’d like to get more information about gestational diabetes, please browse the online health library at www.columbushosp.org. And if you found this podcast helpful, please share it on your social channels and check out the entire podcast library for topics of interest to you. This is Columbus Community Hospital Healthcasts from Columbus Community Hospital. I’m Bill Klaproth. Thanks for listening.
Bill Klaproth (Host): Getting ready to welcome a new baby is an exciting time especially for an expecting mother. But there are several things to watch out for when mothers get close to delivery. One of those is gestational diabetes. And joining us now to talk more about that is Dr. Nicholas Wulf, an Obstetrician Gynecologist at Columbus Women’s Healthcare. Dr. Wulf, thank you so much for joining us. So, let’s start with this. Can you tell us what is gestational diabetes?
Nicholas Wulf, DO (Guest): So, gestational diabetes is very common. It’s basically carbohydrate intolerance in pregnancy. It’s caused by a hormone that the placenta produces. And it affects about 7% of all women in pregnancy.
Host: Wow, that’s really interesting. So, how does gestational diabetes differ from type 1 and type 2 diabetes, which we hear a lot about?
Dr. Wulf: Well gestational diabetes is something that only occurs in pregnancy secondary to some physiology that changes during pregnancy mainly because of the placenta and the hormone that the placenta creates. And it makes your body’s insulin less efficient. Now type 1 and type 2 diabetes have more to do with your cells and insulin production and usage in your body. So, gestational diabetes is something completely separate from overt diabetes.
Now that being said though, about 70% of women with gestational diabetes will go on to get type 2 diabetes later on in life.
Host: So, how and when is a woman typically screened or diagnosed with gestational diabetes?
Dr. Wulf: So, typically, we like to screen women before 24 and 28 weeks and that’s the recommendation by the American College of Obstetrics and Gynecology. It’s a pretty simple test. We send you home with a basically a sugary drink. It contains about 50 grams of glucose. So, it’s basically like drinking a soda. You drink that about 45 minutes before your appointment. And then one hour after you drink it, we take your blood sugar. And then we like to have that blood sugar less than 140. And it’s just done by a simple blood draw in the office.
Host: So, tell us more about this test. How does it work?
Dr. Wulf: So, the first test if you fail that, that is a screening test; then what we do is you do what’s called a three hour glucose tolerance test where you actually have to go into the lab. You drink a 100 gram glucose drink. So, it’s like drinking two sodas. And then we take your blood sugar when you are fasting, one hour, two hours and then three hours after you’ve had the glucose drink. If you fail that, which is failing two out of four of the values; then you are diagnosed with gestational diabetes. So, it’s really a two part test; a screening test done in the office, if that’s failed, then we do the three hour test in the lab.
Host: Okay and are some women more prone to this?
Dr. Wulf: Well, we used to only screen women based on risk factors but then in about 2014, we found that risk factors alone would leave out about 50% of women diagnosed with gestational diabetes. So, there are some risk factors. Now obviously, if you’ve had it once before in pregnancy, you are more likely to have it again, twin gestations, or moms at extremes of age, very young moms, older moms are a little bit more likely to have gestational diabetes as well. And then weight and activity also plays a part in that.
Host: So, knowing that you may have a higher risk factor or even if you don’t, is there anything that can be done to prevent this from occurring?
Dr. Wulf: Well, there’s a couple things. First off, if you do have some increased risk factors or say you’ve been diagnosed before; then we might actually screen you a little earlier just to make sure we are not headed down that road at an earlier time. So, for those women that we screen early, if they pass their test, great. We still always go on to screen women at that 24 to 28 week still regardless. And if they fail the test early on; then we might go ahead and just start some counseling.
Now for those women that we would like to decrease their risk of developing gestational diabetes; sometimes we send women just to diabetic education where we talk about special ways to eat during pregnancy and then the other thing, we do is we recommend just regular physical activity. And in fact, you know, exercising for about 30 minutes in the morning before you have eaten anything is shown to really decrease your risk of gestational diabetes and if you have gestational diabetes; it really does help control that.
Host: So, you were talking about diagnosis earlier. So, if a woman is diagnosed with gestational diabetes; how do you treat that?
Dr. Wulf: Well once they are diagnosed, we send them to a diabetic educator and they talk to them about really diet, the amount of carbohydrate in their diet and then kind of spacing that out throughout the day. We also talk to them about regular physical activity, approximately 30 minutes a day, five days a week. Now if you can do that in the morning, that’s great, however wherever you can fit it in during your day helps. And even if it’s ten minutes here and ten minutes there; that all adds up. So, those are the two big factors we use, really diet and exercise. And about 90% of women will be controlled with just diet and lifestyle changes alone.
Now for those women that aren’t controlled on diet and lifestyle changes; we do have medications that we put women on. Insulin is really the gold standard as far as medications go to control blood sugars. For those women that are not able to take that though we do have some oral medications that we use that work very well also.
Host: And what happens if this goes untreated?
Dr. Wulf: If it goes untreated, there’s risk factors. So, for either those who go untreated or those who are not controlled well with either diet or with medications; there are some risk factors for mom. The biggest risk factor; well you are at increased risk for other complications in pregnancy such as preeclampsia or high blood pressure in pregnancy. You are actually at an increased risk for C-section as well. You are at increased risk for having a large baby which could increase your risk of a shoulder dystocia which could be a complication of delivery and complication for baby at delivery. There’s also an increased risk for babies of increased NICU admission or having to go to the high risk nursery and a lot of times, that’s because their blood sugars are also somewhat uncontrolled if mom’s blood sugars are uncontrolled.
Host: So, treating and management of this is really, really important. And what about after delivery? Does it typically go away?
Dr. Wulf: So, typically, it does go away after delivery. Now at about six weeks after delivery, we like to test again. For those women that might have been an overt diabetic or a type 2 diabetic, so we do what’s called a two hour glucose tolerance test. Very similar – you drink a 75 gram glucose load and then we take a fasting blood sugar, and then we take one two hours after the glucose has been drank. And then from that, we can prove that you are not diabetic.
Host: So, is there anything else we should know about gestational diabetes Dr. Wulf as we wrap up?
Dr. Wulf: Well I think the big things are, it’s important – anything you can do to prevent any complications during pregnancy is something we want to focus on. So, eating a regular diet, continuing to be active during pregnancy; those are important things. For women that have had gestational diabetes in the past; it’s important that you get screened at your yearly exam to make sure that you don’t become an overt diabetic as well. So, I think those are primarily the big things we are looking for.
Host: Yeah, really good information. Dr. Wulf, thanks so much for talking with us today, and thank you for your time.
Dr. Wulf: Thank you for having me.
Host: That’s Dr. Nicholas Wulf, Obstetrician Gynecologist at Columbus Women’s Healthcare. And if you’d like to get more information about gestational diabetes, please browse the online health library at www.columbushosp.org. And if you found this podcast helpful, please share it on your social channels and check out the entire podcast library for topics of interest to you. This is Columbus Community Hospital Healthcasts from Columbus Community Hospital. I’m Bill Klaproth. Thanks for listening.
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