Gestational diabetes is a form of diabetes found in pregnant women. There is no known specific cause but it is believed the hormones of pregnancy reduce a woman's receptivity to insulin resulting in high blood sugar. Gestational diabetes affects an estimated two to three percent of pregnant women.[1] The International Statistical Classification of Diseases and Related Health Problems (commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... The following codes are used with International Statistical Classification of Diseases and Related Health Problems. ... The International Statistical Classification of Diseases and Related Health Problems (commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... The following is a list of codes for International Statistical Classification of Diseases and Related Health Problems. ... MedlinePlus (medlineplus. ... This article is about the disease that features high blood sugar. ... A pregnant woman Pregnancy is the process by which a mammalian female carries a live offspring from conception until it develops to the point where the offspring is capable of living outside the womb. ... Image of a woman on the Pioneer plaque sent to outer space. ... Insulin (from Latin insula, island, as it is produced in the Islets of Langerhans in the pancreas) is a polypeptide hormone that regulates carbohydrate metabolism. ... In medicine, blood sugar is a term used to refer to levels of glucose in the blood. ...

Fructosamine, also known as Glycated Serum Protein (GSP) or Glycated Albumin, is used primarily to identify the plasma glucose concentration over time and so assess diabetic control . ... A glucose tolerance test in medical practice is the administration of glucose to determine how quickly it is cleared from the blood. ... Glycosylated (or glycated) hemoglobin (hemoglobin A1c, Hb1c , HbA1c or HgA1c) is a form of hemoglobin used primarily to identify the plasma glucose concentration over time. ...

Risk factors

Risk factors for gestational diabetes include:

• a family history of type 2 (adult-onset) diabetes
• maternal age - a woman's risk factor increases the older she is
• ethnic background (those with higher risk factors include African-Americans, North American native peoples and Hispanics)
• obesity
• gestational diabetes in a previous pregnancy
• a previous pregnancy that resulted in a child with a birth weight of 9 pounds or more
• smoking doubles the risk of gestational diabetes^[1]

In medicine, a family history consists of information about disorders that a patients direct blood relatives have suffered from. ... See diabetes mellitus for further general information on diabetes. ...

Presentation

Frequently women with gestational diabetes exhibit no symptoms. However, possible symptoms include increased thirst, increased urination, fatigue, nausea and vomiting, bladder and yeast infection, and blurred vision. Candidiasis, commonly called yeast infection or thrush, is a fungal infection of any of the Candida species, of which Candida albicans is probably the most common. ...

Testing and treatment

Generally a test for gestational diabetes is carried out between the 24th and 28th week of pregnancy.

Often, gestational diabetes can be managed through a combination of diet and exercise. If that is not possible, it is treated with insulin, in a similar manner to diabetes mellitus. For the disease characterized by excretion of large amounts of severely diluted urine, see diabetes insipidus. ...

Diagnosis

A health care team will check the affected person's blood glucose level. Depending on the mother's risk and her test results, she may have one or more of the following tests.

• Fasting blood glucose or random blood glucose test
• Screening glucose challenge test
• Oral glucose tolerance test (OGTT)

Screening glucose challenge test

There are several tests intended to identify gestational diabetes in pregnant women. The first, called the Screening glucose challenge test, is a preliminary screening test performed between 26-28 weeks. If a woman tests positive during this screening test, the second test, called the Glucose Tolerance Test, may be performed. This test will diagnose whether diabetes exists or not by indicating whether or not the body is using glucose (a type of sugar) effectively. The Glucose Challenge Screening is now considered to be a standard test performed during the second trimester of pregnancy.

The glucose values used to detect gestational diabetes were first determined by O'Sullivan and Mahan (1964) in a retrospective study designed to detect risk of developing type II diabetes in the future. The values were set using whole blood and required two values reaching or exceeding the value to be positive. ^[2] Subsequent information has led to alteration in O'Sullivan's criteria. For example: when methods for blood glucose determination changed from the use of whole blood to venous plasma samples, the criteria for GDM were also changed once whole blood glucose values are lower than plasma levels due to glucose uptake by hemoglobin (NDDG,1979).

The diagnostic criteria from the National Diabetes Data Group (NDDG) have been used most often, but some centers rely on the Carpenter and Coustan criteria, which set the cutoff for normal at lower values. Compared with the NDDG criteria, the Carpenter and Coustan criteria lead to a diagnosis of gestational diabetes in 54 percent more pregnant women, with an increased cost and no compelling evidence of improved perinatal outcomes. ^[3]

Oral glucose tolerance test

Women who are considered at risk for gestational diabetes are given a screening test called a 50 gram glucose challenge between the 24th and 28th weeks of pregnancy (those with two or more risk factors may be tested earlier). The glucose challenge is performed by giving 50 grams of a glucose drink and then drawing a blood sample one hour later and measuring the level of blood glucose present. Women with a blood sugar level greater than 140 mg/dl may have gestational diabetes, and require a follow up test called a 3-houroral glucose tolerance test (OGTT). ^[4]

The test should be done in the morning after an overnight fast of between 8 and 14 h and after at least 3 days of unrestricted diet (>=150 g carbohydrate per day) and unlimited physical activity. The subject should remain seated and should not smoke throughout the test. The American Diabetes Association sets the following guidelines for results from the OGTT (oral glucose tolerance test)

Fasting blood glucose or random blood glucose test

A fasting plasma glucose level >126 mg/dl (7.0 mmol/l) or a casual plasma glucose >200 mg/dl (11.1 mmol/l) meets the threshold for the diagnosis of diabetes, if confirmed on a subsequent day, and precludes the need for any glucose challenge. In the absence of this degree of hyperglycemia, evaluation for GDM in women with average or high-risk characteristics should follow one of two approaches: ^[5]

• One-step approach
• Two-step approach

The following are the values that the American Diabetes Association considers to be abnormal during the Glucose Tolerance Test:

• Fasting Blood Glucose Level=95 mg/dl (5.33 mmol/L)
• 1 Hour Blood Glucose Level=180 mg/dl (10 mmol/L)
• 2 Hour Blood Glucose Level=155 mg/dl (8.6 mmol/L)
• 3 Hour Blood Glucose Level=140 mg/dl (7.8 mmol/L)

Associated conditions

Poorly controlled gestational diabetes can lead to the growth of a macrosomic or large baby. This in turns increases the need for instrumental deliveries (eg forceps, vacuum and caesarean section). These babies often need specialized care in the post partum period. Birth weight is the weight of a baby at its birth. ... Forceps are a hand-held instrument used for grasping and holding objects, similar in concept to tongs, tweezers or pincers. ... A caesarean section (cesarean section AE), or c-section, is a form of childbirth in which a surgical incision is made through a mothers abdomen (laparotomy) and uterus (hysterotomy) to deliver one or more babies. ...

In the future the mother is at increased risk of developing type 2 diabetes.

Treatment

Specific treatment will be determined by the physician(s) based on:

• age, overall health, and medical history
• extent of the disease
• tolerance for specific medications, procedures, or therapies
• expectations for the course of the disease
• opinion or preference ^[6]

Treatment for gestational diabetes focuses on keeping blood glucose levels in the normal range. Treatment may include:

• special diet
• exercise
• daily blood glucose monitoring
• insulin injections

Complications

Unlike type 1 diabetes, gestational diabetes generally does not cause birth defects. Birth defects usually originate sometime during the first trimester (before the 13th week) of pregnancy.

Infants of mothers with gestational diabetes are vulnerable to several chemical imbalances, such as low serum calcium and low serum magnesium levels, but in general, there are two major problems of gestational diabetes: macrosomia and hypoglycemia.^[6]

For Mother

• Hypertension
• Preeclampsia
• Increased risk for developing type 2 diabetes

For Baby

• Macrosomia
• Hypoglycemia
• Jaundice
• Low calcium and magnesium
• Respiratory distress syndrome (RDS)
• Increased risk for childhood and adult obesity
• Increased risk of type 2 diabetes later in life

See also

• Diabetes mellitus and pregnancy

References

2006 (MMVI) was a common year starting on Sunday of the Gregorian calendar. ... November 27 is the 331st day (332nd on leap years) of the year in the Gregorian Calendar. ... 2006 (MMVI) was a common year starting on Sunday of the Gregorian calendar. ... November 27 is the 331st day (332nd on leap years) of the year in the Gregorian Calendar. ... 2006 (MMVI) was a common year starting on Sunday of the Gregorian calendar. ... November 29 is the 333rd (in leap years the 334th) day of the year in the Gregorian Calendar. ...

External links

• Islets of Hope Diabetes Support
• Canadian Diabetes Association
• Plus Size Pregnancy.org
• Gestational Diabetes Diet
• Diabetic Mommy
• Answers to frequently asked questions on gestational diabetes